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Documenting and Disrupting the Healt...

Hughto, Jaclyn White.

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Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration./
作者:	Hughto, Jaclyn White.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2017,
面頁冊數:	150 p.
附註:	Source: Dissertation Abstracts International, Volume: 79-05(E), Section: B.
Contained By:	Dissertation Abstracts International79-05B(E).
標題:	Epidemiology. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10767244
ISBN:	9780355681581

Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration.
Hughto, Jaclyn White.

Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration. - Ann Arbor : ProQuest Dissertations & Theses, 2017 - 150 p.

Source: Dissertation Abstracts International, Volume: 79-05(E), Section: B.

Thesis (Ph.D.)--Yale University, 2017.

Background: Transgender women experience substantial health disparities and a high prevalence of incarceration relative to the U.S. general population. Incarcerated transgender women face widespread structural (e.g., sex-segregated prisons) and interpersonal (e.g., verbal harassment, violence) stigma; however, less is known about their clinical interactions with correctional healthcare providers or the multilevel factors that shape their access to correctional healthcare. Additionally, while cross-sectional research with transgender women finds that incarceration is associated with poor mental health, no longitudinal research has examined risk factors for incarceration or the health-related sequelae of incarceration for this population. Further, while incarceration provides an opportunity to clinically intervene to improve the health of inmate populations, the health of transgender inmates will not improve if they do not have access to culturally and clinically competent providers. This dissertation aims to contextualize the healthcare experiences of transgender women during incarceration; identify risk factors for incarceration and document the prospective relationship between incarceration and poor health among transgender women; and develop and test an educational intervention to increase correctional healthcare providers' ability to care for transgender patients.

ISBN: 9780355681581Subjects--Topical Terms:

568544
Epidemiology.

Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration.
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245 1 0 $a Documenting and Disrupting the Health-Risk Trajectories of Criminal-Justice-Involved Transgender Women Before, During, and After Incarceration.
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300 $a 150 p.
500 $a Source: Dissertation Abstracts International, Volume: 79-05(E), Section: B.
500 $a Adviser: John Pachankis.
502 $a Thesis (Ph.D.)--Yale University, 2017.
520 $a Background: Transgender women experience substantial health disparities and a high prevalence of incarceration relative to the U.S. general population. Incarcerated transgender women face widespread structural (e.g., sex-segregated prisons) and interpersonal (e.g., verbal harassment, violence) stigma; however, less is known about their clinical interactions with correctional healthcare providers or the multilevel factors that shape their access to correctional healthcare. Additionally, while cross-sectional research with transgender women finds that incarceration is associated with poor mental health, no longitudinal research has examined risk factors for incarceration or the health-related sequelae of incarceration for this population. Further, while incarceration provides an opportunity to clinically intervene to improve the health of inmate populations, the health of transgender inmates will not improve if they do not have access to culturally and clinically competent providers. This dissertation aims to contextualize the healthcare experiences of transgender women during incarceration; identify risk factors for incarceration and document the prospective relationship between incarceration and poor health among transgender women; and develop and test an educational intervention to increase correctional healthcare providers' ability to care for transgender patients.
520 $a Methods: Study 1: In the summer of 2015, 20 transgender women who had been incarcerated in the U.S. within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated. Study 2: Between 2012 and 2015, 221 young transgender women from Chicago and Boston were assessed quarterly over one year. Mixed effects models identified risk factors for recent incarceration and examined whether recent incarceration was associated with somatic, anxiety, and depressive symptoms, illicit drug use, and binge drinking over time, controlling for baseline mental health and substance use dependence diagnoses. Study 3: In the summer of 2016, a theoretically-informed, group-based intervention to improve transgender cultural and clinical competence was delivered to 34 correctional healthcare providers in New England. A confidential survey assessed providers' cultural and clinical competence to care for transgender patients, self-efficacy to provide hormones, subjective norms related to transgender care, and willingness to provide gender-affirming care before, immediately after, and three months after the intervention. Linear mixed effects regression models were fit to assess change in study outcomes over time. Qualitative exit interviews assessed intervention feasibility and acceptability.
520 $a Results: Study 1: Recently incarcerated transgender women described an institutional culture in which their feminine gender identity was not recognized, and in which institutional policies acted as a form of structural stigma to create and reinforce a binary understanding of gender and restrict access to healthcare. While some participants attributed healthcare barriers to providers' transgender bias, others described providers' limited knowledge or inexperience caring for transgender patients as barriers. Whether due to institutional (e.g., sex-segregated prisons), interpersonal (e.g., biased or inexperienced providers), or individual (e.g., healthcare avoidance) factors, insufficient access to physical-, mental-, and gender affirmation healthcare negatively impacted participants' health while incarcerated. Study 2: Overall, 38% of the young transgender women sample had been incarcerated in their lifetime, while 18% were incarcerated over the one-year study period. Dropping out of school, sex work, homelessness, and number of times incarcerated prior to enrollment predicted past 4-month incarceration. In separate models, past 4-month incarceration was significantly associated with illicit drug use during the same time period and also predicted elevated somatic symptoms (p's<0.05). Study 3: Correctional healthcare providers' willingness to provide gender-affirming care improved immediately and three months post-intervention compared to baseline (p<0.001). On average, transgender cultural competence, medical gender affirmation knowledge, self-efficacy to initiate hormones for transgender women, and subjective norms related to transgender care all significantly increased over time ( p<0.01). Providers found the intervention to be highly acceptable and recommended that the training be scaled-up to correctional healthcare providers in other geographic regions and expanded to custody staff.
520 $a Conclusion: This dissertation research documents how structural, interpersonal, and individual barriers restrict transgender women's access to gender-affirming care and contribute to poor health outcomes while incarcerated. This research also prospectively identifies structural and behavioral risk factors for incarceration and demonstrates that recent incarceration prospectively predicts elevated mental health symptoms and is associated with concurrent substance use among young transgender women. The intervention developed and tested here successfully equips correctional healthcare providers with the cultural and clinical competencies necessary to effectively care for transgender inmates. Continued efforts should be made to train correctional healthcare providers in culturally and clinically competent gender-affirming care in order to improve the health of transgender people while incarcerated and upon release. Such interventions can reduce the multilevel pathways to risk for this increasingly visible, and vulnerable segment of the U.S. population.
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