%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 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