189 results on '"John R. Blosnich"'
Search Results
2. Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations
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Guneet K. Jasuja, Hill L. Wolfe, Joel I. Reisman, Varsha G. Vimalananda, Sowmya R. Rao, John R. Blosnich, Nicholas A. Livingston, and Jillian C. Shipherd
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gender-affirming hormone therapy ,clinical guidelines ,guideline concordance ,transgender and gender diverse ,veterans ,Veterans Health Administration ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundGender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies have examined how current GAHT initiation compares to recommended GAHT initiation.ObjectiveThis study assessed guideline concordance around feminizing and masculinizing GAHT initiation in the Veterans Health Administration (VHA).MethodsThe sample included 4,676 veterans with a gender identity disorder diagnosis who initiated feminizing (n=3,547) and masculinizing (n=1,129) GAHT between 2007 and 2018 in VHA. Demographics and health conditions on veterans receiving feminizing and masculinizing GAHT were assessed. Proportion of guideline concordant veterans on six VHA guidelines on feminizing and masculinizing GAHT initiation were determined.ResultsCompared to veterans receiving masculinizing GAHT, a higher proportion of veterans receiving feminizing GAHT were older (≥60 years: 23.7% vs. 6.3%), White non-Hispanic (83.5% vs. 57.6%), and had a higher number of comorbidities (≥7: 14.0% vs. 10.6%). A higher proportion of veterans receiving masculinizing GAHT were Black non-Hispanic (21.5% vs. 3.5%), had posttraumatic stress disorder (43.0% vs. 33.9%) and positive military sexual trauma (33.5% vs.16.8%; all p-values50%) prior to starting masculinizing GAHT. Among veterans initiating feminizing and masculinizing GAHT, 91.2% had documentation of a gender identity disorder diagnosis prior to GAHT initiation.ConclusionWe observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT. Findings suggest that VHA clinicians are initiating feminizing GAHT in concordance with clinical guidelines. Future work should assess guideline concordance on monitoring and management of GAHT in VHA.
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- 2024
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3. Sexual and Gender Minority Status and Suicide Mortality: An Explainable Artificial Intelligence Analysis
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Ying Yin, T. Elizabeth Workman, John R. Blosnich, Cynthia A. Brandt, Melissa Skanderson, Yijun Shao, Joseph L. Goulet, and Qing Zeng-Treitler
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sexual and gender minority ,suicide mortality ,risk factors ,deep learning ,explainable artificial intelligence ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: Suicide risk is elevated in lesbian, gay, bisexual, and transgender (LGBT) individuals. Limited data on LGBT status in healthcare systems hinder our understanding of this risk. This study used natural language processing to extract LGBT status and a deep neural network (DNN) to examine suicidal death risk factors among US Veterans.Methods: Data on 8.8 million veterans with visits between 2010 and 2017 was used. A case-control study was performed, and suicide death risk was analyzed by a DNN. Feature impacts and interactions on the outcome were evaluated.Results: The crude suicide mortality rate was higher in LGBT patients. However, after adjusting for over 200 risk and protective factors, known LGBT status was associated with reduced risk compared to LGBT-Unknown status. Among LGBT patients, black, female, married, and older Veterans have a higher risk, while Veterans of various religions have a lower risk.Conclusion: Our results suggest that disclosed LGBT status is not directly associated with an increase suicide death risk, however, other factors (e.g., depression and anxiety caused by stigma) are associated with suicide death risks.
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- 2024
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4. Identifying suicide documentation in clinical notes through zero‐shot learning
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Terri Elizabeth Workman, Joseph L. Goulet, Cynthia A. Brandt, Allison R. Warren, Jacob Eleazer, Melissa Skanderson, Luke Lindemann, John R. Blosnich, John O'Leary, and Qing Zeng‐Treitler
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computer ,international classification of diseases ,natural language processing ,neural networks ,suicide ,Veterans ,Medicine - Abstract
Abstract Background and Aims In deep learning, a major difficulty in identifying suicidality and its risk factors in clinical notes is the lack of training samples given the small number of true positive instances among the number of patients screened. This paper describes a novel methodology that identifies suicidality in clinical notes by addressing this data sparsity issue through zero‐shot learning. Our general aim was to develop a tool that leveraged zero‐shot learning to effectively identify suicidality documentation in all types of clinical notes. Methods US Veterans Affairs clinical notes served as data. The training data set label was determined using diagnostic codes of suicide attempt and self‐harm. We used a base string associated with the target label of suicidality to provide auxiliary information by narrowing the positive training cases to those containing the base string. We trained a deep neural network by mapping the training documents’ contents to a semantic space. For comparison, we trained another deep neural network using the identical training data set labels, and bag‐of‐words features. Results The zero‐shot learning model outperformed the baseline model in terms of area under the curve, sensitivity, specificity, and positive predictive value at multiple probability thresholds. In applying a 0.90 probability threshold, the methodology identified notes documenting suicidality but not associated with a relevant ICD‐10‐CM code, with 94% accuracy. Conclusion This method can effectively identify suicidality without manual annotation.
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- 2023
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5. Commentary: Absence of behavioral harm following non-efficacious sexual orientation change efforts: A retrospective study of United States sexual minority adults, 2016–2018
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Ilan H. Meyer and John R. Blosnich
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research methodology ,sexual minorities ,sexual orientation change efforts (SOCE) ,suicide ,conversion therapy ,Psychology ,BF1-990 - Published
- 2022
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6. Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders
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Olivia V. Fletcher, Jessica A. Chen, Jenna van Draanen, Madeline C. Frost, Anna D. Rubinsky, John R. Blosnich, and Emily C. Williams
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Social determinants of health ,SDOH ,Alcohol use disorders ,Transgender ,LGBTQ ,Social stressors ,Public aspects of medicine ,RA1-1270 ,Social sciences (General) ,H1-99 - Abstract
Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09–7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2–3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values
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- 2022
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7. Strengths and vulnerabilities: Comparing post-9/11 U.S. veterans’ and non-veterans’ perceptions of health and broader well-being
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Dawne Vogt, Shelby Borowski, Shira Maguen, John R. Blosnich, Claire A. Hoffmire, Paul A. Bernhard, Katherine M. Iverson, and Aaron Schneiderman
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Military service ,Post-9/11 veterans ,Survey ,Health and health behavior ,Employment ,Finances ,Public aspects of medicine ,RA1-1270 ,Social sciences (General) ,H1-99 - Abstract
Background: Prior research has examined how the post-military health and well-being of both the larger veteran population and earlier veteran cohorts differs from non-veterans. However, no study has yet to provide a holistic examination of how the health, vocational, financial, and social well-being of the newest generation of post-9/11 U.S. military veterans compares with their non-veteran peers. This is a significant oversight, as accurate knowledge of the strengths and vulnerabilities of post-9/11 veterans is required to ensure that the needs of this population are adequately addressed, as well as to counter inaccurate veteran stereotypes. Methods: Post-9/11 U.S. veterans’ (N = 15,160) and non-veterans’ (N = 4,533) reported on their health and broader well-being as part of a confidential web-based survey in 2018. Participants were drawn from probability-based sampling frames, and sex-stratified weighted logistic regressions were conducted to examine differences in veterans’ and non-veterans’ reports of health, vocational, financial, and social outcomes. Results: Although both men and women post-9/11 veterans endorsed poorer health status than non-veterans, they reported greater engagement in a number of positive health behaviors (healthy eating and exercise) and were more likely to indicate having access to health care. Veterans also endorsed greater social well-being than non-veterans on several outcomes, whereas few differences were observed in vocational and financial well-being. Conclusion: Despite their greater vulnerability to experiencing health conditions, the newest generation of post-9/11 U.S. veterans report experiencing similar or better outcomes than non-veterans in many aspects of their lives. Findings underscore the value of examining a wider range of health and well-being outcomes in veteran research and highlight a number of important directions for intervention, public health education, policy, and research related to the reintegration of military veterans within broader civilian society.
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- 2022
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8. Establishing a Research Agenda for Suicide Prevention Among Veterans Experiencing Homelessness
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Maurand Robinson, Ryan Holliday, Lindsey L. Monteith, John R. Blosnich, Eric B. Elbogen, Lillian Gelberg, Dina Hooshyar, Shawn Liu, D. Keith McInnes, Ann Elizabeth Montgomery, Jack Tsai, Riley Grassmeyer, and Lisa A. Brenner
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Veterans ,homelessness ,housing insecurity ,suicide ,Delphi ,suicide prevention ,Psychology ,BF1-990 - Abstract
Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors (e.g., clinical complexity including multimorbidity, difficulty monitoring risk across systems). To address this challenge, the United States Department of Veterans Affairs (VA) convened the Health Services Research and Development (HSR&D) Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness.
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- 2022
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9. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey
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Sonya Gabrielian, Audrey L. Jones, April E. Hoge, Aerin J. deRussy, Young-il Kim, Ann Elizabeth Montgomery, John R. Blosnich, Adam J. Gordon, Lillian Gelberg, Erika L. Austin, David Pollio, Sally K. Holmes, Allyson L. Varley, and Stefan G. Kertesz
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely ( P
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- 2021
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10. Proceedings of the 14th annual conference of INEBRIA
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Aisha S. Holloway, Jennifer Ferguson, Sarah Landale, Laura Cariola, Dorothy Newbury-Birch, Amy Flynn, John R. Knight, Lon Sherritt, Sion K. Harris, Amy J. O’Donnell, Eileen Kaner, Barbara Hanratty, Amy M. Loree, Kimberly A. Yonkers, Steven J. Ondersma, Kate Gilstead-Hayden, Steve Martino, Angeline Adam, Robert P. Schwartz, Li-Tzy Wu, Geetha Subramaniam, Gaurav Sharma, Jennifer McNeely, Anne H. Berman, Karoline Kolaas, Elisabeth Petersén, Preben Bendtsen, Erik Hedman, Catharina Linderoth, Ulrika Müssener, Kristina Sinadinovic, Fredrik Spak, Ida Gremyr, Anna Thurang, Ann M. Mitchell, Deborah Finnell, Christine L. Savage, Khadejah F. Mahmoud, Benjamin C. Riordan, Tamlin S. Conner, Jayde A. M. Flett, Damian Scarf, Bonnie McRee, Janice Vendetti, Karen Steinberg Gallucci, Kate Robaina, Brendan J. Clark, Jacqueline Jones, Kathryne D. Reed, Rachel M. Hodapp, Ivor Douglas, Ellen L. Burnham, Laura Aagaard, Paul F. Cook, Brett R. Harris, Jiang Yu, Margaret Wolff, Meighan Rogers, Carolina Barbosa, Brendan J. Wedehase, Laura J. Dunlap, Shannon G. Mitchell, Kristi A. Dusek, Jan Gryczynski, Arethusa S. Kirk, Marla T. Oros, Colleen Hosler, Kevin E. O’Grady, Barry S. Brown, Colin Angus, Sidney Sherborne, Duncan Gillespie, Petra Meier, Alan Brennan, Divane de Vargas, Janaina Soares, Donna Castelblanco, Kelly M. Doran, Ian Wittman, Donna Shelley, John Rotrosen, Lillian Gelberg, E. Jennifer Edelman, Stephen A. Maisto, Nathan B. Hansen, Christopher J. Cutter, Yanhong Deng, James Dziura, Lynn E. Fiellin, Patrick G. O’Connor, Roger Bedimo, Cynthia Gibert, Vincent C. Marconi, David Rimland, Maria C. Rodriguez-Barradas, Michael S. Simberkoff, Amy C. Justice, Kendall J. Bryant, David A. Fiellin, Emma L. Giles, Simon Coulton, Paolo Deluca, Colin Drummond, Denise Howel, Elaine McColl, Ruth McGovern, Stephanie Scott, Elaine Stamp, Harry Sumnall, Luke Vale, Viviana Alabani, Amanda Atkinson, Sadie Boniface, Jo Frankham, Eilish Gilvarry, Nadine Hendrie, Nicola Howe, Grant J. McGeechan, Amy Ramsey, Grant Stanley, Justine Clephane, David Gardiner, John Holmes, Neil Martin, Colin Shevills, Melanie Soutar, Felicia W. Chi, Constance Weisner, Thekla B. Ross, Jennifer Mertens, Stacy A. Sterling, Gillian W. Shorter, Nick Heather, Jeremy Bray, Hildie A. Cohen, Tracy L. McPherson, Cyrille Adam, Hugo López-Pelayo, Antoni Gual, Lidia Segura-Garcia, Joan Colom, India J. Ornelas, Suzanne Doyle, Dennis Donovan, Bonnie Duran, Vanessa Torres, Jacques Gaume, Véronique Grazioli, Cristiana Fortini, Sophie Paroz, Nicolas Bertholet, Jean-Bernard Daeppen, Jason M. Satterfield, Steven Gregorich, Nicholas J. Alvarado, Ricardo Muñoz, Gozel Kulieva, Maya Vijayaraghavan, Angéline Adam, John A. Cunningham, Estela Díaz, Jorge Palacio-Vieira, Alexandra Godinho, Vladyslav Kushir, Kimberly H. M. O’Brien, Laika D. Aguinaldo, Christina M. Sellers, Anthony Spirito, Grace Chang, Tiffany Blake-Lamb, Lea R. Ayers LaFave, Kathleen M. Thies, Amy L. Pepin, Kara E. Sprangers, Martha Bradley, Shasta Jorgensen, Nico A. Catano, Adelaide R. Murray, Deborah Schachter, Ronald M. Andersen, Guillermina Natera Rey, Mani Vahidi, Melvin W. Rico, Sebastian E. Baumeister, Magnus Johansson, Christina Sinadinovic, Ulric Hermansson, Sven Andreasson, Megan A. O’Grady, Sandeep Kapoor, Cherine Akkari, Camila Bernal, Kristen Pappacena, Jeanne Morley, Mark Auerbach, Charles J. Neighbors, Nancy Kwon, Joseph Conigliaro, Jon Morgenstern, Molly Magill, Timothy R. Apodaca, Brian Borsari, Ariel Hoadley, J. Scott Tonigan, Theresa Moyers, Niamh M. Fitzgerald, Lisa Schölin, Nicolas Barticevic, Soledad Zuzulich, Fernando Poblete, Pablo Norambuena, Paul Sacco, Laura Ting, Michele Beaulieu, Paul George Wallace, Matthew Andrews, Kate Daley, Don Shenker, Louise Gallagher, Rod Watson, Tim Weaver, Pol Bruguera, Clara Oliveras, Carolina Gavotti, Pablo Barrio, Fleur Braddick, Laia Miquel, Montse Suárez, Carla Bruguera, Richard L. Brown, Julie Whelan Capell, D. Paul Moberg, Julie Maslowsky, Laura A. Saunders, Ryan P. McCormack, Joy Scheidell, Mirelis Gonzalez, Sabrina Bauroth, Weiwei Liu, Dawn L. Lindsay, Piper Lincoln, Holly Hagle, Sara Wallhed Finn, Anders Hammarberg, Sven Andréasson, Sarah E. King, Rachael Vargo, Brayden N. Kameg, Shauna P. Acquavita, Ruth Anne Van Loon, Rachel Smith, Bonnie J. Brehm, Tiffiny Diers, Karissa Kim, Andrea Barker, Ashley L. Jones, Asheley C. Skinner, Agatha Hinman, Dace S. Svikis, Casey L. Thacker, Ken Resnicow, Jessica R. Beatty, James Janisse, Karoline Puder, Ann-Sofie Bakshi, Joanna M. Milward, Andreas Kimergard, Claire V. Garnett, David Crane, Jamie Brown, Robert West, Susan Michie, Ingvar Rosendahl, Claes Andersson, Mikael Gajecki, Matthijs Blankers, Kim Donoghue, Ellen Lynch, Ian Maconochie, Ceri Phillips, Rhys Pockett, Tom Phillips, R. Patton, Ian Russell, John Strang, Maureen T. Stewart, Amity E. Quinn, Mary Brolin, Brooke Evans, Constance M. Horgan, Junqing Liu, Fern McCree, Doug Kanovsky, Tyler Oberlander, Huan Zhang, Ben Hamlin, Robert Saunders, Mary B. Barton, Sarah H. Scholle, Patricia Santora, Chirag Bhatt, Kazi Ahmed, Dominic Hodgkin, Wenwu Gao, Elizabeth L. Merrick, Charles E. Drebing, Mary Jo Larson, Monica Sharma, Nancy M. Petry, Richard Saitz, Constance M. Weisner, Kelly C. Young-Wolff, Wendy Y. Lu, John R. Blosnich, Keren Lehavot, Joseph E. Glass, Emily C. Williams, Kara M. Bensley, Gary Chan, Julie Dombrowski, John Fortney, Anna D. Rubinsky, Gwen T. Lapham, Ariadna Forray, Todd A. Olmstead, Kathryn Gilstad-Hayden, Trace Kershaw, Pamela Dillon, Michael F. Weaver, Emily R. Grekin, Jennifer D. Ellis, and Lucy McGoron
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Medicine (General) ,R5-920 ,Social pathology. Social and public welfare. Criminology ,HV1-9960 - Published
- 2017
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11. Cigarette smoking disparities among sexual minority cancer survivors
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Charles Kamen, John R. Blosnich, Megan Lytle, Michelle C. Janelsins, Luke J. Peppone, and Karen M. Mustian
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Smoking ,Neoplasms ,Sexuality ,Homosexuality ,Female ,Male ,Minority health ,Medicine - Abstract
Objective: Sexual minority (i.e., lesbian, gay, and bisexual) adults smoke cigarettes at higher rates than heterosexual adults. Smoking after receiving a cancer diagnosis is a major health concern, yet risk of continued smoking among sexual minority cancer survivors is as yet unknown. The current study examines current smoking among sexual minority vs. heterosexual adult cancer survivors. Method: Data drawn from the 2010 Behavioral Risk Factor Surveillance System survey in five states (Alaska, California, Massachusetts, New Mexico, and Wisconsin) included items about sexual orientation, cancer diagnosis, and tobacco use. The analytic sample included 124 sexual minority and 248 propensity score matched heterosexual adult cancer survivors. Results: Bivariate analysis showed that sexual minority cancer survivors had twice the odds of current smoking as their heterosexual counterparts (OR = 2.03, 95%CI:1.09–3.80). In exploratory analyses stratified by sex, sexual minority disparities in prevalence of smoking post-cancer showed a trend toward significance among females, not males. Conclusion: The current study offers preliminary evidence that sexual minority status is one variable among many that must be taken into account when assessing health behaviors post-cancer diagnosis. Future research should identify mechanisms leading from sexual minority status to increased rates of smoking and develop tailored smoking cessation interventions.
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- 2015
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12. Leveraging Contextual Relatedness to Identify Suicide Documentation in Clinical Notes through Zero Shot Learning.
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Terri Elizabeth Workman, Joseph L. Goulet, Cynthia A. Brandt, Allison R. Warren, Jacob Eleazer, Melissa Skanderson, Luke Lindemann, John R. Blosnich, John O. Leary, and Qing Zeng-Treitler
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- 2023
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13. Refusal Rates to Sexual Orientation and Gender Identity Items in the Behavioral Risk Factor Surveillance System, 2014-2019
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Rory P. O’Brien and John R. Blosnich
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Adult ,Male ,Sociodemographic Factors ,Time Factors ,Adolescent ,Sexual Behavior ,Public Health, Environmental and Occupational Health ,Age Factors ,Gender Identity ,Middle Aged ,Health Surveys ,United States ,Behavioral Risk Factor Surveillance System ,Young Adult ,Sex Factors ,Humans ,Female ,Aged ,Language - Abstract
Objectives. To explore trends in sexual orientation and gender identity (SOGI) item refusal in the Behavioral Risk Factor Surveillance System (BRFSS). Methods. We used annual data from 7 US states that implemented the SOGI module of the BRFSS from 2014 to 2019 to examine prevalence of sexual orientation (n = 373 332) and gender identity (n = 373 336) item refusal. Analyses included the weighted Wald χ2 test of association between refusal and year and logistic regressions predicting refusal by year. We weighted analyses to account for complex sampling design. Results. We found low SOGI item refusal rates, significant declines in these refusal rates over time, and differences in refusal rates by age, sex, race, education, and language. We also found that Hispanic group membership did not explain SOGI item refusal when accounting for interview language; interview language was strongly associated with both sexual orientation and gender identity item refusal. Conclusions. Our results indicate acceptance of SOGI measurement and empirically support continuation of SOGI in health surveillance surveys. Findings indicate a need to further investigate the association between survey translation and item refusal.
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- 2024
14. Neighborhood Disadvantage, Patterns of Unhealthy Alcohol Use, and Differential Associations by Gender, Race/Ethnicity, and Rurality: A Study of Veterans Health Administration Patients
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Amy T, Edmonds, Isaac C, Rhew, Jessica, Jones-Smith, Kwun C G, Chan, A B, De Castro, Anna D, Rubinsky, John R, Blosnich, and Emily C, Williams
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Rural Population ,Alcoholism ,Alcohol Drinking ,Residence Characteristics ,Humans ,Veterans Health ,Alcohol-Related Disorders - Abstract
Stressful conditions within disadvantaged neighborhoods may shape unhealthy alcohol use and related harms. Yet, associations between neighborhood disadvantage and more severe unhealthy alcohol use are underexplored, particularly for subpopulations. Among national Veterans Health Administration (VA) patients (2013-2017), we assessed associations between neighborhood disadvantage and multiple alcohol-related outcomes and examined moderation by sociodemographic factors.Electronic health record data were extracted for VA patients with a routine Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen. Patient addresses were linked by census block group to the Area Deprivation Index (ADI), dichotomized at the 85th percentile, and examined in quintiles for sensitivity analyses. Using modified Poisson generalized estimating equations models, we estimated associations between neighborhood disadvantage and five outcomes: unhealthy alcohol use (AUDIT-C ≥ 5), any past-year heavy episodic drinking (HED), severe unhealthy alcohol use (AUDIT-C ≥ 8), alcohol use disorder (AUD) diagnosis, and alcohol-specific conditions diagnoses. Moderation by gender, race/ethnicity, and rurality was tested using multiplicative interaction.Among 6,381,033 patients, residence in a highly disadvantaged neighborhood (ADI ≥ 85th percentile) was associated with a higher likelihood of unhealthy alcohol use (prevalence ratio [PR] = 1.06, 95% CI [1.05, 1.07]), severe unhealthy alcohol use (PR = 1.14, 95% CI [1.12, 1.15]), HED (PR = 1.04, 95% CI [1.03, 1.05]), AUD (PR = 1.14, 95% CI [1.13, 1.15]), and alcohol-specific conditions (PR = 1.21, 95% CI [1.18, 1.24]). Associations were larger for Black and American Indian/Alaska Native patients compared with White patients and for urban compared with rural patients. There was mixed evidence of moderation by gender.Neighborhood disadvantage may play a role in unhealthy alcohol use in VA patients, particularly those of marginalized racialized groups and those residing in urban areas.
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- 2023
15. Addressing Barriers to Clinical Trial Participation for Transgender People With Cancer to Improve Access and Generate Data
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Ash B. Alpert, Jamie Renee Brewer, Spencer Adams, Lexis Rivers, Sunshine Orta, John R. Blosnich, Susanne Miedlich, Charles Kamen, Don S. Dizon, Richard Pazdur, Julia A. Beaver, and Lola Fashoyin-Aje
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Cancer Research ,Oncology - Published
- 2023
16. Differences in Beliefs About Suicide by Occupation in a Representative Sample of Adults in the United States, General Social Survey 2002–2021
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John R. Blosnich, Alexandra M. Haydinger, Harmony Rhoades, and Susan M. De Luca
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Psychiatry and Mental health ,Clinical Psychology - Published
- 2023
17. Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes.
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John R. Blosnich, John Cashy, Adam J. Gordon, Jillian C. Shipherd, Michael R. Kauth, George R. Brown, and Michael J. Fine
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- 2018
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18. Treatment Utilization for Posttraumatic Stress Disorder in a National Sample of Veterans and Nonveterans
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Rachel M. Ranney, Shira Maguen, Paul A. Bernhard, Nicholas Holder, Dawne Vogt, John R. Blosnich, and Aaron I. Schneiderman
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Public Health, Environmental and Occupational Health - Published
- 2023
19. Primary sources of health care among <scp>LGBTQ</scp> + veterans: Findings from the Behavioral Risk Factor Surveillance System
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Hunter Hahn, Kelly H. Burkitt, Michael R. Kauth, Jillian C. Shipherd, and John R. Blosnich
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Health Policy - Abstract
This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non-LGBTQ+ veterans.Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules.We used survey-weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non-LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state.Study data were gathered via computer-assisted telephone interviews with probability-based samples of adults aged 18 and over. Data are publicly available.Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non-LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non-LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex-stratified analyses, fewer female LGBTQ+ veterans than female non-LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed.Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.
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- 2022
20. Recent and Frequent Mental Distress Among Women with a History of Military Service, 2003–2019
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Deirdre A. Quinn, Brittany F. Hollis, Melissa E. Dichter, and John R. Blosnich
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Health (social science) ,Health Policy ,Public Health, Environmental and Occupational Health - Abstract
Examining women veterans' self-reported mental health is critical to understanding their unique mental and physical health needs. This study describes self-reported mental distress over a 17-year period among cross-sectional nationally representative samples of women in the USA using data from the Behavioral Risk Factor Surveillance System (BRFSS) core national surveys from 2003 to 2019. Nationally representative prevalence estimates of self-reported mental distress were compared between women veterans and their (1) men veteran and (2) women civilian counterparts. In each year examined, women veterans report significantly more days of recent mental distress and significantly higher prevalence of frequent mental distress than their men veteran counterparts. In several years, women veterans also report greater levels of recent and frequent mental distress than women civilians. These findings highlight the long-standing high prevalence of self-reported poor mental health among women veterans and suggest that specific efforts to address mental health among women veterans as a unique population may be warranted.
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- 2022
21. Neighborhood Disadvantage, Patterns of Unhealthy Alcohol Use, and Differential Associations by Gender, Race/Ethnicity, and Rurality: A Study of Veterans Health Administration Patients
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Amy T. Edmonds, Isaac C. Rhew, Jessica Jones-Smith, Kwun C. G. Chan, A. B. De Castro, Anna D. Rubinsky, John R. Blosnich, and Emily C. Williams
- Subjects
Psychiatry and Mental health ,Health (social science) ,Toxicology - Published
- 2022
22. Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression
- Author
-
Nicholas Holder, Ryan Holliday, Rachel M. Ranney, Paul A. Bernhard, Dawne Vogt, Claire A. Hoffmire, John R. Blosnich, Aaron I. Schneiderman, and Shira Maguen
- Subjects
Psychiatry and Mental health ,Health (social science) ,Social Psychology ,Epidemiology - Published
- 2023
23. Interpersonal and Self-Directed Violence Among Sexual and Gender Minority Populations: Moving Research from Prevalence to Prevention
- Author
-
John R. Blosnich
- Subjects
General Earth and Planetary Sciences - Published
- 2022
24. Social Determinants of Sexual and Gender Minority Mental Health
- Author
-
Emmett R. Henderson, Jeremy T. Goldbach, and John R. Blosnich
- Subjects
Psychiatry and Mental health ,Clinical Psychology - Published
- 2022
25. Psychosocial Outcomes Among Veteran and Non-Veteran Survivors of Sexual Assault
- Author
-
Nicholas Holder, Shira Maguen, Ryan Holliday, Dawne Vogt, Paul A. Bernhard, Claire A. Hoffmire, John R. Blosnich, and Aaron I. Schneiderman
- Subjects
Adult ,Stress Disorders, Post-Traumatic ,Clinical Psychology ,Military Personnel ,Sex Offenses ,Humans ,Survivors ,social sciences ,Child ,health care economics and organizations ,humanities ,Applied Psychology ,Veterans - Abstract
Although it is well-established that sexual assault results in variable and long-lasting negative impacts on emotional well-being, perceptions of physical health, and relationship functioning, these “psychosocial” outcomes may vary based on the type(s) of sexual trauma experienced. To identify the differential impact of sexual trauma type(s) on psychosocial outcomes among veterans and non-veterans, we conducted a secondary analysis of data from the Comparative Health Assessment Interview Research Study, a large, national survey study sponsored by the Department of Veterans Affairs. Participants included veterans ( n = 3588) and non-veterans ( n = 935) who endorsed experiencing childhood sexual assault (CSA), adult sexual assault (ASA, outside of military service for veteran participants), and/or military sexual assault (MSA). Eight measures were used to assess psychosocial outcomes: Well-Being Inventory (WBI) health satisfaction and physical health functioning items, Posttraumatic Stress Disorder Checklist, Patient Health Questionnaire (depression symptoms), Generalized Anxiety Disorder Questionnaire, WBI social satisfaction items, WBI social functioning items, and the Multidimensional Scale of Perceived Social Support (social). A profile analysis was used to determine how sexual trauma type(s) influenced the pattern of responding to the eight psychosocial outcome measures. Veteran sexual assault survivors reported poorer psychological outcomes compared to non-veteran sexual assault survivors. Non-veteran sexual assault survivors reported poorer outcomes on the majority of social variables compared to veteran sexual assault survivors. Survivors of MSA-only reported poorer psychosocial outcomes compared to veteran and non-veteran survivors of CSA-only and ASA-only on most of the variables assessed. Survivors of ASA-only reported similar or modestly worse psychosocial outcomes when compared to survivors of CSA-only on the majority of variables assessed. Survivors of different types of sexual trauma reported distinct psychosocial outcomes, suggesting that assessment and treatment needs may differ by trauma type.
- Published
- 2022
26. Evictions and tenant‐landlord relationships during the 2020–2021 eviction moratorium in the US
- Author
-
Jack, Tsai, Minda, Huang, John R, Blosnich, and Eric B, Elbogen
- Subjects
Male ,Health (social science) ,Social Problems ,Substance-Related Disorders ,Ill-Housed Persons ,Housing ,Public Health, Environmental and Occupational Health ,COVID-19 ,Humans ,Female ,Applied Psychology - Abstract
This study provisionally examined the effects of the US eviction moratorium instituted in response to the Coronavirus Disease 2019 (COVID-19) pandemic. Three waves of data collected May 2020-April 2021 from a nationally representative sample of middle- and low-income US tenants (n = 3393 in Wave 1, n = 1311 in Wave 2, and 814 in Wave 3) were analyzed. Across three waves, 4.3% of tenants reported experiencing an eviction during the moratorium and 6%-23% of tenants reported delaying paying rent because of the moratorium. Multivariable analyses found that tenants who delayed paying their rent, were female, or had a history of mental illness or substance use disorder were more likely to report the eviction moratorium had a negative effect on their landlord relationship. COVID-19 infection was not predictive of eviction but tenants with a history of homelessness were more than nine times as likely to report an eviction than those without such a history. Together, these findings suggest the eviction moratorium may have had some unintended consequences on rent payments and tenant-landlord relationships that need to be considered with the end of the federal eviction moratorium.
- Published
- 2022
27. Correcting a False Research Narrative: A Commentary on Sullins (2022)
- Author
-
John R. Blosnich, Robert W. S. Coulter, Emmett R. Henderson, Jeremy T. Goldbach, and Ilan H. Meyer
- Subjects
Arts and Humanities (miscellaneous) ,sexual orientation ,sexual minorities ,conversion therapy ,General Psychology ,suicide ,mental health - Published
- 2023
28. Insights for conducting large-scale surveys with veterans who have experienced homelessness
- Author
-
Aerin J. deRussy, Audrey L. Jones, Erika L. Austin, Adam J. Gordon, Lillian Gelberg, Sonya E. Gabrielian, Kevin R. Riggs, John R. Blosnich, Ann Elizabeth Montgomery, Sally K. Holmes, Allyson L. Varley, April E. Hoge, and Stefan G. Kertesz
- Subjects
Social Sciences (miscellaneous) - Published
- 2021
29. Patient Characteristics Associated with Receiving Gender-Affirming Hormone Therapy in the Veterans Health Administration
- Author
-
Hill L. Wolfe, Varsha G. Vimalananda, Denise H. Wong, Joel I. Reisman, Sowmya R. Rao, Jillian C. Shipherd, John R. Blosnich, Nicholas A. Livingston, and Guneet K. Jasuja
- Subjects
Gender Studies ,Medicine (miscellaneous) - Published
- 2022
30. Correcting a False Research Narrative: A Commentary on Sullins (2022)
- Author
-
John R, Blosnich, Robert W S, Coulter, Emmett R, Henderson, Jeremy T, Goldbach, and Ilan H, Meyer
- Published
- 2022
31. 'Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF)': Correction
- Author
-
Michelle J. Bovin, Aaron Schneiderman, Paul A. Bernhard, Shira Maguen, Claire A. Hoffmire, John R. Blosnich, Brian N. Smith, Richard Kulka, and Dawne Vogt
- Subjects
Clinical Psychology ,Social Psychology - Abstract
Reports an error in "Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF)" by Michelle J. Bovin, Aaron Schneiderman, Paul A. Bernhard, Shira Maguen, Claire A. Hoffmire, John R. Blosnich, Brian N. Smith, Richard Kulka and Dawne Vogt (It is important to assess warfare experiences beyond direct combat exposure, as these exposures can negatively impact military veterans' health. Although two validated scales from the Deployment Risk and Resilience Inventory-2 [DRRI-2] together capture a broad range of stressful warfare experiences, the length of this combined measure (30 items) is prohibitively long for some settings. Therefore, the goal of this project was to develop and validate a short form Warfare Exposure measure (DRRI-2-WE-SF).U.S. veterans deployed for the wars in Iraq and Afghanistan completed questionnaires across 2 studies (study 1,Study 1 involved developing the DRRI-2 WE-SF, a 9-item self-report instrument with strong internal consistency (α = .86) and large correlations with the full Warfare Exposure measure (The DRRI-2 WE-SF is a psychometrically sound measure of direct exposures to warfare and its consequences. This measure of proximal warfare exposure retains the strong properties of the full measure while significantly reducing completion time. These properties make the DRRI-2 WE-SF a useful tool for efficiently evaluating proximal warfare exposure among individuals who have served in both combat and noncombat roles. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
- Published
- 2022
32. What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience
- Author
-
Allyson L. Varley, April Hoge, Kevin R. Riggs, Aerin deRussy, Audrey L. Jones, Erika L. Austin, Sonya Gabrielian, Lillian Gelberg, Adam J. Gordon, John R. Blosnich, Ann Elizabeth Montgomery, and Stefan G. Kertesz
- Subjects
Sociology and Political Science ,Health Policy ,Public Health, Environmental and Occupational Health ,Social Sciences (miscellaneous) ,Article - Abstract
Surveys of people who experience homelessness can portray their life and healthcare experiences with a level of statistical precision; however, few have explored how the very same surveys can deliver qualitative insights as well. In responding to surveys, people experiencing homelessness can use the margins to highlight health and social concerns that investigators failed to anticipate that standard question batteries miss. This study describes the unprompted comments of a large national survey of Veterans with homeless experiences. The Primary Care Quality-Homeless Services Tailoring (PCQ-HOST) survey presented 85 close-ended items to solicit social and psychological experiences, health conditions, and patient ratings of primary care. Amongst 5377 Veterans responding to the paper survey, 657 (12%) offered 1933 unprompted comments across nearly all domains queried. Using a team-based content analysis approach, we coded and organised survey comments by survey domain, and identified emergent themes. Respondents used comments for many purposes. They noted when questions called for more nuanced responses than those allowed, especially 'sometimes' or 'not applicable' on sensitive questions, such as substance use, where recovery status was not queried. On such matters, the options of 'no' and 'yes' failed to capture important contextual and historical information that mattered to respondents, such as being in recovery. Respondents also elaborated on negative and positive care experiences, often naming specific clinics or clinicians. This study highlights the degree to which members of vulnerable populations, who participate in survey research, want researchers to know the reasons behind their responses and topics (like chronic pain and substance use disorders) that could benefit from open-ended response options. Understanding patient perspectives can help improve care. Quantitative data from surveys can provide statistical precision but may miss key patient perspectives. The content that patients write into survey margins can highlight shortfalls of a survey and point towards future areas of inquiry. Veterans with homeless experience want to provide additional detail about their lives and care experiences in ways that transcend the boundaries of close-ended survey questions. Questions on substance use proved especially likely to draw comments that went beyond the permitted response options, often to declare that the respondent was in recovery. Respondents frequently clarified aspects of their care experiences related to pain, pain care, transportation and experiences of homelessness.
- Published
- 2022
33. Concordance of data about sex from electronic health records and the National Death Index: Implications for transgender populations
- Author
-
John R. Blosnich and Taylor L. Boyer
- Subjects
Male ,Epidemiology ,Electronic Health Records ,Gender Identity ,Humans ,Female ,Transgender Persons ,Article - Abstract
BACKGROUND: Transgender individuals have greater health risks than cisgender individuals, which may bode for greater mortality. However, research is limited by lack of gender identity information at the time of death. Novel opportunities to combine administrative data with National Death Index (NDI) data may facilitate mortality research about transgender populations, but binary measures of sex and gender may pose problems for analyses. This study explored differences in sex recorded in Veterans Health Administration (VHA) electronic health record (EHR) and NDI data between transgender and cisgender decedents. METHODS: We used VHA EHR data from fiscal years 2000-2016 to identify deaths among a sample of transgender and cisgender patients. We cross-tabulated sex recorded in the NDI with EHR-based sex from VHA EHR data. We extracted data in 2018 and conducted analyses in 2020. RESULTS: Death occurred for 1,109 transgender patients and 7,757 cisgender patients. For cisgender decedents, EHR-based sex and NDI-based sex were 100% concordant. For transgender decedents, 46 (4%) were discordant between data sources. Of transgender decedents with female EHR-based sex (n = 259), 17% were indicated as male in NDI data; of those with male EHR-based sex (n = 850), 0.2% were indicated as female in NDI data. CONCLUSIONS: Data linkage between EHR and the NDI can facilitate transgender mortality research, but examining mortality specific to various transgender identities remains difficult. Improved documentation of sex and gender is needed within US mortality surveillance.
- Published
- 2022
34. Suicide, Homicide, and All-Cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration
- Author
-
Michael R. Kauth, Ann Pollinger Haas, Guneet K. Jasuja, Taylor L Boyer, Jillian C. Shipherd, Ada O. Youk, John R. Blosnich, and George R. Brown
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urology ,Poison control ,Dermatology ,Transgender Persons ,Suicide prevention ,Occupational safety and health ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Homicide ,Cause of Death ,Injury prevention ,Transgender ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Psychiatry ,health care economics and organizations ,Aged ,Veterans ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Human factors and ergonomics ,Middle Aged ,United States ,humanities ,Suicide ,United States Department of Veterans Affairs ,Psychiatry and Mental health ,Female ,0305 other medical science ,business ,Administration (government) - Abstract
Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic m...
- Published
- 2021
35. Variation in Sexual Orientation Documentation in a National Electronic Health Record System
- Author
-
Patrick R. Alba, Benjamin Viernes, John R. Blosnich, Elise Gatsby, Karen C. Schliep, Scott L. DuVall, and Kristine E. Lynch
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Urology ,Documentation ,Dermatology ,Sexual and Gender Minorities ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Electronic health record ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Veterans ,Aged, 80 and over ,030505 public health ,Medical record ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Original Articles ,Middle Aged ,Veterans health ,United States ,Sexual minority ,United States Department of Veterans Affairs ,Psychiatry and Mental health ,Variation (linguistics) ,Family medicine ,Sexual orientation ,Female ,0305 other medical science ,Psychology ,Administration (government) - Abstract
PURPOSE: The purpose of this study was to determine variation in sexual minority (SM) sexual orientation documentation within the electronic medical records of the Veterans Health Administration (VHA). METHODS: Documentation of SM sexual orientation was retrospectively extracted from clinical notes and administrative data in the VHA from October 1, 1999 to July 1, 2019. The rate of documentation overall and by calendar year was calculated, and differences across patient, provider, and clinic characteristics were evaluated. RESULTS: Approximately 1.4% of all VHA Veterans (n = 115,911) had at least one documentation of SM sexual orientation, including 79,455 men and 36,456 women. The rate of documentation increased from 81.01/100,000 in 2000 to 568.84/100,000 in 2018. The majority of documentations (58.7%) occurred in mental health settings by non-MD mental health/social work counselors, whereas only 9.6% occurred in primary care settings. Although 99% of these Veterans had a primary care visit, only 19% had SM status recorded in that setting. CONCLUSION: Documentation patterns of SM sexual orientation varied considerably in the VHA with notable gaps in primary care. Diverse approaches to culturally competent training for primary care clinicians and patient-facing collection strategies could facilitate documentation of sexual orientation.
- Published
- 2021
36. Differences in Methods of Suicide Death Among Transgender and Nontransgender Patients in the Veterans Health Administration, 1999–2016
- Author
-
John R. Blosnich, Taylor L Boyer, Michael R. Kauth, Jillian C. Shipherd, and George R. Brown
- Subjects
Adult ,Male ,Research design ,Ethnic group ,Veterans Health ,Disease ,Transgender Persons ,National Death Index ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Transgender ,Electronic Health Records ,Humans ,Medicine ,030212 general & internal medicine ,Heterosexuality ,Depression (differential diagnoses) ,Aged ,Proportional hazards model ,business.industry ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Middle Aged ,United States ,Suicide ,United States Department of Veterans Affairs ,Marital status ,Female ,0305 other medical science ,business ,Demography - Abstract
Background Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers. Objective The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients. Research design This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016. Subjects Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924). Measures and analyses Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression. Results Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers. Conclusions Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care.
- Published
- 2021
37. Gender Differences in the Predictors of Suicide-related Morbidity Among Veterans Reporting Current Housing Instability
- Author
-
Melissa E. Dichter, Ann Elizabeth Montgomery, and John R. Blosnich
- Subjects
Adult ,Male ,Adolescent ,Suicide, Attempted ,Logistic regression ,Suicide prevention ,Suicidal Ideation ,Odds ,Young Adult ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Intervention (counseling) ,Humans ,Medicine ,030212 general & internal medicine ,Suicidal ideation ,health care economics and organizations ,Aged ,Veterans ,Suicide attempt ,business.industry ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Middle Aged ,Mental health ,United States ,humanities ,Cross-Sectional Studies ,Cohort ,Housing ,Female ,medicine.symptom ,0305 other medical science ,business ,Demography - Abstract
Background Veterans experiencing housing instability are at increased risk of suicide. Research is needed to identify gender differences in the predictors of both suicidal ideation and suicide attempt, particularly among Veterans who are unstably housed. Objectives The objective of the present study was to explore whether correlates of suicide-related morbidity among unstably housed Veterans vary by gender and identify implications for improved care for these Veterans. Methods The study cohort included 86,325 Veterans who reported current housing instability between October 1, 2013, and September 30, 2016. This cross-sectional study assessed differences in demographic and outcome variables by gender using χ2 analyses and a series of multiple logistic regressions predicting suicidal ideation and suicide attempt, stratified by gender. Results Among unstably housed female Veterans, being younger than 40 years was associated with more than double the odds of having an indicator of suicidal ideation and >12 times the odds of having an indicator of a suicide attempt. The effect sizes associated with age were much less pronounced among unstably housed male Veterans. The presence of mental health and substance use conditions as well as a positive screen for military sexual trauma were associated with increased risk of suicide morbidity among both women and men. Conclusions Intervention and prevention among unstably housed Veterans may be complicated by unpredictable living situations; further research should explore tailored interventions to address the complex needs of unstably housed Veterans and how suicide prevention can be woven throughout.
- Published
- 2021
38. Demographic Correlates of Veterans’ Adverse Social Determinants of Health
- Author
-
John R. Blosnich, Jack Tsai, and Ann Elizabeth Montgomery
- Subjects
Social Determinants of Health ,Epidemiology ,Psychological intervention ,MEDLINE ,Logistic regression ,01 natural sciences ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Health care ,Electronic Health Records ,Humans ,Medicine ,030212 general & internal medicine ,Social determinants of health ,0101 mathematics ,Poverty ,Veterans ,business.industry ,010102 general mathematics ,Public Health, Environmental and Occupational Health ,United States ,United States Department of Veterans Affairs ,Female ,Rural area ,business - Abstract
Introduction Identifying patient populations most affected by adverse social determinants of health can direct epidemiologic investigation, guide development of tailored interventions, and improve clinical care and outcomes. This study explores how demographic characteristics are associated with specific types—and cumulative burden—of adverse social determinants of health among Veterans seeking Veterans Health Administration health care. Methods Data included electronic health records for 293,872 patients of Veterans Health Administration facilities in one region of the country between October 1, 2015 and September 30, 2016. A series of multiple logistic regressions conducted between August and December 2019 examined how demographic variables are associated with 7 adverse social determinants of health. A negative binomial regression examined the association between demographic characteristics and cumulative burden of social determinants of health. Results Demographic characteristics were associated with increased odds of each type of adverse social determinant of health: minority race, unmarried status, and Veterans’ service connected disability status. Conversely, living in a rural area and being aged >40 years were associated with decreased odds of most of the adverse social determinants of health studied here. Hispanic ethnicity and female sex were inconsistently associated with increased odds of some adverse social determinants of health and decreased odds of others. These results are mirrored in the analysis of predictors of cumulative burden of adverse social determinants of health. Conclusions There is increasing and ongoing interest in ways to identify and respond to patients’ experiences of or exposures to adverse social determinants of health. Demographic characteristics may signal the need to assess for adverse social determinants of health. Analyses exploring latent factors among these social determinants (e.g., poverty) may inform strategies to identify patients experiencing adverse social determinants of health and provide responsive interventions.
- Published
- 2020
39. Disparities in Documented Drug Use Disorders Between Transgender and Cisgender U.S. Veterans Health Administration Patients
- Author
-
John R. Blosnich, Jessica A. Chen, Madeline C. Frost, Joseph E Glass, Keren Lehavot, Anna D. Rubinsky, and Emily C. Williams
- Subjects
Male ,medicine.medical_specialty ,Substance-Related Disorders ,Veterans Health ,Logistic regression ,Transgender Persons ,01 natural sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Transgender ,Ethnicity ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,0101 mathematics ,Psychiatry ,Harm reduction ,biology ,business.industry ,010102 general mathematics ,Infant, Newborn ,Gender Identity ,Odds ratio ,biology.organism_classification ,Mental health ,Health equity ,Psychiatry and Mental health ,Female ,Cannabis ,Diagnosis code ,business - Abstract
Objectives Transgender people-those whose gender identity differs from their sex assigned at birth-are at risk for health disparities resulting from stressors such as discrimination and violence. Transgender people report more drug use than cisgender people; however, it is unclear whether they have higher likelihood of drug use disorders. We examined whether transgender patients have increased likelihood of documented drug use disorders relative to cisgender patients in the national Veterans Health Administration (VA). Methods Electronic health record data were extracted for VA outpatients from 10/1/09 to 7/31/17. Transgender status and past-year documentation of drug use disorders (any, opioid, amphetamine, cocaine, cannabis, sedative, hallucinogen) were measured using diagnostic codes. Logistic regression models estimated odds ratios for drug use disorders among transgender compared to cisgender patients, adjusted for age, race/ethnicity and year. Effect modification by presence of ≥1 mental health condition was tested using multiplicative interaction. Results Among 8,872,793 patients, 8619 (0.1%) were transgender. Transgender patients were more likely than cisgender patients to have any drug use disorder (Adjusted Odds Ratio [aOR] 1.67, 95% confidence interval [CI] 1.53-1.83), amphetamine (aOR 2.22, 95% CI 1.82-2.70), cocaine (aOR 1.59, 95% CI 1.29-1.95), and cannabis (aOR 1.82, 95% CI 1.62-2.05) use disorders. There was no significant interaction by presence of ≥1 mental health condition. Conclusions Transgender VA patients may have higher likelihood of certain drug use disorders than cisgender VA patients, particularly amphetamine use disorder. Future research should explore mechanisms underlying disparities and potential barriers to accessing treatment and harm reduction services faced by transgender people.
- Published
- 2020
40. Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012–2016
- Author
-
Melissa E. Dichter, Thomas Byrne, Ann Elizabeth Montgomery, and John R. Blosnich
- Subjects
Suicide mortality ,Social work ,Epidemiology ,Proportional hazards model ,business.industry ,Public Health, Environmental and Occupational Health ,Context (language use) ,Retrospective cohort study ,Suicide prevention ,030227 psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Intervention (counseling) ,Medicine ,030212 general & internal medicine ,business ,All cause mortality - Abstract
Background People without stable housing—and Veterans specifically—are at increased risk of suicide. This study assessed whether unstably housed Veterans’ participation in homeless services is associated with reduced risk of all-cause and suicide mortality. Methods This retrospective cohort study used a sample of 169 221 Veterans across the US who self-reported housing instability between 1 October 2012 and 30 September 2016. Multivariable Cox regression models assessed the association between Veterans’ utilisation of homeless services and all-cause and suicide mortality, adjusting for sociodemographics and severity of medical comorbidities. Results More than one-half of unstably housed Veterans accessed homeless services during the observation period; utilisation of any homeless services was associated with a 6% reduction in hazards for all-cause mortality (adjusted HR[aHR]=0.94, 95% CI[CI]=0.90–0.98). An increasing number of homeless services used was associated with significantly reduced hazards of both all-cause (aHR=0.93, 95% CI=0.91–0.95) and suicide mortality (aHR=0.81, 95% CI=0.73–0.89). Conclusions The use of homeless services among Veterans reporting housing instability was significantly associated with reduced hazards of all-cause and suicide mortality. Addressing suicide prevention and homelessness together—and ensuring ‘upstream’ interventions—within the context of the VHA healthcare system holds promise for preventing suicide deaths among Veterans. Mental health treatment is critical for suicide prevention, but future research should investigate if social service programmes, by addressing unmet human needs, may also reduce suicide.
- Published
- 2020
41. 'If I Had Access to a Gun, I Think I Would Have Used it Instead': Motivations for Method Choice Among Sexual and Gender Minority Adults Who Made a Recent Near-Fatal Suicide Attempt
- Author
-
Kirsty A. Clark and John R. Blosnich
- Subjects
Adult ,Psychiatry and Mental health ,Motivation ,Sexual and Gender Minorities ,Short Reports ,Urology ,Sexual Behavior ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Gender Identity ,Humans ,Suicide, Attempted ,Dermatology - Abstract
PURPOSE: We examined motivations for suicide attempt method choice among sexual and/or gender minority (SGM) adults who attempted suicide in the previous 18 months. METHODS: Individual semistructured interviews (N = 22) explored participants' motivations. RESULTS: Five reasons influenced method choices: accessibility, perceived lethality, familiarity, not having access to a firearm, and concerns about pain and violence involved with other methods. CONCLUSION: Methods of suicide attempt are critical for informing SGM suicide prevention efforts. Future research should investigate whether and how lethal means restriction efforts are implemented within the contexts in which SGM people live and obtain mental health care (e.g., SGM community centers).
- Published
- 2022
42. Moral injury and chronic pain in veterans
- Author
-
Rachel M. Ranney, Shira Maguen, Paul A. Bernhard, Nicholas Holder, Dawne Vogt, John R. Blosnich, and Aaron I. Schneiderman
- Subjects
Male ,Stress Disorders, Post-Traumatic ,Psychiatry and Mental health ,Humans ,Female ,Myalgia ,Chronic Pain ,Arthralgia ,Biological Psychiatry ,Veterans - Abstract
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.
- Published
- 2022
43. Training Death Investigators to Identify Decedents’ Sexual Orientation and Gender Identity: A Feasibility Study
- Author
-
John R. Blosnich, Barbara A. Butcher, Maggie G. Mortali, Andrew D. Lane, and Ann Pollinger Haas
- Subjects
Male ,Gender identity ,Sexual Behavior ,education ,Gender Identity ,Article ,Pathology and Forensic Medicine ,Identification (information) ,Sexual and Gender Minorities ,Surveys and Questionnaires ,Sexual orientation ,Relevance (law) ,Feasibility Studies ,Humans ,Female ,Psychology ,Clinical psychology - Abstract
There is growing impetus within mortality surveillance to identify decedents’ sexual orientation and gender identity (SOGI), but key personnel to this effort (e.g., death investigators) are not currently trained to collect SOGI information. To address this gap, we developed a training for death investigators on this topic and tested its feasibility with 114 investigators in three states. Participants completed pre- and post-training questionnaires that measured four perceived outcomes: training relevance, success of delivery, adequacy for future use, and likelihood of future use. Overall, strongly positive responses affirmed the training’s relevance, success of delivery, and adequacy for future use. Responses about attempting to identify the decedent’s sexual orientation and gender identity in future cases were not quite as positive, with close to 80%) of participants saying they were at least “somewhat likely” to collect this information. Despite design limitations, the study results support the feasibility of training death investigators to gather SOGI information. Although not systematically assessed in the study, investigators’ positive endorsement of training outcomes appeared higher in training sites where leadership strongly supported SOGI identification, suggesting the role of leadership may be key to encouraging SOGI identification among death investigators.
- Published
- 2022
44. Association between clinically recognized suicidality and subsequent initiation or continuation of medications for opioid use disorder
- Author
-
Madeline C. Frost, Julie E. Richards, John R. Blosnich, Eric J. Hawkins, Judith I. Tsui, E. Jennifer Edelman, and Emily C. Williams
- Subjects
Pharmacology ,Analgesics, Opioid ,Psychiatry and Mental health ,Suicide ,Opiate Substitution Treatment ,Humans ,Pharmacology (medical) ,Toxicology ,Opioid-Related Disorders ,Methadone ,Buprenorphine ,Suicidal Ideation - Abstract
Among individuals with opioid use disorder (OUD), medications for OUD (MOUD) may lower suicide risk. Therefore, it is important that individuals with OUD and suicidality receive MOUD. This study examined associations between clinically recognized suicidality and subsequent initiation or continuation of MOUD among patients with OUD in the national Veterans Health Administration (VA).Electronic health record data were extracted for outpatients with OUD who received VA care 10/1/2016-7/31/2017. Suicidality was measured using diagnostic codes for suicidal ideation/attempt and patient record flags. Analyses were conducted separately among patients without prior-year MOUD receipt to examine MOUD initiation, and with prior-year MOUD receipt to examine MOUD continuation. Poisson regression models estimated likelihood of MOUD receipt in the following year for patients with prior-year suicidality relative to those without. Models were adjusted for sociodemographic and clinical characteristics.Among 20,085 patients with no prior-year MOUD, 12% had suicidality and 12% received MOUD in the following year. Suicidality was positively associated with MOUD initiation (adjusted incidence rate ratio [aIRR]: 1.15, 95% confidence interval [CI]: 1.04-1.28). Among 10,162 patients with prior-year MOUD, 9% had suicidality and 84% received MOUD in the following year. Suicidality was negatively associated with MOUD continuation (aIRR: 0.95, 95% CI 0.91-0.98).Among VA patients with OUD, clinically recognized suicidality may increase likelihood of MOUD initiation but decrease likelihood of continuation. Efforts to increase initiation overall and to support retention for patients with suicidality are needed.
- Published
- 2022
45. Tailored Recruitment Strategies among Transgender and Non-Transgender Veterans: Participants’ Perceptions and Response
- Author
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Kristina L. Hruska, Keri L. Rodriguez, Gloria J. Klima, Ann Elizabeth Montgomery, Taylor L Boyer, Jillian C. Shipherd, John R. Blosnich, Jesse K. Vazzano, and Michael R. Kauth
- Subjects
050103 clinical psychology ,medicine.medical_specialty ,Data collection ,business.industry ,media_common.quotation_subject ,05 social sciences ,Veterans health ,030227 psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Perception ,Family medicine ,Health care ,Transgender ,medicine ,0501 psychology and cognitive sciences ,Transgender Person ,Psychology ,business ,General Psychology ,Social Sciences (miscellaneous) ,media_common ,Qualitative research - Abstract
Primary data collection is imperative for understanding the health care experiences of transgender veterans to ensure equitable care. However, it is unclear how to best engage transgender individua...
- Published
- 2020
46. Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas
- Author
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John R. Blosnich, Vickie M. Mays, Susan D. Cochran, and Kirsty A. Clark
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Adult ,Male ,Firearms ,Adolescent ,Suicide prevention ,Behavioral Risk Factor Surveillance System ,Sexual and Gender Minorities ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Transgender ,Humans ,030212 general & internal medicine ,Minority status ,Aged ,030505 public health ,Gender identity ,Suicide attempt ,Research ,Public Health, Environmental and Occupational Health ,Middle Aged ,Socioeconomic Factors ,Sexual orientation ,Female ,Lesbian ,0305 other medical science ,Psychology ,Clinical psychology - Abstract
Objectives Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. Methods We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. Results Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. Conclusions Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
- Published
- 2020
47. Association Between Registered Sex Offender Status and Risk of Housing Instability and Homelessness among Veterans*The contents of this article do not necessarily represent the views of the Department of Veterans Affairs or the US government
- Author
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Stephen Metraux, Thomas Byrne, D. Keith McInnes, Meagan Cusack, John R. Blosnich, Dennis P Culhane, Ann Elizabeth Montgomery, Emmett Culhane, and John Cashy
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030505 public health ,Recidivism ,business.industry ,Sex offender ,050901 criminology ,05 social sciences ,Logistic regression ,humanities ,Confidence interval ,Odds ,03 medical and health sciences ,Clinical Psychology ,Increased risk ,Cohort ,Medicine ,Residence ,0509 other social sciences ,0305 other medical science ,business ,health care economics and organizations ,Applied Psychology ,Demography - Abstract
Research is limited about whether and to what extent registered sex offenders (RSOs) face an increased risk of housing instability. The intersection of RSO and housing instability is particularly salient for veterans as there are disproportionately higher rates of veterans among both RSOs and homeless populations. This study assessed the relationship between RSO status and risk of housing instability and homelessness among military veterans. We matched a list of 373,774 RSOs obtained from publicly available sex offender registries in 19 states with a cohort of 5.9 million veterans who responded to a brief screening for housing instability administered throughout the Veterans Health Administration between 2012 and 2016. Logistic regression estimated adjusted odds of any housing instability and homelessness among veterans identified as RSOs. Veterans identified as RSOs had 1.81 (95% confidence interval [CI] 1.46–2.25) and 2.97 (95% CI 1.67–5.17) times greater odds of reporting any housing instability and homelessness, respectively, than non-RSOs. Findings represent some of the strongest evidence to date for the high risk of housing instability and homelessness among RSOs, suggesting a clear gap in policy and programmatic responses to their unique housing needs. Evidence-based alternative approaches to residence restriction laws may reduce recidivism and protect public safety.
- Published
- 2020
48. Examining veteran housing instability and mortality by homicide, suicide, and unintentional injury
- Author
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Melissa E. Dichter, Thomas Byrne, John R. Blosnich, Ann Elizabeth Montgomery, John Cashy, and Meagan Cusack
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body regions ,Unintentional injury ,medicine.medical_specialty ,Homicide ,business.industry ,medicine ,Homicide suicide ,Retrospective cohort study ,Psychiatry ,business ,health care economics and organizations ,humanities ,Social Sciences (miscellaneous) - Abstract
To examine the relationship between Veterans’ housing instability and mortality by homicide, suicide, and unintentional injury, this retrospective study examined administrative data from Veterans H...
- Published
- 2020
49. Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults
- Author
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Susan M. De Luca, Megan C. Lytle, Chris Brownson, and John R. Blosnich
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Adult ,Male ,Adolescent ,Sexual Behavior ,Poison control ,Suicide prevention ,Suicidal Ideation ,Odds ,Sexual and Gender Minorities ,Young Adult ,medicine ,Humans ,Young adult ,Heterosexuality ,Suicidal ideation ,Public Health, Environmental and Occupational Health ,Sexual minority ,Psychiatry and Mental health ,Clinical Psychology ,Cross-Sectional Studies ,Sexual orientation ,Bisexuality ,Female ,medicine.symptom ,Lesbian ,Psychology ,Clinical psychology - Abstract
Objective To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. Method This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18-29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. Results Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97-5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. Conclusions Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.
- Published
- 2020
50. Response Variations to Survey Items About Firearms in the 2004 and 2017 Behavioral Risk Factor Surveillance System
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John R. Blosnich, Elizabeth Karras, and Robert M. Bossarte
- Subjects
Adult ,Male ,Firearms ,Health (social science) ,Idaho ,Behavioral Risk Factor Surveillance System ,Oregon ,03 medical and health sciences ,0302 clinical medicine ,Public health surveillance ,Surveys and Questionnaires ,Utah ,Environmental health ,Humans ,030212 general & internal medicine ,030505 public health ,Public Health, Environmental and Occupational Health ,Kansas ,Middle Aged ,Texas ,United States ,Cross-Sectional Studies ,Health survey ,Female ,0305 other medical science ,Psychology - Abstract
Purpose: The aim of this investigation was to document the prevalence and correlates of refusing to answer a US federal health survey item about firearms in the household. Design: The cross-sectional analysis was conducted with 2004 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data from Texas, Oregon, Idaho, California, Kansas, and Utah states whose surveys included items about firearms in the household. Participants: Probability-based samples of adults over the age of 18 (n = 34 488 in 2017 BRFSS; n = 33 136 in 2004 BRFSS). Measures: Dichotomized measure of whether respondents answered versus refused to answer “Are any firearms now kept in or around your home?” Analysis: Weighted multiple logistic regression was used to assess how sociodemographic and health-related characteristics were associated with item refusal. Results: Approximately 1.8% (95% CI: 1.6-2.1) of respondents in 2004 and 3.9% (95% CI: 3.4-4.5) of respondents in 2017 sample refused the firearms item ( P < .01). Men were more likely than women (2004: adjusted odds ratio [aOR] = 1.81, 95% CI: 1.24-2.62; 2017: aOR = 1.60, 95% CI = 1.17-2.18) and Latino/a respondents were less likely than white respondents (2004: aOR = 0.24, 95% CI: 0.10-0.60; 2017: aOR = 0.21, 95% CI: 0.13-0.34) to refuse the firearms question. In 2004, refusal was more likely among older than younger respondents, but in 2017, age was not associated with refusal. Conclusions: Refusal to firearm-related survey items along sociodemographic characteristics warrants further research. Community-informed strategies (eg, focus groups, cognitive testing, in-depth interviews) could improve the context and wording of firearm-related items to maximize response to these items in public health surveys.
- Published
- 2020
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