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We study the steady upward trend of Health Care Expenditures (HCE) over GDP for a sample of OECD countries between 1970 and 2007. Although the United States is clearly an outlier, almost all of the additional increase in US HCE happened during the 1978–1990 period. We perform two growth accounting exercises to explore sources of variability of HCE over GDP across countries. In the first growth accounting exercise based on value added we find that factor accumulation is unable to replicate the observed growth patterns. We also show that the additional increase in markups in the US corporate medical sector mimics well the ratio of HCE over GDP in the United States. This suggests that differences in the relative price of health care—rather than technology, product quality, and factor accumulation—could explain the divergent growth patterns of HCE over GDP across these countries. In the second growth accounting exercise, we filter out prices from HCE over GDP, and confirm that there is very little variability for the product quality residual to explain the variation in HCE across countries. [ABSTRACT FROM AUTHOR]

Failure to receive proper oral health care including both prevention and maintenance is influenced by myriad and complex social, economic, and dental factors, including access to care. Reducing oral health disparities requires changes in the preparation of future dentists as well as measuring and influencing the attitudes and knowledge of practicing dentists. The aim of this study was to determine the likelihood that future dentists (students and residents) and faculty members at one U.S. dental school would treat Medicaid participants. Attitudes were measured using the Deamonte Driver scenario survey, which assesses factors affecting dentists' participation in Medicaid. In October 2012, all 113 full-time faculty members were invited to participate, and 60 completed the survey, for a response rate of 53.1%. In January and February 2013, all 18 residents in the dental clinics and university hospital were invited to participate, and 16 completed the survey, for a response rate of 88.9%. From 2013 to 2015, all 267 students in three classes were invited to participate: first-year students in the Classes of 2017 and 2018 and fourth-year students in the Class of 2015. A total of 255 students completed the survey, for an overall student response rate of 95.5%. The results showed that the students were more likely to participate in caring for Medicaid patients than the faculty and residents. The white and male students had stronger negative stereotypes about Medicaid patients than the females and underrepresented minority students, while residents had stronger negative stereotypes about Medicaid patients than the students and faculty. Overall, the cultural competency skills, beliefs, and attitudes of these faculty members and residents were less developed than those of their students, signaling a need for broad educational and faculty development programs to fully prepare the future dental workforce to care for these patients. [ABSTRACT FROM AUTHOR]

An ever-present challenge for the oral health profession is to reduce the extent of oral disease among racial and ethnic minority populations. Adding to this complex dilemma is the linkage between oral health and systemic health. We describe enhanced cultural competency, in the context of individual cultural beliefs, values, language, practice, and health behaviors, among dental professionals, as one approach to meeting the dental care needs of the underserved. An overview and examples of teaching methods used by University of Florida dental educators to enhance student cultural competency is provided. Evidence-based evaluation results provide evidence of methodology efficacy. We conclude by describing actions that can be implemented by academic dental institutions to facilitate development of culturally competent practitioners. [ABSTRACT FROM AUTHOR]

Recently, there has been increased attention to including cultural diversity in the education of health professionals, including concern for lesbian, gay, bisexual, and transgender (LGBT) inclusion and visibility. Studies regarding cultural exposure and acceptance of LGBT populations have been concentrated in medicine, with findings showing that medical providers often graduate having missed the preparation required to care for LGBT persons. A visible, comprehensive, culturally competent environment in dental schools would help ensure that all oral health professionals and students are aware of services available to address the particular needs of LGBT students. The aims of this survey-based study conducted in 2015-16 were to determine dental students' perceptions regarding LGBT students' needs and to assess dental students' knowledge of resources for LGBT persons at three U.S. dental schools, one each in the Midwest, West, and South. Of the 849 students invited to participate, 364 completed the survey (338 dental, 26 dental hygiene), for an overall response rate of 43%. The response rate at individual schools ranged from 30% to 55%. The results showed perceptions of insufficient LGBT information, resources, and support at these institutions, especially at the Western school. There were significant differences among the three schools, with students at the Western school more than the other two schools perceiving that their institution was less aware of whether it met the academic, social support, and spiritual needs of LGBT students. There were no significant differences between LGBT and non-LGBT students' perceptions. The authors urge dental school administrators to explore the degree to which their programs teach respectful and caring behavior towards LGBT students and, by extension, LGBT patient populations. [ABSTRACT FROM AUTHOR]

Recently, there has been increased attention to including cultural diversity in the education of health professionals, including concern for lesbian, gay, bisexual, and transgender (LGBT) inclusion and visibility. Studies regarding cultural exposure and acceptance of LGBT populations have been concentrated in medicine, with findings showing that medical providers often graduate having missed the preparation required to care for LGBT persons. A visible, comprehensive, culturally competent environment in dental schools would help ensure that all oral health professionals and students are aware of services available to address the particular needs of LGBT students. The aims of this survey-based study conducted in 2015-16 were to determine dental students' perceptions regarding LGBT students' needs and to assess dental students' knowledge of resources for LGBT persons at three U.S. dental schools, one each in the Midwest, West, and South. Of the 849 students invited to participate, 364 completed the survey (338 dental, 26 dental hygiene), for an overall response rate of 43%. The response rate at individual schools ranged from 30% to 55%. The results showed perceptions of insufficient LGBT information, resources, and support at these institutions, especially at the Western school. There were significant differences among the three schools, with students at the Western school more than the other two schools perceiving that their institution was less aware of whether it met the academic, social support, and spiritual needs of LGBT students. There were no significant differences between LGBT and non-LGBT students' perceptions. The authors urge dental school administrators to explore the degree to which their programs teach respectful and caring behavior towards LGBT students and, by extension, LGBT patient populations. [ABSTRACT FROM AUTHOR]

Approaches for managing carious tissues during cavity preparations vary considerably among clinicians, which may reflect inconsistencies in the teaching of this subject by dental schools. The aims of this study were to investigate practices related to the preclinical and clinical teaching of caries removal at U.S. dental schools and the relationship between that teaching and requirements for U.S. dental licensure examinations. The electronic survey included questions about terminology, methods, instruments and materials, treatment planning, criteria for clinical exams, faculty calibration sessions, and licensure exams. The faculty members at U.S. dental schools responsible for teaching cariology were invited to participate; 54 of the 65 schools had identified a contact person at the time of the survey in October 2015. Of those 54 invited to participate, 43 completed the survey (response rate of 79.6%). Most of the respondents indicated that depth of carious lesions was a clinical determinant of the amount of carious dentin being removed in cavity preparations. Caries removal was used as a criterion in restorative clinical examinations by 95% of responding schools. Marked differences were observed regarding the criteria used for assessment and removal of carious tissues, management of deep carious lesions, and definition of "caries remaining at cavity preparations," which is considered a critical error on licensure exams. Faculty calibration sessions on caries removal were reported to occur in 65% of these schools and at different time frames. Overall, the study found a wide range of teaching practices related to caries removal. Best evidence in caries management needs to be aligned with teaching and the criteria used to calibrate faculty members and examiners. [ABSTRACT FROM AUTHOR]

The high prevalence of distress among health professionals during their education has fostered increased interest in the study of student well-being. The aim of this study was to assess the self-perceived wellness of dental students and determine the relationship between factors affecting wellness and demographic variables. An online questionnaire was distributed to 334 first-through fourth-year dental students at one U.S. dental school. The questionnaire consisted of modified versions of the Perceived Wellness Survey, Medical Outcomes Study Social Support Survey, and Mental Health Inventory and also collected demographic information. The response rate was 78% (N=261). More than 80% of the respondents reported that they were happy all, most, or a good bit of the time. These students exhibited a strong sense of self-worth, were positive about their friendships, and perceived they had good social support. Less than 20% of respondents did not view their physical health as excellent and identified a lack of self-perceived wellness. First-year and single students reported statistically less social support. Students who were parents perceived their wellness less favorably. Hispanic and Asian students were less happy regarding their mental health than white and African American students. These findings suggest that students, especially Hispanic and Asian students, may benefit from programs that promote student well-being. Academic programs that encourage students to work together and promote peer-to-peer involvement may be beneficial, especially for first-year and single students. [ABSTRACT FROM AUTHOR]

Concordance studies indicate the degree to which instruments measure the same or similar constructs or something different. The aims of this study were to identify the factor structure of the Deamonte Driver Survey and determine the relationship between the Deamonte Driver (a measure of social class stereotyping), the Defining Issues Test 2 (DIT2; a measure of ethical sensitivity), the Color-Blind Racial Attitudes Scale (CoBRAS; a measure of racial stereotyping), and the Knowledge, Efficacy, and Practices Instrument (KEPI; a measure of cultural competence). The results showed a three-factor solution for the Deamonte Driver Survey and significant relationships between CoBRAS and DIT2 subscales and between CoBRAS and Deamonte Driver subscales. Significant relationships between the measures and exploratory variables, underrepresented minority status, age, citizenship, marital status, political stance, English as a first language, and gender were found. The lack of a significant relationship between the KEPI and Deamonte Driver, DIT2, or CoBRAS subscales suggests that the KEPI is measuring a unique construct. These findings showed how these scales contributed to the assessment of cultural competence among dental students and faculty. [ABSTRACT FROM AUTHOR]

Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge. [ABSTRACT FROM AUTHOR]

The purpose of this study was: 1) to explore the pre-tenure experiences of an African American female faculty member in a counselor education program; and 2) to compare the themes that ascended from a precursor study to the current one. By using critical ethnography and case study format, this research gave voice to the participant by prompting responses to questions of why and how. Evidence from this study reaffirms that female faculty of color are adversely impacted by racism and sexism in the Academy. Findings from this study support the notion that mentoring and across cultural affiliation with tenure-track faculty members from diverse backgrounds contributes to their professional achievement. Moreover, this study asserts that the milieu of research-intensive universities may foster psychic numbing, which has an intergenerational effect. [ABSTRACT FROM AUTHOR]

How African American girls cope and excel amidst the discriminations and inequities they experience within U.S. educational systems has not been widely discussed in the body of research about African Americans’ schooling experiences. In this study, the researchers examined the applicability of Ogbu’s cultural–ecological theory to the self-described school experiences of eight high-achieving African American high school girls. Using an inductive analysis of interviews, focus groups, journal, and field notes, this article draws attention to the role that school policies and practices, caring adults play, and how the participants’ negotiated academic and racial identities contributed to their academic success. [ABSTRACT FROM PUBLISHER]

Objective This purpose of this case study was to assess how a medicine/surgery unit patients and nursing staff in the southeast United States perceived patient safety in comparison with US federal patient safety goals. Method Researchers verbally administered 3 rating scales (0-10) and 21 open-ended questions to 45 patients. Their responses were recorded verbatim and inductively analysed. Ten unit RNs filled out a survey with 18 open-ended questions with 1 rating scale (0-10). Results Using a 10-point scale, patients rated the average degree of control over their care as 7.29 and facility safety as 8.74 while nurses rated their degree of control as 6.6 and facility safety at 7.2. 80% of patients but only 20% of nurses described their response time to call lights in a specific number of minutes with 20% of patients reporting a wait time of greater than 30 minutes. Patient themes included medical errors, concerns about not being heard, lack of knowledge regarding safety, and passivity. Nursing staff themes included reporting errors, call light response, and expectations for patient participation. Conclusions This exploratory study supports previous research and depicts how hospital patients and nurses perceive care and safety differently. Of importance, patients possess little understanding of hospital safety creating a paradox of patient dependency. [ABSTRACT FROM AUTHOR]

Mentoring is believed to be one of the most influential factors in US efforts to encourage college-aged students to seek careers in science, yet the role that mentoring plays in this process has not been elucidated. The researchers were interested in understanding whether the long-held beliefs about the importance of mentoring would be revealed as what actually occurs in an undergraduate research program. They describe students' perceptions of the mentoring process and students' beliefs about how it impacted their experiences as undergraduate researchers and their development as scientists. Also described are professors' perceptions of their roles and effectiveness as mentors in students' development as scientists. A multi-case narrative analysis was conducted of two groups, undergraduate science scholars (n=5) and mentoring professors (n=5), who were each interviewed on two occasions at the beginning and end of the first year of a funded research program. As this grounded research study shows, students and professors described student gains as increased technical expertise and communication skills. Professors suggested that they were available to students on a regular and frequent basis. However, students' experiences suggested a contradiction. They were often mentored by postgraduates, technical assistants, and other students; their meetings with mentoring professors were infrequent and at times distant. With respect to mentoring, this finding highlights the differences between beliefs and the reality of what was delivered. Professors discussed the challenges associated with mentoring including the recruitment of and difficulty of working with students whose first language was not English and concerns about the quality of instruction from graduate students. [ABSTRACT FROM AUTHOR]

The article discusses the issue of culturally responsive school leadership in the U.S. It states that a culturally responsive leader should understand the assumptions, beliefs and values about people and cultures of individuals which are different from their own. The National Association for Colleges of Teacher Education (NACTE) Leadership standard states that school leaders are responsible for the promotion of multicultural awareness, gender sensitivity as well as racial and ethnic appreciation. According to the article, school leaders should acquire the skills necessary to differentiate leadeship practices.

The term 'leadership' metaphorically embodies a gendered hierarchy of labour. In this study women deans' values were found to be incongruent with the masculine discourse creating inner conflicts and alternative discourses. Data collected from 10 women deans from both male-dominated and female-dominated colleges were used to deconstruct leadership using a feminist poststructuralist perspective. Unlike a critical perspective, poststructuralism questions hierarchical relationships between knowledge and power, thus enabling us to understand leadership in differently shaded terms. The data portrays the multidimensional qualities of power and how women use power consciously and unconsciously to move within academic discourses. [ABSTRACT FROM AUTHOR]

Background: Bone-marrow derived progenitor cells (PCs) may play a role in maintaining vascular health by actively repairing damaged endothelium. The purpose of this study in asymptomatic Old Order Amish men (n = 90) without hypertension or diabetes was to determine if PC count, as determined by CD34+ cell count in peripheral blood, was associated with 10-year risk of cardiovascular disease (CVD) and measures of subclinical atherosclerosis. Methods and Results: CD34+ cell count by fluorescence-activated cell sorting, coronary artery calcification (CAC) by electron beam computed tomography, and CVD risk factors were obtained. Carotid intimal-medial thickness (CIMT) also was obtained in a subset of 57 men. After adjusting for 10-year CVD risk, CD34+ cell count was significantly associated with CAC quantity ( p = 0.03) and CIMT ( p < 0.0001). A 1-unit increase in natural-log transformed CD34+ cell count was associated with an estimated 55.2% decrease (95% CI: -77.8% to -9.3%) in CAC quantity and an estimated 14.3% decrease (95% CI: -20.1% to -8.1%) in CIMT. Conclusions: Increased CD34+ cell count was associated with a decrease in extent of subclinical atherosclerosis in multiple arterial beds, independent of 10-year CVD risk. Further investigations of associations of CD34+ cell count with subclinical atherosclerosis in asymptomatic individuals could provide mechanistic insights into the atherosclerotic process. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the factors that influence African American parents' involvement in their children's middle school experiences. Two focus group interviews were conducted with African American parents. While the participants viewed parent involvement as important, they reported that family structure and socioeconomic status, school personnel's expectations of parents, and the practices and policies of middle school personnel influenced their level of involvement. The participants suggested that: setting higher expectations for African American students, establishing flexible meeting locations, offering workshops for homework help at home, and creating cultures that believe parents care would likely increase African American parent involvement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the types of publications produced by the Professors of Curriculum (POC) between 1996 and 2006. Publications were analyzed to determine the number of articles that were evidence-based (data-driven), in refereed or non-refereed journals, and their major descriptors. The majority of the POC's 513 publications appeared in refereed journals, however, only 26% of the publications across all journals were data-driven. Professors of Curriculum writings failed to meet the current national expectations for evidence-based research. [ABSTRACT FROM AUTHOR]

Researchers investigated if early childhood teachers could become reflective practitioners when they studied culturally specific constructs within a digital collegial environment. Three female African American early childhood teachers within three different settings (a faith-based primary school, a home school, and a government-funded pre-school agency) developed mini-research projects using a mediated form of Lesson Study. Data consisted of teachers' electronic mail, application artifacts, synchronous and asynchronous online activities via Blackboard, and videotaped exit interviews. Findings showed that even when there is ethnic congruence, teachers are inclined to teach in ways that propagate the Eurocentric curriculum model. The teachers' use of a culturally-specific reflective teaching model resulted in culturally responsive teaching practices within their individual classrooms. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the loss of instructional time within a K-12 school and identify whether students or teachers initiated time loss. A mixed methods approach and critical incident technique were used. At this southeastern United States school, loss of allocated instructional time ranged from 14% to 39% across the elementary, middle and high levels. Both students and teachers initiated non-use of instructional time. A small magnitude of effect showed a significant relationship between schools and non-instructional use of time, and schools and student-initiated non-instructional use of time. Creating awareness about loss of instructional time, establishing commitments to classroom management practices, and using instructional time for its intended purposes are likely to reduce the loss of allocated time. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if self-reported teaching style beliefs were different among faculty at a U.S. and an Israeli dental school. Teacher-centered practices refer to beliefs that the teacher holds the subject matter expertise and students are generally passive learners who must be told what to think. Student-centered practices refer to beliefs, that students must learn how to construct their own understanding. Student-centered teaching is directed towards enabling students to think about complex issues. Twenty-seven of fifty-eight (47.37 percent) faculty at a dental school in the United States and thirty of thirty-four (88 percent) Israeli dental faculty teaching in basic science courses completed the Teaching Behavior Preferences Survey (TBPS). The TBPS is a thirty-item instrument that measures two domains of teaching styles--teacher-centered (TC) and student-centered (SC)--and four subdomains: methods of instruction (MI), classroom milieu (CM), use of questions (UQ), and use of assessment (UA). Findings revealed that there were no significant differences in student-centered and teacher-centered teaching practices and methods of instruction, classroom milieu, and use of questions. There was a significant difference between the U.S. and Israeli groups in their reported use of assessment. The U.S. faculty reported a greater preference for student-centered assessment practices than did the Israeli faculty. [ABSTRACT FROM AUTHOR]

Cites a study conducted by researchers in the U.S. which found that Carney triad is a rare syndrome. Symptoms associated with the syndrome; Overview of the clinical tests on the syndrome; Disclosure of the report that patients with Carney triad have presented gastric stromal sarcoma and pulmonary chondroma.

As a result of the Joint Commission on Accreditation of Healthcare Organizations accreditation standards for 2001, pain management for hospitalized patients has become a top priority of healthcare facilities. In addition to using the traditional pharmacological approach to pain management, many patients also use complementary or alternative medicine (CAM) treatments. However, CAM treatments may not be discussed or offered to patients by healthcare providers who lack awareness about these alternatives. The purpose of this study was to assess patients' perceptions of pain, their beliefs about the use of pharmacological and CAM pain management techniques, and their satisfaction with pain management. Researchers verbally administered a survey to patients by using a combination of open-ended questions and a 0-10 rating scale, and they recorded their responses. This study was conducted in a not-for-profit teaching hospital in the southeast United States. Convenience sampling was used to select the 137 patients who completed the surveys. No treatment intervention was provided. Pharmacological treatment was the primary method expected and used by the majority of patients for pain management. Chi-squared statistics were used to analyze nonparametric data. An analysis of variance was used to analyze parametric data. The frequency with which nonpharmacological CAM options were used ranged from 6 to 34 percent. The most commonly used CAM method was distraction, such as watching television or reading. [ABSTRACT FROM AUTHOR]

Summary Twenty men undergoing vasectomies completed the Tennessee Self Concept Scale shortly before the operation and again at 6- and 18-month postoperative follow-up periods. Twenty nonvasectomy comparison subjects completed the test at the same points in time. Results indicated that vasectomy adversely affects psychological adjustment, and this effect fluctuates over time as a function of preoperative level of defensiveness. In contrast, vasectomy was not found to effect changes in self-concept. [ABSTRACT FROM AUTHOR]

The article discusses the study regarding the use of pharmaceutical drugs reserpine and chlorpromazine in psychiatric disorders of patients with mental defectives in the U.S. The study found out that reserpine and chlorpromazine are effective in controlling excessive motor activity based primarily on an organic impairment. Both drugs were equally effective in curbing hyperactivity in a group of mental defectives.

This article discusses the dynamics and treatment of child abuse. The problem of child abuse and maltreatment is presently a major social and psychological problem in the United States. In attempt to cope with this serious problem it appears that the practitioners have put the proverbial cart before the horse and tried to provide services to abusive families, but failed to study the research conducted by their esteemed colleagues, the comparative psychologists. Not only did these monkeys avoid their own infants and fail to nurse them and provide them with adequate mothering, but frequent instances of abusive maternal behavior were noted.

Introduction: Patient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE)., Methods and Analysis: The current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline., Ethics and Dissemination: The study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18-603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets. Trial registration number NCT03837496; Pre-results., Competing Interests: Competing interests: JJ is a paid consultant from Blue Note Therapeutics. JG receives royalties from Springer Humana Press, has research funding from Gaido Health/BCG Digital Ventures, and is a paid consultant from Concerto HealthAI and Blue Note Therapeutics. JP has received research funding from Pfizer, is a paid consultant for Athenex, and JP’s spouse is an employee of GlaxoSmithKline. All other authors declare that they have no conflicts of interest., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Transgender and gender nonconforming (TGNC) individuals frequently confront discrimination, rejection, and violence. Such experiences may put TGNC individuals at risk for minority stress and associated psychiatric symptoms. Protective factors like social support, pride in one's gender identity, or connectedness to similar others may make TGNC individuals less vulnerable to psychiatric symptoms, and the presence of risk and protective factors may vary depending on living environment. This study examined the relationship of living environment (urban vs. suburban vs. small-town/rural) to social anxiety (SA) in a sample of 902 TGNC individuals who participated in the Trans Health Survey. Analysis of variance revealed a significant difference in SA across living environments. Those living in small-town/rural environments reported significantly higher levels of SA compared to those living in urban environments. There was a trend-level difference in SA in suburban compared to urban environments. Linear regression analyses revealed that living environment significantly moderated the relationship between social support and SA. Higher social support was more protective against elevated SA in urban and suburban than in small-town/rural environments. This study is the first to demonstrate the experience of elevated SA among TGNC individuals living in rural environments. Implications and future directions for research are discussed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)