Tag Archives: Health Disparities

What Does Our Past Tell Us About Our Future? The Essential Role of Psychologists in Fighting HIV

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(L-R) Dr. Rich Wolitski (HHS/OHAIDP); Dr. Fayth Parks (Georgia Southern University) APA Ad Hoc Committee on Psychology & AIDS (COPA) chair and symposium co-chair; Dr. Sherry Wang (Santa Clara University) COPA symposium co-chair; Ms. Cherie Mitchell (APA); Dr. Karen Ingersoll (University of Virginia); Dr. Richard Jenkins (NIH/NIDA); and Dr. Ramani Durvasula (California State University, Los Angeles)

This article is cross-posted from the HIV.gov blog with their permission.

 

By Richard Wolitski, PhD (Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services)

 

Since the early days of the HIV/AIDS epidemic, psychologists have been essential in the response to HIV:

  • They offered mental health support for people living with, or at risk for, HIV—as well as for their families and communities, and those who provide HIV medical care and social services.
  • Psychologists developed programs to educate people about HIV and motivate behavior change to reduce risk.
  • They counseled and supported those who were diagnosed, and also played important roles in working to eliminate the stigma that attaches to HIV/AIDS, sexual minority status, gender identity, substance use, and other characteristics associated with HIV infection.
  • They conducted research that gave us an understanding of cognitive, behavioral, and social determinants of health that create health disparities.

 

They continue to do all of these things, and they play a vital role as the response to HIV/AIDS continues to evolve.

This year, the professional organization for psychologists, the American Psychological Association (APA), celebrated its 125th anniversary. The APA has been deeply involved in the response to HIV/AIDS in the United States:

  • From 1996-2014, the Centers for Disease Control and Prevention (CDC) funded APA’s Behavioral and Social Science Volunteer (BSSV) Program. The program established a national network of more than 300 psychologists, sociologists, anthropologists, and public health experts who provided capacity-building technical assistance to improve the delivery and effectiveness of HIV prevention services to more than 700 organizations.
  • And from 1991-2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded APA’s HIV Office for Psychology Education (HOPE) Program, which trained more than 36,500 psychologists and allied mental health providers about HIV, substance use, and mental health.

 

Today, the organization continues its mission to address the ongoing toll of HIV on the mental and physical health of people living with HIV. You can view information about activities, events, and resources on the APA’s HIV webpage.

 

Dr. Arthur C. Evans, Jr. , PhD, APA’s Chief Executive Officer, expressed his support for APA’s role in this work. He shared with me that he sees psychology’s role in this way:  

Psychology plays a critical role in HIV prevention and treatment by promoting behaviors aimed at helping to improve overall health, mental health and well-being and providing a better understanding of social and cultural factors, such as stigma and culturally appropriate counseling and treatment interventions. We know that access to quality behavioral health services facilitate better outcomes across the HIV care continuum, including viral suppression.

Dr. Arthur C. Evans, Jr., PhD

 

Given the organization’s commitment and long track record of service to the HIV community, I was honored when APA asked me to be a discussant as part of the 125th Anniversary Talk, Past, Present and Future of HIV/AIDS Science and Practice in Psychology. Under the skillful direction of co-chairs Dr. Fayth Parks and Dr. Sherry Wang, the panelists addressed a number of important topics:

  • Eugene Farber, PhD, ABPP, Emory University School of Medicine, The Future of Psychology as a Health Service Discipline: Clinical Lessons from the HIV Epidemic
  • Ramani Durvasula, PhD, California State University, Los Angeles: A History of HIV/AIDS in Women: Shifting Narrative and a Structural Call to Arms
  • Karen Ingersoll, PhD, Professor of Psychiatry and Neurobehavioral Sciences at the Center for Behavioral Health & Technology, University of Virginia: Internet Intervention for HIV+ Substance Users to Improve ART Adherence and Addictive Behaviors
  • Richard Jenkins, PhD, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse: Roles for Psychologists in a World of Changing Epidemics and Policies

Each of the presentations drew attention to the ways that psychologists have contributed to the fight against HIV. A key point made by all the participants is that behavioral approaches to HIV prevention, care, and treatment optimize biomedical approaches—and that the two are inextricably linked.

Dr. Eugene Barber speaking
Dr. Eugene Farber, Emory University

Dr. Gene Farber set the frame for the session by reflecting on the essential role of behavioral health service providers in supporting a humanistic, culturally responsive, and patient-centered care experience for people living with HIV. He stressed that behavioral health services must encompass not only assessment and treatment of behavioral disorders but also interventions to prevent the onset of other health conditions and to optimize biopsychosocial well-being. He also noted that psychologists can make substantial contributions to patient care and evaluation in medical settings.

Dr. Karen Ingersoll took his points a step further to show how psychologists can help individuals even when in-person contact is impossible. She is working on finding better ways to support substance users who are living with HIV—particularly those in rural areas, where HIV and other types of care are not always available and may require time away from work. These individuals are at significantly higher risk for nonadherence to their HIV medications and disengaging from care—so Dr. Ingersoll and her colleagues have developed an interactive online video intervention  that features peer role models offering advice and support to viewers. (Much like our own Positive Spin series, which takes a similar approach to supporting people living with HIV to achieve viral suppression.) This behavioral intervention is currently being tested to see if it can support substance users to take full advantage of biomedical treatment for their HIV disease.

Dr. Ramani Durvasula spoke about the need for holistic approaches to psychological care for women living with HIV. Her presentation focused on “the story of HIV in women,” which includes the multiple challenges women have faced in attempting to:

  • Get information on HIV risk;
  • Obtain an HIV diagnosis, care and treatment; and
  • Participate in HIV clinical trials.

For many women, neither biomedical or behavioral interventions were available.

Dr. Durvasula then discussed the current need for psychologists to be aware of the multiple psychosocial stressors women with HIV face (e.g., economic and caregiving burdens, relational issues, stigma, intersectional discrimination) and how they affect women’s physical health. She also emphasized the need to focus on women’s resiliencies, strengths, and growth rather than just their HIV disease. She ended with the observation that, for the future, psychology training programs should be looking at social justice and advocacy training as key to producing psychologists with the skill sets necessary for the future.

Finally, Dr. Richard Jenkins took the audience through a history of the role of psychologists in the U.S. epidemic, including a look at the ways in which the advent of antiretroviral therapy (ART) and other biomedical approaches have pushed many behavioral interventions to the margins. However, he noted that many of issues that affected people living with HIV in the early days of the epidemic persist and have not been eliminated by effective biomedical treatment, including stigma, access to care, and racial/ethnic disparities. He ended his presentation with a series of questions about how to connect psychologists to opportunities in HIV work, and raise the value of psychology for workforce development related to HIV.

As I listened to these passionate, committed professionals, I thought about the long history of the HIV/AIDS epidemic in the United States. I thought about how our early efforts, which were based on the best information we had at the time, created systems and approaches that have sometimes hampered our efforts to respond to the realities of today’s epidemic.

For example, when the first HIV test became available, we created a standalone system for HIV testing that was supported with siloed funding (meaning the funds could only be used for HIV testing—not any follow-up care or treatment). This was necessary because of the large number of people who needed to be tested and the fact that many people were unwilling to be tested by their usual healthcare providers. They didn’t want their providers to know they were at risk for infection or did not want information about their risk and their HIV test results to be recorded.

So, we set up stand-alone systems for anonymous testing—meaning your name was never attached to your HIV test. You were given a number that matched the one on the vial of blood the worker at the testing site took from you, and you had to have that number to get your results. This approach was intended to alleviate the stigma of testing—but it also meant that we were not able to set up linkages to care and treatment for newly diagnosed people.

The lack of connection with health care was further reinforced—first, by the absence of effective treatment, and, then, for almost three decades, by guidelines indicating that ART was not needed until later in the course of the infection, when damage to the immune system became clear. This history—and the fact that funding streams were established for HIV testing separately from health care—have required substantial changes to facilitate immediate linkage to care, and establishing late in the epidemic coordinated prevention, care, and treatment plans.

Another way that our past response affects our future is in the way that surveillance systems were established. Initially we were focused on AIDS. We did not know what caused it, and we focused on documenting the cases when and where they were identified and when and where the person died. We did not need to gather data to support engagement in HIV care over a lifetime. We were focused on keeping people alive for the next year (or month) and preventing new cases. This changed as we learned what caused HIV, its effects on the body and how to treat it effectively. As changes occurred, we had to start playing catch-up on the surveillance front, and we continue to wrestle with how to collect data in ways that will help us end the epidemic.

We know now that being diagnosed and beginning HIV treatment as soon as possible are essential to the health of people living with HIV. We also know that good physical health and good mental health are closely connected, and that people who feel a sense of well-being are also more likely to feel motivated to care for their bodies. That’s particularly important for people living with HIV.

Our goal is to support every person to engage in care, remain on treatment, and achieve viral suppression—and that goal can only be reached if people feel empowered to take charge of their healthcare. That is where the contributions of my colleagues at APA come in.

Even though biomedical tools are clearly the way we will ultimately win this battle against the HIV epidemic, they will not work if people do not engage in the behaviors that are needed to use them effectively. Psychologists have the training and the skills to help them do just that.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, AIDS research, behavioral health, discrimination, HIV, hiv prevention, HIV treatment, mental health, stigma

Is Poking Fun at Birthdays a Harmless Way to Celebrate Them?

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By Sheri R. Levy, PhD, & MaryBeth Apriceno (Stony Brook University)

 

Have you ever noticed that the tone of birthday cards for children is upbeat with messages like, “way to go, you’re another year older”? Whereas that is rarely the theme in cards for adults older than 21, at least in the United States.

 

Next time you find yourself in a card store, read through a few birthday cards for adults. You might find one or two cards with an upbeat and pro-age sentiment like “Fifty and fabulous.”  More likely you’ll encounter a lot that reiterate false and negative stereotypes of aging and older adults — cards that exaggerate the incidence of Alzheimer’s disease, depict dramatic age-related physical changes, portray older adults as very unattractive and cranky, as well as cards that suggest older adults lack sexual interest or have inappropriate sexual interest.  Nothing appears to be off limits.

 

Likewise, the aisles for adults at party supply stores are often devoted to party supplies and gifts poking fun of older adulthood. Here you’ll encounter a lot of “over the hill” themed party supplies such as balloons and serveware. You’ll also likely see favors and gifts that refer to ageist stereotypes, like signs that say “CAUTION, slow senior zone,” over the hill potty night lights, over the hill emergency diaper kits, and over the hill canes equipped with a horn, plastic chattering teeth, and a mini fine-extinguisher.

 

Funny or foul?

 

Birthday cards and gifts that poke fun of older adulthood are communicating negative ageist stereotypes found in society, including negative depictions of older adults in books, movies, and television. Together, these negative stereotypes and images take a toll on older adults.  Negative ageist messages may be internalized over the course of a lifetime and cause older adults to adopt an older self-image.  Older adults may then tailor their behaviors to these learned stereotypes, resulting in more sedentary lifestyles, decreases in cognitive functioning, decline in overall health, and a shorter lifespan (see Levy, 2009). Such effects may be amplified in women who face ageism as well as sexism (see Chrisler, Barney, & Palatino, 2016).

 

Widespread sale of birthday cards and supplies poking fun of older adulthood indicates the accepted nature of the stereotypes they communicate and the pressing problem of ageism. In fact, the World Health Organization (2015) has noted, “Ageism may now be more pervasive than sexism or racism.”

 

Ageism affects society. It can limit intergenerational contact and undermine intergenerational harmony. It contributes to age discrimination in the workplace, worse health care and poorer health for older adults, as well as financial and physical abuse of older adults.

 

“The world is in the midst of a unique and irreversible process of demographic transition that will result in older populations everywhere” (United Nations, 2014).

It is more important than ever to take steps to reduce ageism, and this includes no longer tolerating cards and gifts that poke fun of aging and older adults.

 

If you would like to learn more about this topic, the following might be of interest to you:

 

Chrisler, J., Barney, A., & Palatino, B. (2016). Ageism can be hazardous to women’s health: Ageism, sexism, and stereotypes of older women in the health care system. Journal of Social Issues, 72(1), 86-104. doi: 10.1111/josi.12157

Demos, V., & Jache, A. (1981). When you care enough: An analysis of attitudes toward ageing in humorous birthday cards. The Gerontologist, 21, 209-215.

Levy, B. R. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6): 332-336.

Levy, S.R. (2016). Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. The Gerontologist. 10 AUG 2016, doi: 10.1093/geront/gnw116

Levy, S.R., & Macdonald, J.L. (2016). Progress on Understanding Ageism. Journal of Social Issues, 72(1), 5-25. doi: 10.1111/josi.12153

United Nations (2014). Retrieved from http://www.un.org/en/globalissues/ageing/

World Health Organization (WHO; September, 2015). Ageing and Health. Retrieved from http://www.who.int/mediacentre/factsheets/fs404/en/

 

Biographies:

 

Sheri R. Levy, PhD, is a Professor in the Department of Psychology at Stony Brook University, USA. She earned her PhD at Columbia University in New York City, USA. Levy studies factors that cause and maintain prejudice, stigmatization, and negative intergroup relations and that can be harnessed to reduce bias, marginalization, and discrimination. Her research focuses on bias based on age, ethnicity, gender, nationality, race, sexual orientation, and social class.  With Jamie L. Macdonald and Todd D. Nelson, Levy co-Edited a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016). Levy’s research has been funded by the National Science Foundation, and Levy publishes her research in journals such as Basic and Applied Social Psychology, Child Development, Cultural Diversity and Ethnic Minority Psychology, Group Processes and Intergroup Relations, Journal of Personality and Social Psychology, Personality and Social Psychology Bulletin, and Social Issues and Policy Review. Levy was Editor-in-Chief of Journal of Social Issues from 2010-2013 and is a Fellow of the Society for the Psychological Study of Social Issues (Division 9 of American Psychological Association).

 

MaryBeth Apriceno is a graduate student and teaching assistant at Stony Brook University. She received her BA in Forensic Psychology from John Jay College of Criminal Justice. Her research investigates factors that affect ageist attitudes, aging anxiety, and self-stereotyping.

 

Image source: Flickr user tawest64 via Creative Commons

 

 


Filed under: Aging, Health Disparities Tagged: age discrimination, ageism, aging, stereotypes, stereotyping

How Can We Better Protect LGBTQ Students: Psychologists Take Action

Click to view slideshow.

By Joshua R. Wolff, PhD (Adler University); H.L. “Lou” Himes, PsyD (QuIPP); and Theresa Stueland Kay, PhD (OUTReach Utah)

Over the last year, we have witnessed regular news media headlines coming out of Washington, D.C. with a state of shock, horror, and anger. Specifically, we have been alarmed by the rollback of protections for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and students.

We know from first-hand experience that LGBTQ students face many forms of discrimination which contribute to health disparities, such as increased rates of suicide and homelessness. Specifically:

  • I (Lou) have been gender non-conforming my whole life and I have faced harassment in educational institutions from elementary school through my doctoral studies.
  • I (Theresa) work with LGBTQ youth at an organization called OUTreach Utah. All too often, the youth I see are marginalized and bullied at home and at school. When they suffer at school, personnel frequently fail to protect these students. Even worse, faculty, staff, and administration often blame the youth for the fact that they are bullied.
  • I (Joshua) came out as gay at a faith-based college, Biola University, where I risked academic expulsion based solely on my sexual orientation, and realized I did not have any legal protections.

Together, we have each dedicated our careers as clinical psychologists to helping support LGBTQ people in the face of discrimination, which we have done through research, clinical services, and volunteering.

LGBTQ children and youth face daily roadblocks to their education and threats to their safety. This is a systemic issue and requires a systemic response.

Like many Americans, we have at times felt powerless against what seems to be an overwhelming recent assault on many of the most marginalized groups of Americans, including (but certainly not limited to) LGBTQ students. Hence, we asked ourselves “what can we do to help”? We decided to visit Washington, D.C. to talk to Members of Congress, including some who may not share our views, about the importance of protecting LGBTQ students.

Our first step was to contact staff at the APA to help us get started. We felt particularly fortunate to receive wonderful assistance from staff in the Public Interest and Education Government Relations Offices.

Prior to meetings with congressional offices, we connected with leading LGBTQ advocacy groups in Washington to learn about their current federal priorities and strategies. We met with the Human Rights Campaign, GLSEN, and the Trevor Project, as well as APA staff from the Safe and Supportive Schools Project. As a result, we learned about several important priorities. These included:

  • re-instating Title IX protections for transgender youth;
  • the ‘Safe Schools Improvement Act’ which would require schools to create plans to combat bullying, specifically including LGBTQ students;
  • fully funding Title IV (school climate improvement grants) of ‘Every Student Succeeds Act’; and
  • ensuring that federal surveys and surveillance systems  collect sexual orientation and gender identity data.

Further, we were alarmed to learn that the Trevor Project has seen a dramatic increase in the number of transgender youth calling their suicide prevention crisis hotline following the announcement of President Trump’s military ban for transgender service members. This provided a sobering reminder of how our government’s words and decisions affect those most vulnerable in our society.

Our meetings with these groups affirmed two clear messages:

(1) LGBTQ students need critical legal protections, and

(2) we need data to tell us how we can help.

We lobbied staff from the National Governors Association and the offices of Rep. Rob Bishop (R-UT), Rep. Katherine Clark (D-MA), Sen. Orin Hatch (R-UT), and Sen. John McCain (R-AZ) on these important legal protections and data collection. Among the issues raised by the advocacy groups we met with the day before, we talked about:

  • the high rates of LGBTQ suicide attempts and homelessness, as well as
  • the lack of Title IX protections that could reduce bullying and victimization of transgender students
  • the need for greater legal protections and data collection to end these health disparities.

Each of us explained why these issues are important to us personally, how they impact our work as psychologists, and how they affect the Members’ constituents. Unsurprisingly, some offices did not agree on how to address the concerns. But others were eager to listen, and shared concerns about the high rates of suicide attempts among LGBTQ youth and other health disparities. All of the offices agreed that there should be ongoing Congressional oversight of the Department of Education to continue to protect students, and asked us to follow up and continue the conversation.

The experience reminded us that advocacy isn’t a one-time deal, and it’s not just happening in Washington. Advocacy can happen through a phone call or an email to our Members of Congress. Hence, we will follow up with the various offices we contacted to remind them about the critical protections that LGBTQ youth need.

We encourage you to get involved, too. Join the APA Federal Action Network or get involved at the local or community level. Psychologists have a lot to contribute to advocacy, and it’s vital to make your voice heard.

 

Biographies:

Joshua R. Wolff, PhD, is an Assistant Professor in the Department of Psychology at Adler University in Chicago, IL. Further, he was a contributor to the U.S. government’s (SAMHSA/HHS) report, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth”. His current research is directed at developing evidence-based public health strategies to reduce suicide rates and health risk behaviors for SGM people in non-affirming religious environments by building partnerships with clergy and faith leaders.

Theresa Stueland Kay, PhD, trained at Biola University, a faith-based institution, and is a licensed psychologist in Utah.  She is also an Associate Professor of Psychology at Weber State University.  Dr. Kay also serves as Board Chair at OUTreach Utah, a nonprofit organization that serves and supports LGBTQ youth.

H. L. “Lou” Himes, PsyD, is a licensed clinical psychologist and president at QuIPP, the Queer Identities Psychology Partnership—a group psychotherapy practice in Manhattan, NY that focuses on providing psychotherapy and transition-related support for trans/queer individuals.  Dr. Himes uses they/them/theirs pronouns.


Filed under: Children and Youth, Health Disparities, Human Rights and Social Justice, LGBT Issues, Public Policy Tagged: advocacy, Capitol Hill, data collection, Every Student Succeeds Act, gender identity, health disparities, LGBT, LGBT health, LGBT rights, LGBT students, LGBT youth, Safe Schools Improvement Act, sexual orientation, student health, suicide prevention, surveillance, Title IV, Title IX, transgender, transgender youth

A Fate Worse than Death? Being Transgender in Long-term Care

Serious transgender couple standing together

 

By Mark Brennan-Ing, PhD (Senior Research Scientist, Brookdale Center for Healthy Aging)

 

“I would kill myself.” This is what a 70 year-old transgender woman told me recently when I asked what she would do if she needed long-term care. While this sounds dramatic, it is a common sentiment among older transgender and gender nonconforming (TGNC) adults (Witten, 2014). Many TGNC older adults do not have family caregivers available to meet their needs for assistance in later life, having been rejected and ostracized by their families of origin according to a study by Grant and colleagues (2011), and long-term care services may be their only option.

 

Plans for concealing gender identities, suicide and euthanasia are one way for older TGNC adults to cope with the fears of entering long-term care (Bockting & Coleman, 2007; Ippolito & Witten, 2014). The National Senior Citizens Law Center (2011) reports that TGNC older adults, regardless of the degree of gender transitioning, are at risk for abuse, mistreatment, or violence in institutionalized settings, especially those needing assistance with activities of daily living such as showering, dressing, and toileting.

 

Accessing medically competent care may also be a problem for older TGNC adults in long-term care. Geriatric care for TGNC older adults requires special considerations. Due to potential drug interactions, contraindications, and polypharmacy, TGNC older adults using hormone therapy concurrent with other medications may require close monitoring (Grant et al., 2011; SAGE & NCTE, 2012; Witten & Eyler, 2015). Sometimes these problems may require stopping hormone therapy, which may be especially traumatic for those who have transitioned later in life and not yet achieved their goals for masculinizing or feminizing their appearance.

 

Since private rooms in long-term care facilities are not covered by insurance, older TGNC adults may be assigned shared rooms based on their birth sex instead of their gender identities, which is problematic for the TGNC person as well as their roommate. The Department of Veterans Affairs (2013) has issued a directive that rooms for TGNC veterans are assigned based upon self-identified gender without regard to physical presentation or surgical history. This policy should be a requirement in all long-term care facilities.

 

The Nursing Home Reform Act and the Fair Housing Act prohibit TGNC discrimination and mistreatment in long-term care. The Affordable Care Act (ACA) also prohibits discrimination on the basis of gender identity by health care organizations (NCTE, 2015), but this legal protection is at risk following the 2016 election with promises by those in power to repeal the ACA. If ACA repeal is successful, older TGNC people will lose safeguards around denial of services, access to facilities like restrooms that conform to their gender identities, isolation, deprivation, and harassment by staff.

 

For long-term care providers, there are a number of resources available for continuing education to better serve their TGNC clients. These include the National Resource Center on LGBT Aging, which offers a variety of in-person and on-line training options (http://www.lgbtagingcenter.org/training/index.cfm). Providers working with veterans can review training and education options in the VA system at http://www.patientcare.va.gov/LGBT/index.asp . And TRANSLINE provides on-line consultation for medical providers (http://project-health.org/transline/ ).

 

Sadly, we may soon witness a rollback of protections for TGNC individuals in long-term care. Therefore it is imperative that the TGNC community and their allies work harder than ever to insure that policies, legislation, and training programs are in place to guarantee that older TGNC people are treated with the dignity and respect they deserve in long-term care and other clinical settings.

 

Portions of this blog were drawn from “Providing competent and affirming services for transgender and gender nonconforming older adults” (Porter, Brennan-Ing et al., 2016), and “Guidelines for psychological practice with transgender and gender nonconforming people (American Psychological Association, 2015).

 

References:

American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. http://dx.doi.org/10.1037/a0039906 .

Bockting, W. O., & Coleman, E. (2007). Developmental stages of the transgender coming‐out process. In R. Ettner, S. Monstrey, & A. Eyler (Eds.), Principles of transgender medicine and surgery (pp. 185‐208). New York, NY: Haworth.

Department of Veterans Affairs (VA; 2013). Providing health care for transgender and intersex veterans (VHA Directive 2013–003). Retrieved from http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality & National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf

Ippolito, J., & Witten, T. M. (2014). Aging. In L. Erickson-Schroth (Ed.), Trans bodies, trans selves: A resource for the transgender community (pp. 476-497). New York, NY: Oxford University Press.

National Center for Transgender Equality (2015). Know your rights: Healthcare. Retrieved from http://www.transequality.org/know-your-rights/healthcare

National Senior Citizens Law Center (2011). LGBT Older Adults in Long-Term Care Facilities: Stories from the Field.  Washington, DC: National Senior Citizens Law Center.

Porter, K. E., Brennan-Ing, M., Chang, S. C., dickey, l. m., Singh, A. A., Bower, K. L., & Witten, T. M. (2016). Providing competent and affirming services for transgender and gender nonconforming older adults. Clinical Gerontologist. http://dx.doi.org/10.1080/07317115.2016.1203383

Services and Advocacy for GLBT Elders (SAGE) & National Center for Transgender Equality (NCTE; 2012). Improving the lives of transgender older adults. New York, NY: Authors. Retrieved from http://transequality.org/Resources/TransAgingPolicyReportFull.pdf

Witten, T.M. (2014). End of life, chronic illness and trans-identities. J. Social Work in End-of-Life and Palliative Care, 10(1), 1-26. doi:10.1080/15524256.2013.988864

Witten, T.M. & Eyler, A.E. (2015). Care of aging transgender and gender non-conforming patients. In. R. Ettner, S. Monstrey and A.E. Eyler (Eds.), Principles of transgender medicine and surgery. New York, NY: Routledge Press.

 

Biography:

Mark Brennan-Ing, PhD is the Senior Research Scientist, Brookdale Center for Healthy Aging at Hunter College, City University of New York. He was the 2016 Chair of the APA Committee on Sexual Orientation and Gender Diversity.

 


Filed under: Aging, Health Disparities, LGBT Issues Tagged: health disparities, health equity, LGBT, long-term care, older adults, transgender

Historical Trauma in the Present: Why APA Cannot Remain Silent on the Dakota Access Pipeline

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By Susan H. McDaniel, PhD (2016 APA President)

Protesters being marked with numbers, put in dog kennels and shot with rubber bullets. These do not sound like events that should occur in modern day America. Unfortunately, according to media reports, these are some of the first-hand accounts of what is happening in North Dakota as protests escalate over the Dakota Access Pipeline.

For those unfamiliar with the dispute between environmental and human rights protesters on behalf of the Standing Rock Sioux Reservation and law enforcement, I would invite to you read the New York Times detailed summary of events. In short, there is a growing perception of injustice as a 1,172-mile oil pipeline that is slated to run from North Dakota to Illinois was rerouted near the Standing Rock Sioux Reservation due its potential threat of contamination to Bismarck, North Dakota’s water supply.

Native Americans have been historically marginalized and mistreated by the United States. For instance, not all States recognized Native Americans’ right to vote until 1957 and many tribes experienced great loss of life, land and culture as the result of State and Federal legislation.

According to the psychological literature, chronic, systemic loss and mistreatment, as described above, may lead to historical trauma in which the pain experienced by one generation transfers to subsequent generations through biological, psychological, environmental, and social means. Studies show that historical trauma is linked to health disparities, including increased likelihood of early death due to chronic liver disease and cirrhosis, unintentional injuries, assault/homicide, and suicide.

APA’s mission is to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives.” This mission makes it incumbent upon our field and our association to speak out when the health and well-being of marginalized and other populations are being threatened and when possible to prevent trauma from occurring.

Due to the current proposed placement of the Dakota Access pipeline, we are concerned about possible leakage, which could harm the people of the Standing Rock Sioux Reservation. As psychologists, we are troubled by the potential for adverse neurological effects arising from exposure to oil-contaminated water.

In response to current events, I sent a letter on behalf of APA to President Obama with Dr. Jacqueline Gray, President of the Society for the Psychological Study of Culture, Ethnicity and Race (APA Division 45) that expressed:

  • Our support for the Administration’s hold on the construction of the oil pipeline near the Standing Rock Reservation, and praise for his consideration of alternate routes for the project; and
  • A request to urge law enforcement to show restraint as they try to diffuse the conflict.

It is critical that APA and the mental health community continue to show our support and bring attention to the issues impacting Native American communities and to help alleviate historical trauma.

In closing, I recommend you sign up for APA’s Federal Action Network to influence policy makers and make sure your voice is heard on critical issues in the future.

Dr. McDaniel is president of the American Psychological Association.

 

Image source: Flickr via Creative Commons.


Filed under: Culture, Ethnicity and Race, Health Disparities, Human Rights and Social Justice Tagged: #DAPL, #noDAPL, American Indians, Dakota Access Pipeline, environmental racism, health disparities, historical trauma, human rights, human rights abuses, law enforcement, Native Americans, police brutality, public health, public policy, racism, trauma, violence, water is life

Latinxs: Take Action to Stop HIV

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By Karen Nieves-Lugo, PhD, MPH (Postdoctoral Fellow at George Washington University)

October 15th is National Latinx AIDS Awareness Day, and this year’s theme is “We’ll Defeat AIDS con Ganas!” But why is it important to talk about acquired immunodeficiency syndrome (AIDS) in the Latino community? Latinxs are disproportionally affected by the human immunodeficiency virus (HIV)—the virus that causes AIDS. Our community represents 17% of the total U.S. population, but accounts for 21% of all new HIV infections and 21% of people living with HIV.1 In addition, research shows that Latinxs are more likely to receive late diagnosis and HIV care compared to other races and ethnicities.2

Benita Ramírez3, a Honduran activist and poet living with HIV, wrote:

I dance

the sound of the wind

lifts my hair

of my old spirit

I learned to succeed.

Drawing inspiration from the title of Benita’s poem “Triumph,” the pathway to prevent new HIV infections is early detection and treatment of the disease in order to avert heath complications. By detecting HIV early and connecting to care, people living with HIV can have better quality of life and decrease the risk of transmission of HIV by adhering to treatment. While testing and treatment are steps an individual must decide to take on their own, we as a community should provide support wherever possible. Together we can make a difference.

What kind of action can we do?

Let’s start talking about HIV with our family, partner(s), friends, peers, and neighbors. Educating ourselves about HIV–how it is transmitted, how to practice safer sex, and how to use condoms–not only prevents new infections, but also empowers Latinxs to protect themselves. It’s also important to talk about HIV prevention with our youth because they are one of the most vulnerable groups in our community. Let’s talk to our teens about the ways to have safer sex to decrease their risk of getting HIV and other sexually transmitted infections.

Fight stigma and discrimination. Negative attitudes about HIV can discourage Latinxs from seeking testing and treatment services. Some people avoid getting tested for HIV out of fear of being rejected or discriminated against. As a Latina, I know that a central value in our community is to take care of our loved ones and that should not exclude those living with HIV. Supporting your loved ones to seek testing, prevention, and treatment services is a way of honoring them and our community. If you are a leader in your neighborhood, start a dialogue about HIV and encourage your community to get tested. The support from our family, friends, peers, and community can ease the potential physical and emotional difficulties of living with HIV. By destigmatizing HIV and encouraging community members to get tested, we can make a difference in early detection and treatment. These are the most effective strategies to stop HIV in our community.

Ask to be tested for HIV. Raising our voices to get tested for HIV is an important prevention measure, even when we do not recognize having any risk factor (e.g. multiple partners, drug use, having unprotected sex). Research shows that over a third of Latinxs (36%) were tested for HIV late compared to 31% of Black and 32% of White populations4. Although receiving an HIV diagnosis is frightening, an early detection brings the opportunity to take care of ourselves preventing health complications and transmitting HIV to others.

You can talk to your healthcare provider about getting tested or visit community organizations that offer free and anonymous HIV testing.  Many of these organizations have staffs who speak English and Spanish, understand our culture, and offer information about HIV prevention and access to care regardless of your immigration status.

Take action if you are HIV positive. When living with HIV, it is important to remain in regular care. As any other chronic disease (e.g. diabetes, hypertension) having regular treatment improves the quality of life, allowing people to live longer, healthier lives. Using medication as directed by your healthcare provider is beneficial for your health and reduces the risk of HIV transmission to others.

Together we can make a difference. In 2010, President Obama signed a National HIV/AIDS Strategy that outlines the principles, priorities, and actions needed to win the battle against HIV. The goals of this plan are: reducing HIV, incidence, increasing access to care and optimizing health outcomes and reducing HIV-related health disparities5. Some of the strategies to achieve these goals are: increase HIV testing, adhere to HIV treatment and remain in care. We need to take advantage of that strategy and advocate for our community in order to fight against HIV. History has shown that when we are united as a community we can be successful, overcome obstacles, and gain respect through our work and social actions. I am confident that in this occasion we can also win the battle against HIV, stopping new HIV infections and improving the health of those Latinxs living with HIV. We have the power to change our history and make a difference in our community.

We want to hear from you – Tell us in the comments:

  • What we can do as a community to fight against HIV?
  • What do you do to encourage other Latinxs seeking testing and treatment services for HIV?
  • What tools and strategies do you have to manage being HIV positive?

Acknowledgements: Thank you to Veronica Pinho and Maria Cecilia Zea for their encouragement in the development of this blog.

Biography:

Karen Nieves-Lugo, PHD, MPH, was born and raised in Mayaguez, Puerto Rico. She obtained her doctoral degree in Psychology at the University of Puerto Rico, Rio Piedras Campus and has a master’s degree in Public Health from the University of Puerto Rico, Medical Sciences Campus. She is a postdoctoral fellow at George Washington University, Department of Psychology. Dr. Nieves-Lugo’s research focuses on health disparities, aging, sexuality, and chronic diseases specifically examining the role of cultural, psychological and behavioral factors significant to HIV/AIDS. She has worked with Latino populations in research focused on: the experiences of sexual migration among Dominican gay men; the prevalence of eating disorders and body image among Puerto Rican college men; the relationship of gender roles and sexuality in the prevention of HIV infection among Puerto Rican heterosexual men; and the psychological and behavioral factors related to adherence to HIV medication among Puerto Rican men. She is a principal investigator in a Ruth L. Kirschstein National Research Service postdoctoral fellowship (F32) award funded by the National Institute of Mental Health, where she is examining the relationship of depression and substance use (alcohol, tobacco and drug use) with physical function over time in HIV-infected veterans compared to uninfected veterans in VACS. Dr. Nieves-Lugo is a member of the District of Columbia Center for AIDS Research (CFAR), the MSM and Sexual Minorities CFAR Scientific Interest Group, the Mid-Atlantic CFAR Consortium of Latinos and HIV, the Physical Function Working Group, Veterans Aging Cohort Study, and the American Psychological Association divisions 20 and 44.

 

References:

1 Center of Disease Control and Prevention. (2016). Today’s HIV/AIDS epidemic. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/TodaysEpidemic-508.pdf.

2 Dennis, A. M., Napravnik, S., Seña, A. C., & Eron, J. J. (2011). Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort. Clinical Infectious Diseases, 53(5), 480-487.

3 Evers, L. (2010) “I´m black, I´m a woman and I am HIV positive. But I am going to make a difference”. Retrieved from https://www.trocaire.org/blogs/make-a-difference.

4 “Latinos and HIV/AIDS”. (2014, April 15). Retrieved from http://kff.org/hivaids/fact-sheet/latinos-and-hivaids/

5 “HIV/AIDS National Strategies”. (2010, July). Retrieved from https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf


Filed under: AIDS, Culture, Ethnicity and Race, Health Disparities Tagged: aids, health disparities, HIV, hiv prevention, HIV testing, HIV treatment, HIV/AIDS research, Latina, Latino, Latinx, National Latino HIV/AIDS Awareness Day

“I’m Not Just Black!”: Exploring Intersections of Identity

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By Faye Z. Belgrave, PhD (Professor, Virginia Commonwealth University) and Sarah J. Javier, MS (Doctoral Candidate, Virginia Commonwealth University)

Through a very complete body of research, the field of psychology has established that a person’s identity is composed of several different parts. However, psychological research projects often only focus on one or two aspects of identity. As we move towards a more complete picture of human behavior, we must remember to keep in mind that the intersections of identity are a vital piece of that picture.

“Intersectionality” is a term that is coming to the forefront in psychological research. It encompasses race, ethnicity, gender, socioeconomic status, sexual orientation, and other intersecting, categorical dimensions that describe groups of people. For example, think about different parts of your identity. You may describe yourself as a single, older, African American female who makes a modest income. Or perhaps you are a young, White male who identifies as gay. These different parts of our identities make us who we are, and professionals interested in intersectionality have come to understand that these different components of identity are integral to why individuals do the things they do.

Intersectionality in National Data Sets

Data collection on the intersections of identity and how they affect health is of utmost importance. By examining combinations of identities (e.g. Gender X Race, Race X Sexual Orientation, etc.), researchers can more completely understand why some groups do better on certain health outcomes than others.

For instance, research on the intersecting identities of Race X Gender yields findings that there are different outcomes among African American males compared to, not only White males, but also African American females, including lower levels of academic achievement and higher levels of incarceration. These data can then be used to create culturally and identity-appropriate programs to decrease disparities and promote wellness among African American males.

But data aren’t perfect. And often, these identities get lost, even in well-known national data sets. For example, because it is politically charged, sexual orientation may be omitted completely from national data sets, based on the idea that children and adolescents should be protected from this information. However, research indicates that sexual orientation may develop anywhere between middle childhood and early adolescence, and being a sexual minority is associated with a host of worsened physical and mental health disparities (e.g., higher levels of suicidality, depression, substance use, risk for sexually transmitted infections, etc.). What’s more, not asking these questions limits the amount of research that can be done in exploring how sexual orientation intersects with other identities.

Youth Risk Behavioral Surveillance Survey

On August 11, 2016 the Centers for Disease Control and Prevention released sexual minority youth data from the Youth Risk Behavioral Surveillance Survey (YRBSS). The YRBSS is a survey collected from millions of 9th through 12th grade students in the continental U.S. bi-annually. The survey asks questions about a diverse array of health behaviors, including violence, sexual activity, sexually transmitted infections including HIV infection, alcohol, tobacco, and other drug use, and physical activity.

One key feature of the YRBSS is its inclusion of identities in asking these questions. For instance, the survey asks items on race, gender, grade, and includes the following items on sexual orientation:

  1. “During your life with whom have you had sexual contact?” with response items being I have not had sexual contact, females, males, or females and males; and
  2. “Which of the following describes you?” with response items being heterosexual (straight), gay or lesbian, bisexual, or not sure.

The 2015 report yielded startling findings, including that more than 40% of LGB students seriously considered suicide, while 30% attempted suicide in the past year. According to the 2015 report, LGB students were more than five times more likely than individuals identifying as heterosexual to report using multiple illegal drugs.

Research that can come from this report includes how the intersection of sexual orientation and other identities (i.e., race/ethnicity) affect these outcomes, if at all. Individuals at intersections of identity in adolescence are especially at high risk for mental and physical consequences, and intersecting identities may be a vital component to risk for these consequences. Thus, the YRBSS is setting a precedent as one can now explore different aspects of identity and their relation to health outcomes in an adolescent population.

Data from the YRBSS may also help us understand whether certain intersections of identity act as protective factors that will help to combat negative health outcomes. Potential data analyses may in fact find that being at the intersection of a marginalized group may be correlated with being less likely to engage in certain negative health behaviors. For instance, African American adult females on the whole have been shown to smoke cigarettes at lower rates compared with both African men and White women. With the YRBSS, researchers can determine if this is true at a younger age, and whether this varies by grade, gender, sexual orientation, or any combination of these identities. 

What We Can Do

  • Acknowledge different parts of individuals’ identities. Too often, we make assumptions about individuals based on surface-level interactions. It is important to acknowledge that new individuals you may meet may have different parts of their identity that can’t just be seen on the surface.
  • Use existing resources from APA. APA recently released a Resolution on Data about Sexual Orientation and Gender Identity that speaks to the importance of collecting data from diverse groups in national surveys. Behavioral health professionals can use these tools, as well as others, to make the case for conducting research on underserved populations.
  • Fill in the gaps. One major limitation of the YRBSS is that it does not ask questions on gender identity. Researchers should examine these kinds of gaps in data collection so that yet another aspect of identity can be used in studies to improve the outcomes of people of different gender identities.
  • Be an advocate. Parents of underserved children, teachers, and allies of the LGBT community can help to advocate for these individuals and push their members of Congress to pass legislation that helps to improve the lives of the LGBT population.

 

References:

American Psychological Association, Task Force on Resilience and Strength in Black Children and Adolescents. (2008). Resilience in African American children and adolescents: A vision for optimal development. Washington, DC: Author. Retrieved from http://www.apa.org/pi/cyf/resilience.html

American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: Author. Retrieved from www.apa.org/topics/lgbt/orientation.pdf

American Psychological Association, Presidential Task Force on Educational Disparities.(2012). Ethnic and racial disparities in education: Psychology’s contributions to understanding and reducing disparities. Retrieved from http://www.apa.org/ed/resources/racial-disparities.aspx

Centers for Disease Control and Prevention. (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9–12 — youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR, 60. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss60e0606.pdf

Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170-180. Retrieved from: http://psycnet.apa.org/journals/amp/64/3/170.html

Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., …, & King, B. A. (2015). Current cigarette smoking among young adults – United States, 2005-2014. MMWR, 64(44), 1233-1240. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm

Kann, L., Olsen, E. O., McManus, T., et al. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9–12 — United States and selected sites, 2015. MMWR Surveillance Summaries, 65(No. SS-9):1–202. DOI: http://dx.doi.org/10.15585/mmwr.ss6509a1

Neal, D., & Rick, A. (2014). The prison boom and the lack of Black progress after Smith and Welch. National Bureau of Economic Research. NBER Working Paper No. 20283. Retrieved from http://www.nber.org/papers/w20283

 

Biographies:

Faye Belgrave, PhD, is a professor in the Department of Psychology at Virginia Commonwealth University. Her work is focused on cultural factors (gender, ethnicity, age) that affect the health and wellbeing of African American youth and young adults.

Sarah Javier is a doctoral candidate in Health Psychology at Virginia Commonwealth University. Her research interests include developing culturally tailored prevention programs for underserved populations.

 Image source: iStockphoto.com

 


Filed under: Culture, Ethnicity and Race, Health Disparities, LGBT Issues Tagged: data collection, gender, health disparities, identity, intersectionality, race, research, sexual orientation, YRBS

How to Help People with Mental Health Conditions Quit Smoking for Good

blog-cdc-tips-smokers-mhconditions

By Corinne M. Graffunder, DrPH, MPH (Director of the Office on Smoking and Health,  Centers for Disease Control and Prevention)

Rebecca’s Story                                                                                                                                         

Rebecca, a former smoker featured in CDC’s Tips From Former Smokers campaign, started smoking cigarettes at age 16. Everyone in her family smoked, and once she started smoking, she quickly became addicted. She kept smoking into adulthood. While she tried to stop, she had difficulty quitting. “I probably tried to quit smoking at least half a dozen times, but the addiction was so strong.”

Rebecca was also diagnosed with depression at age 33, and she is not alone. Smoking is more common among people with mental health conditions than among people in the general population. In fact, people with mental health conditions smoke about 4 out of every 10 cigarettes smoked by adults in the United States.

Rebecca recalls the shame she felt when she tried to quit smoking and couldn’t. “All this time, I didn’t even realize that smoking and my depression went hand in hand. I was smoking to try to help my depression, but it only made things worse.” Struggling to quit made her feel even more depressed.

Smoking didn’t just affect Rebecca’s mental health. She also had gum disease and started losing her teeth. The additional toll smoking had on her health motivated her more than ever before to lead a healthy lifestyle. “I finally realized I had to look to myself for my own happiness and health. I had to quit,” she said. She finally quit smoking and received treatment for her depression.

Today Rebecca feels better than ever, both mentally and physically. “Today, I take care of myself. I eat right. I went back into therapy to self-check and to have a professional to talk to about the trials and tribulations that I go through as a single grandmother, and as someone who wants to stay healthy.”

After she quit smoking, Rebecca began running while taking her grandson along for a ride in his stroller. This activity helped her manage stress and depression and to stay smokefree. Six months after starting to run, Rebecca ran her first 5K. “I actually placed third in my age group. That gave me the confidence to keep going,” she said. Learn more about Rebecca’s story, and the wake-up call that  helped her quit smoking for good.

Smoking and Adults with Mental Health Conditions

The percentage of adults with mental health conditions who smoke is at least twice that of the general population, compared with fewer than one in five (17%) adults in the general population.

Smoking-related diseases such as heart disease, lung disease, and cancer are among the most common causes of death among adults. Smoking is not a treatment for depression or anxiety.

Quitting smoking is not easy, but it is possible! Like other smokers, adults with mental health conditions who smoke want to quit, can quit, and can benefit from using proven stop-smoking treatments. By including cessation as part of your treatment plan, you can improve more than just your patients’ physical health – you can improve their overall mental and emotional well-being.

Resources to Help Smokers Quit for Good

Primary care and mental health care providers should routinely screen patients for tobacco use and offer evidence-based smoking cessation treatments. You can help by asking patients about their tobacco use and providing support and education about cessation to those who smoke.

Mental health care professionals and primary care providers can:

  • Ask their patients if they use tobacco; if they do, help them quit.
  • Offer proven quitting treatments, including tailored quit assistance, to patients who use tobacco.
  • Refer patients interested in quitting to 1-800-QUIT-NOW, Smokefree.gov, or other resources.
  • Provide counseling, support, and stop-smoking medicines, as appropriate.
  • Make quitting tobacco part of an overall approach to treatment and wellness.
  • Monitor and adjust mental health medicines as needed in people trying to quit using tobacco.

Free resources to support smokers in their quit journey are at CDC.gov/quit.  These tools can help smokers:

  • Choose a quit date. A new month as a start date is a great idea.
  • Let loved ones know about their quit journey, so they can be supportive.
  • List the reasons for quit smoking.
  • Find out what triggers cause them to smoke, especially during the early days.
  • Have places to turn to for help right away.

Just like Rebecca, smokers can end the cycle of nicotine addiction. If you are a mental health professional who works with patients who smoke, please take a look at CDC’s Resources for Mental Health Care Professionals.

No matter what your specialty is, you know the damaging effects that smoking can have on your patients’ health. Most smokers want to quit. Getting started often takes support and motivation from trusted sources, like you. With CDC’s Resources for Health Care Professionals, you can help your patients quit smoking for good and begin a healthy, smokefree life.

For more information, check out APA’s Smoking and Health Disparities resource page.

 

References:

Centers for Disease Control and Prevention. (2013). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62 (05):81–7 [accessed 2016 July 28].

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013. Rockville, MD [accessed 2016 May 18 ].

Biography:

blog-graffunder

Dr. Corinne Graffunder is Director of the Office on Smoking and Health within the National Center for Chronic Disease Prevention and Health Promotion. She is responsible for providing broad leadership and direction for all scientific, policy, and programmatic issues related to tobacco control and prevention.

Prior to her current position she served as the Deputy Associate Director for Policy in CDC’s Office of the Director, working to strengthen collaboration between public health, health care, and other sectors to advance CDC’s population health priorities. She has more than 25 years of experience with national, state, and local prevention efforts and working with the US Surgeon General and National Prevention Council, led the development of the first ever National Prevention Strategy: America’s Plan for Better Health and Wellness.

Since joining CDC in 1987, she has held leadership positions in the National Center for Chronic Disease Prevention and Health Promotion and in the National Center for Injury Prevention and Control, working on a range of health issues including tobacco control, cancer prevention and control, and violence prevention.  She received her doctorate from the University of North Carolina and her Masters of Public Health and Bachelors of Science from the University of South Carolina.

 


Filed under: Health and Wellness, Health Disparities Tagged: CDC, CDC Tips from Former Smokers Campaign, depression, health disparities, mental health, mental illness, smoking, smoking and mental health, smoking cessation, tobacco

How to Help People with Mental Health Conditions Quit Smoking for Good

blog-cdc-tips-smokers-mhconditions

By Corinne M. Graffunder, DrPH, MPH (Director of the Office on Smoking and Health,  Centers for Disease Control and Prevention)

Rebecca’s Story                                                                                                                                         

Rebecca, a former smoker featured in CDC’s Tips From Former Smokers campaign, started smoking cigarettes at age 16. Everyone in her family smoked, and once she started smoking, she quickly became addicted. She kept smoking into adulthood. While she tried to stop, she had difficulty quitting. “I probably tried to quit smoking at least half a dozen times, but the addiction was so strong.”

Rebecca was also diagnosed with depression at age 33, and she is not alone. Smoking is more common among people with mental health conditions than among people in the general population. In fact, people with mental health conditions smoke about 4 out of every 10 cigarettes smoked by adults in the United States.

Rebecca recalls the shame she felt when she tried to quit smoking and couldn’t. “All this time, I didn’t even realize that smoking and my depression went hand in hand. I was smoking to try to help my depression, but it only made things worse.” Struggling to quit made her feel even more depressed.

Smoking didn’t just affect Rebecca’s mental health. She also had gum disease and started losing her teeth. The additional toll smoking had on her health motivated her more than ever before to lead a healthy lifestyle. “I finally realized I had to look to myself for my own happiness and health. I had to quit,” she said. She finally quit smoking and received treatment for her depression.

Today Rebecca feels better than ever, both mentally and physically. “Today, I take care of myself. I eat right. I went back into therapy to self-check and to have a professional to talk to about the trials and tribulations that I go through as a single grandmother, and as someone who wants to stay healthy.”

After she quit smoking, Rebecca began running while taking her grandson along for a ride in his stroller. This activity helped her manage stress and depression and to stay smokefree. Six months after starting to run, Rebecca ran her first 5K. “I actually placed third in my age group. That gave me the confidence to keep going,” she said. Learn more about Rebecca’s story, and the wake-up call that  helped her quit smoking for good.

Smoking and Adults with Mental Health Conditions

The percentage of adults with mental health conditions who smoke is at least twice that of the general population, compared with fewer than one in five (17%) adults in the general population.

Smoking-related diseases such as heart disease, lung disease, and cancer are among the most common causes of death among adults. Smoking is not a treatment for depression or anxiety.

Quitting smoking is not easy, but it is possible! Like other smokers, adults with mental health conditions who smoke want to quit, can quit, and can benefit from using proven stop-smoking treatments. By including cessation as part of your treatment plan, you can improve more than just your patients’ physical health – you can improve their overall mental and emotional well-being.

Resources to Help Smokers Quit for Good

Primary care and mental health care providers should routinely screen patients for tobacco use and offer evidence-based smoking cessation treatments. You can help by asking patients about their tobacco use and providing support and education about cessation to those who smoke.

Mental health care professionals and primary care providers can:

  • Ask their patients if they use tobacco; if they do, help them quit.
  • Offer proven quitting treatments, including tailored quit assistance, to patients who use tobacco.
  • Refer patients interested in quitting to 1-800-QUIT-NOW, Smokefree.gov, or other resources.
  • Provide counseling, support, and stop-smoking medicines, as appropriate.
  • Make quitting tobacco part of an overall approach to treatment and wellness.
  • Monitor and adjust mental health medicines as needed in people trying to quit using tobacco.

Free resources to support smokers in their quit journey are at CDC.gov/quit.  These tools can help smokers:

  • Choose a quit date. A new month as a start date is a great idea.
  • Let loved ones know about their quit journey, so they can be supportive.
  • List the reasons for quit smoking.
  • Find out what triggers cause them to smoke, especially during the early days.
  • Have places to turn to for help right away.

Just like Rebecca, smokers can end the cycle of nicotine addiction. If you are a mental health professional who works with patients who smoke, please take a look at CDC’s Resources for Mental Health Care Professionals.

No matter what your specialty is, you know the damaging effects that smoking can have on your patients’ health. Most smokers want to quit. Getting started often takes support and motivation from trusted sources, like you. With CDC’s Resources for Health Care Professionals, you can help your patients quit smoking for good and begin a healthy, smokefree life.

For more information, check out APA’s Smoking and Health Disparities resource page.

 

References:

Centers for Disease Control and Prevention. (2013). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62 (05):81–7 [accessed 2016 July 28].

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013. Rockville, MD [accessed 2016 May 18 ].

Biography:

blog-graffunder

Dr. Corinne Graffunder is Director of the Office on Smoking and Health within the National Center for Chronic Disease Prevention and Health Promotion. She is responsible for providing broad leadership and direction for all scientific, policy, and programmatic issues related to tobacco control and prevention.

Prior to her current position she served as the Deputy Associate Director for Policy in CDC’s Office of the Director, working to strengthen collaboration between public health, health care, and other sectors to advance CDC’s population health priorities. She has more than 25 years of experience with national, state, and local prevention efforts and working with the US Surgeon General and National Prevention Council, led the development of the first ever National Prevention Strategy: America’s Plan for Better Health and Wellness.

Since joining CDC in 1987, she has held leadership positions in the National Center for Chronic Disease Prevention and Health Promotion and in the National Center for Injury Prevention and Control, working on a range of health issues including tobacco control, cancer prevention and control, and violence prevention.  She received her doctorate from the University of North Carolina and her Masters of Public Health and Bachelors of Science from the University of South Carolina.

 


Filed under: Health and Wellness, Health Disparities Tagged: CDC, CDC Tips from Former Smokers Campaign, depression, health disparities, mental health, mental illness, smoking, smoking and mental health, smoking cessation, tobacco

New CDC Survey Data Confirm the Severe Health Risks LGB Youth Face

blog-YRBS-LGB-youth

By Clinton Anderson, PhD (Director, APA Office on Lesbian, Gay, Bisexual and Transgender Concerns) & Lacey Rosenbaum, MEd (Director, APA Safe and Supportive Schools Project)

 

On August 11, 2016, the Centers for Disease Control and Prevention released the results of the first national study of sexual minority high school students: “Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12 – United States and Selected Sites, 2015.”

This is the first nationally representative data on a wide range of risks among lesbian, gay, and bisexual (LGB) students, and it was made possible by CDC adding questions to the 2015 national Youth Risk Behavior Survey (YRBS), which is conducted biannually among students in grades 9-12 in high schools.

 

What does this new research tell us?

 

LGB students experience much higher levels of physical and sexual violence and bullying compared to their heterosexual peers:

  • LGB high school students are more likely to report being forced to have sex (18% vs. 5%),
  • to experience sexual dating violence (23% vs. 9%),
  • to experience physical dating violence (18% vs. 8%),
  • and to be bullied at school or online (at school: 34% vs. 19%; online: 28% vs. 14%).

LGB students are at increased risk for suicide:

  • More than 40% of LGB students reported seriously considering and roughly 30% reported attempting suicide in the last year.

60% of LGB youth reported having been so sad or hopeless they stopped doing some usual activities.

More than 10% reported having missed school because of safety concerns.

LGB students were up to 5 times more likely than other students to report using several illegal drugs.

These results confirm the need for school-based interventions that APA called for in its Resolution on Sexual Orientation and Gender Diversity in Children and Adolescents in Schools.

 

What about transgender students? 

 

The 2015 results include no findings on transgender students. To date, federal officials have not been able to devise scientifically sound gender identity questions for inclusion in the YRBS. The Department of Health and Human Services recognizes this research challenge and seeks to address it in its federal sexual orientation and gender identity data collection plans. APA in its Resolution supports the validation of gender identity measures to better understand the experiences of transgender and gender diverse students and calls for schools to create supportive environments for these students.

 

What does other research on LGB youth say?

 

Other research points to a number of shared risk factors for violence, which may affect LGB youth:

  • Social isolation and lack of social support;
  • Poor parent-child relationships (lack of parental caring and support);
  • History of violent victimization (violence makes one vulnerable to more violence);
  • Perceived by others as not masculine or feminine enough.

 

So, what works to protect LGB youth?

 

There is no simple solution to these dangerous intersections of risks, but research has identified shared protective factors that can help young people at the individual, family, and community levels.

  • Individual-level protective factors include helping young people develop problem-solving and coping skills and encouraging bystander interventions.
  • Family-level protective factors include family support and connectedness, connection to other caring adults, connection to and commitment to school and peers.
  • Community-level protective factors include community support and connectedness and access to mental health and substance abuse services.

All of us, including parents, schools and communities, can and must take action to ensure gay, lesbian, and bisexual youth survive and thrive. APA’s Respect Workshop, developed with CDC support, provides school counselors, nurses, psychologists, and social workers with the knowledge, attitudes, and skills to make schools safe and supportive for LGB students.

 

What can we all do?

 

Professionals and parents can:

  • Work with schools to ensure comprehensive, community-wide support systems that reduce risk and promote protective factors for LGB youth.

Schools can:

  • Work to support and encourage parents to foster resiliency in their children by providing strong family support and teaching all children nonviolent problem solving skills.
  • Build environments that provide safety and connectedness for all students, including gay, lesbian, and bisexual youth.

Communities can:

  • Adopt policies and practices to reduce discrimination and forms of victimization that contribute to vulnerability and thereby reduce stressors for LGB youth.

 

Connectedness is key

 

At the end of the day, making sure that LGB youth feel connected – to parents, to peers, to teachers, and to schools and other community organizations – is key to protecting their health. Students are more likely to thrive in their schools and communities if they know they matter – if they know the adults, teachers, and friends in their lives care about their safety and success.

For more info, check out APA’s Safe and Supportive Schools Project.

Image source: Flickr user ankxt via Creative Commons


Filed under: Children and Youth, LGBT Issues Tagged: bullying, CDC Youth Risk Behavior Survey, health disparities, health risks, LGB youth, online bullying, safe schools, school bullying, school connectedness, school safety, sexual assault, sexual minorities, sexual minority youth, sexual violence, suicide, violence, YRBS