Search Results (31)

Background: Canada’s Prairie Provinces have become a focal point for contentious educational policy debates. Saskatchewan’s Bill 137 (2023) and Alberta’s Education Amendment Act, 2024 (Bill 27) enacted sweeping restrictions on sexual health education and 2SLGBTQ+ student identity recognition, framed as ‘parental rights’. Manitoba maintains a rights-affirming, inclusive framework grounded in the Public Schools Act. This policy divergence has direct implications for students’ mental health, sexual health literacy, and equity. We conducted a systematic document search of official government websites of three Prairie Provinces (Alberta, Saskatchewan, Manitoba) and four major school boards, selected by size and demographic diversity: the Calgary Board of Education (CBE), Edmonton Public Schools (EPSB), Regina Public Schools (RPS), and the Winnipeg School Division (WSD). Searches were conducted in May 2026. The Intersectionality-Based Policy Analysis (IBPA) framework guided structured content analysis across three categories: (1) 2SLGBTQ+ recognition and affirming policy; (2) sexual health accessibility provisions; and (3) culturally responsive and EDI-consistent care. Documents were coded as ‘Yes’, ‘No’, or ‘Not Reported’ for each sub-category. The search yielded 56 documents; 34 met the inclusion criteria (20 provincial, 16 school board). The Alberta (n = 5) and Saskatchewan (n = 6) provincial documents were dominated by restrictive legislation: Bill 27 shifts sexual health education to an opt-in model, with ministerial vetting of all SOGI materials; Bill 137 bans third-party sexual health educators entirely and mandates parental consent for pronoun use, pre-emptively invoking the notwithstanding clause. Manitoba’s nine provincial documents (n = 8) reflect an affirmative legislative framework: 100% explicitly affirm 2SLGBTQ+ students, 100% cite human rights frameworks, and 78% maintain community health partnerships. At the school board level, EDI-consistent provisions were the strongest in the EPSB (n = 5) and WSD (n = 4), which have standalone SOGIE policies and active equity frameworks. The CBE (n = 3) retains affirming guidelines while implementing provincial opt-in requirements. The RPS (n = 3) maintains AP 353 on Gender and Sexual Diversity. Only two provincial documents (11%), both from Manitoba, explicitly referenced sexual health community partnerships; zero Alberta or Saskatchewan provincial documents did so post-2023. The structural divergence between provinces is stark. The Alberta and Saskatchewan policies render 2SLGBTQ+ students structurally vulnerable through opt-in exclusion, compel parental disclosure, and eliminate community health expertise from classrooms. Manitoba’s model demonstrates that EDI-consistent, rights-affirming sexual health policy is legislatively achievable. Urgent systemic reform is required to restore affirming care, reinstate community partnerships, and reverse opt-in models that deny students access to evidence-based sexual health education. Full article

Background/Objectives: Coaches substantially influence athletes’ psychological well-being, yet the specific strategies they use to enhance happiness remain insufficiently understood. Given the established contribution of happiness to motivation, resilience, and long-term sport engagement, identifying these strategies and the perceptual patterns underlying them is essential. This study examined coaches’ subjective viewpoints regarding happiness-oriented strategies and identified the psychosocial orientations that structure these perspectives. Methods: Q methodology was applied using a 30-item Q set developed from interviews and expert review. Thirty professional coaches (≥5 years of experience) ranked the items according to perceived importance. By-person factor analysis and z-score interpretation were used to derive shared viewpoints. Results: Two coherent factors emerged. Factor 1 (59% variance) reflected a group-oriented psychosocial support approach, emphasizing team cohesion, positive feedback, social support, and mental resilience. Factor 2 (9% variance) represented an individual-centered, empathy-driven orientation, characterized by value affirmation, personalized communication, and emotional sensitivity. Distinct z-score patterns underscored clear contrasts between collective and individualized strategies. Conclusions: Coaches promote athlete happiness through two complementary orientations: collective psychosocial support and individualized psychological sensitivity. These findings extend self-determination theory and positive psychology by demonstrating how relatedness, competence, and individualized care are operationalized within coaching practice. The results offer practical guidance for integrating well-being into coach education and organizational policies. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Background/Objectives: Persistent inequities in healthcare experiences and outcomes among marginalized racial/ethnic groups and sexual and gender minority (SGM) populations have been well documented. However, disparities in perceptions of discrimination and bias between patients and health providers remain insufficiently understood. This review synthesizes the current evidence on how these groups differently perceive discrimination, how bias manifests in clinical encounters, and how intersecting identities shape healthcare experiences. Methods: A comprehensive review using SANRA guidelines examined racial/ethnic discrimination, SGM-related bias, provider implicit attitudes, minority stress processes, and structural determinants of inequity in healthcare settings. Articles were identified through systematic search strategies across major databases, and their conceptual, methodological, and theoretical contributions were analyzed. Results: Across studies, marginalized patients consistently reported discrimination, stigma, and mistrust in healthcare, whereas providers often underestimated the prevalence and impact of these experiences. Evidence indicates that implicit pro-White biases among providers influence communication quality, clinical decision-making, and patient comfort. Structural racism and intersecting minority statuses further compound disparities, contributing to delayed care, unmet health needs, and poorer outcomes. Limited alignment between patient and provider perceptions suggests a gap in recognition of inequitable treatment and its drivers. Conclusions: Healthcare inequities arise from interconnected, interpersonal, and structural mechanisms. Addressing these disparities requires multilevel interventions targeting provider training, institutional policy reform, and system-level barriers. Integrating both patient and provider perspectives is essential for developing equitable, affirming models of care and improving health outcomes for racial/ethnic and SGM populations. Full article

This study delves into the necessity for gender-affirming practices, particularly focusing on the underrepresented transgender and non-binary communities in California’s Central Valley. Despite the recognized standards by the World Professional Association for Transgender Health (WPATH) for best practices in mental health care, adequately trained professionals in this region remains a notable scarcity. The paper highlights the heightened risks these communities face, including discrimination and mental health challenges, underscoring the critical need for compassionate and competent care. The research aims to bridge the gap in education and training for practitioners on gender diversity and improve mental health services for transgender and non-binary individuals. Through thematic analysis of individual interviews, the study captures the experiences of gender diverse individuals with behavioral health care, emphasizing the importance of gender-affirming care, the dangers of pathologizing gender diversity, and the adverse impacts of gatekeeping and conversion therapy. Conclusively, the study advocates for an informed consent model for medical transitions, as per WPATH guidelines, and calls for a shift towards intersectional, inclusive practices. It stresses the need for ongoing education, policy reform, and advocacy to ensure equitable, affirming mental health care for gender diverse populations. Full article

Background: Gender-diverse populations in India, including transgender and non-binary individuals, experience systemic barriers to healthcare, with dentistry remaining particularly underexplored. Despite legislative protections, oral health professionals (OHPs) often lack the knowledge, sensitivity, and preparedness needed to provide inclusive care. This study aimed to benchmark gender sensitivity, inclusivity, and clinical preparedness of Indian OHPs using the novel Oral Healthcare Professional’s Gender Sensitivity, Inclusivity, and Preparedness (OHP–GSIP ©) tool. Methods: A descriptive cross-sectional survey was conducted among 3660 registered dental practitioners across six zones of India using probability proportional to size sampling. The prevalidated OHP–GSIP © scale assessed five domains: gender sensitivity, inclusive environments, diversity in practice, professional attitudes, and preparedness for transgender oral healthcare. Data were collected through a structured online questionnaire and analyzed with SPSS 17.0 using descriptive statistics, chi-square tests, correlation matrices, and multiple regression. Results: Participants demonstrated moderate LGBTQIA+ knowledge (mean = 6.52/10, SD = 1.78) and comfort in treating transgender patients (mean = 3.81/5, SD = 1.09). Structural inclusivity was limited: only 23.5% reported gender-neutral restrooms, and 17.5% used non-binary intake forms. Over 90% expressed willingness to employ or collaborate with transgender colleagues, though this did not significantly predict clinical comfort. Regression analysis showed inclusivity in practice (β = 0.38, p < 0.001), awareness of gender-affirming clinics (β = 0.29, p < 0.001), and LGBTQIA+ knowledge (β = 0.22, p < 0.001) as the strongest predictors of comfort in treating transgender patients, collectively explaining 41% of the variance. Conclusion: While Indian OHPs displayed generally supportive attitudes toward transgender individuals, substantial gaps persist in structural inclusivity, clinical preparedness, and knowledge. Bridging these gaps requires systemic reforms in dental education, policy, and practice environments. The OHP–GSIP © tool provides a benchmark for guiding curricular integration, institutional inclusivity, and policy advocacy toward equitable, gender-affirming oral healthcare. Full article

Background: Given the healthcare challenges older people and people who identify as LGBTQ+ are faced with, it becomes critical to explore how older transgender individuals experience discrimination in healthcare settings. Objectives: We followed the PRISMA guidelines for scoping reviews to map existing literature, and identify key themes, specific to transgender adults aged 65 and older and how they experience discrimination in healthcare. Eligibility criteria: This scoping review explored studies that focused on discrimination against transgender people older than 65 in any healthcare settings, which were published in English in the last twenty years. Sources of evidence: Evidence was extracted from Scopus, ProQuest Central, Health & Medical Collection, PubMed, CINAHL, Medline, and Psychology and Social Sciences databases. Charting methods: We used streams of search with specific keywords. Two researchers were involved in the screening of articles, coding and analysis. Results: The search showed that research focusing on transgender people older than 65 and discrimination in healthcare was rather limited. The findings revealed that older transgender individuals frequently anticipated or experienced discrimination in healthcare settings, resulting in service avoidance and adverse health outcomes. Despite sometimes reporting lower overt discrimination than younger cohorts, older trans people faced comparable levels of victimization, compounded by age-related vulnerabilities and socioeconomic marginalization. Structural barriers, such as misaligned documentation, lack of provider competence, and financial constraints, further hindered access to healthcare. However, the presence of empathetic, culturally competent providers and access to LGBTQ+-specialized services might improve care engagement and outcomes. Conclusions: This review concluded that targeted policy reforms, inclusive clinical practices, and community-based support systems were essential to address these disparities. It called for greater institutional accountability and interdisciplinary research to ensure safe, affirming, and equitable healthcare for aging transgender populations. Full article

Background/Objectives: Robust, state-level LGBTQ+ health surveillance is scarce in Kentucky, limiting evidence-based healthcare planning and policy. We aimed to evaluate the feasibility and early public-health utility of a community-partnered annual survey and compare selected mental health stressors between Kentucky and non-Kentucky respondents. Methods: We conducted a cross-sectional online survey (13 April–15 July 2024) developed with a statewide LGBTQ+ nonprofit. Recruitment occurred via organizational channels and community events. A content warning preceded the survey, which was administered via Qualtrics. Data quality was screened using reCAPTCHA. We assessed feasibility metrics including recruitment and completion rates. Mental health stressors were captured with a six-item scale. Group differences were estimated with Welch’s t-tests. Results: Of 3852 survey starts, 1559 were retained as analyzable completes (completion rate: 40.47%), with 78.7% residing in-state. Initial analysis revealed a significant divergence in mental health patterns: while Kentucky participants reported lower stress regarding their personal mental health, they reported significantly higher stress stemming from socio-political issues like homophobia and transphobia compared to out-of-state respondents. Conclusions: An annual, community-partnered surveillance platform is a feasible strategy for generating actionable mental health signals relevant to healthcare. These findings will inform targeted outreach and guide health system partnerships to enhance LGBTQ+-affirming care in Kentucky. Full article

The persistence of a binary biomedical framework in healthcare has become increasingly inadequate to address the realities of human diversity. Recent literature highlights how this dichotomous model reinforces inequities for transgender and intersex populations, sustaining barriers to access, stigmatisation, and poorer health outcomes. In this Perspective, I critically reflect on the limitations of the binary paradigm and draw on developments in science, clinical practice, education, and policy to propose a future-oriented approach to health equity. Emerging evidence underscores the complexity of sexual development as a spectrum and the urgent need to move from pathological frameworks toward affirming care based on rights. Key advances include the adoption of affirmative care models, reforms in medical curriculum, and the rise of inclusive research methodologies that capture gender diversity beyond binaries. However, structural barriers—such as rigid clinical protocols, outdated educational content, and insufficient policy alignment—continue to hinder meaningful change. This article advocates for systemic transformation in healthcare education, practice, and research. I outline strategic priorities for the field are the implementation of gender diversity in medical training, the implementation of rights-based clinical guidelines, and the design of inclusive methodologies that remove structural discrimination. These actions are essential to build a more precise, ethical and universally inclusive health system. Ultimately, ensuring sustainable and equitable outcomes requires bridging scientific innovation with human rights principles and focussing on the lived experiences of transgender and intersex individuals. Full article

Transitions from care into adulthood are often a shift from dependence to independence. Yet for care-experienced individuals, this process is neither linear nor complete at a predetermined age. Despite progressive Scottish policies—such as The Promise—many still face unequal access to support. This article explores how structural and relational scaffolding can transform outcomes. Drawing on the lived and professional knowledge of three care-experienced authors, it examines how language, relationship-based practice, and support influence definitions of success. Reframing care experience as lifelong challenges systems to provide enduring, person-centered support. While research affirms the importance of responsive scaffolding, few studies center the voices of care-experienced adults in defining what effective support looks like. This article addresses that gap by placing care-experienced authors not as subjects, but as analysts and advocates. The article is based on a collaborative, care-informed reflective process. The authors adapted the Gibbs Reflective Cycle to suit a trauma-aware and relational approach. Their reflections are not anecdotal—they are critically analyzed, thematically structured, and used as evidence to interrogate systems and propose alternatives. Key findings highlight the importance of sustained relational practice, responsive educational support, and recognizing care experience as lifelong. Full article

Black Canadians are one of the fastest-growing groups in Canada, with 59% of this population comprising immigrants. Ongoing systemic racism and discrimination have serious consequences for the mental health of Black Canadians. While research and policy efforts to address the mental health needs of this population are ongoing, a greater understanding of the healing practices relevant to this diverse population is needed. This scoping review synthesized and discussed key features of culturally inclusive, affirming, and contextually relevant approaches and practices for mental health care and healing with Black Canadians, as well as identified limitations and gaps in the current research. This study followed the PRISMA guidelines for scoping reviews and conducted a search in PsycINFO, MEDLINE, Embase, SocINDEX, CINAHL, Sociological Abstracts, and Global Health in October 2023. A total of 34 articles met the inclusion criteria. The review identified that most studies were conducted in one Canadian province (i.e., Ontario) and involved diverse perspectives, including service users and providers. The thematic review of articles revealed limited research regarding specific interventions, but identified many commonly reported features of culturally and contextually relevant approaches to mental health care and healing for Black Canadians that broaden the scope of mental health care beyond Euro-Western clinical models, including taking a holistic and empowerment-based approach, engaging in culturally affirming care, a social justice approach, community-centred and collaborative healing, and the necessity of practitioner education. Recommendations for practice, policy, education, and research are provided to support more inclusive and responsive mental health care systems for Black Canadians. Full article

This study explores how Black student leaders (BSLs) at public historically white institutions (HWIs) in Florida and Georgia navigate racial battle fatigue (RBF) in the context of anti-DEI legislation. Amid rising political hostility toward diversity, equity, and inclusion (DEI) efforts, this research examines the lived experiences of 11 BSLs as they respond to racialized campus climates that are increasingly ambiguous and unsupportive. Using a critical qualitative approach, data were collected through two in-depth interviews per participant and analyzed using inductive and deductive coding. Four major findings emerged: (1) BSLs experience heightened psychological, physiological, and emotional forms if stress linked to their identity and leadership roles; (2) anti-DEI policies contribute to institutional erasure and confusion; (3) students express emotional withdrawal, hypervigilance, and disillusionment with performative leadership; (4) students employ culturally grounded coping strategies centered on self-care, spirituality, and community. This study underscores that BSLs are both empowered and burdened by their leadership, especially under politically restrictive conditions. The findings call for student affairs educators to prioritize engagement and belonging and offer identity-affirming support. Further, scholars with academic freedom are urged to continue documenting racialized student experiences. These insights are critical to protecting Black student leadership and equity-centered educational transformation. Full article

Background: Cardiovascular disease remains a leading cause of preventable mortality in the United States, with rural counties in the Deep South experiencing disproportionately high burdens. Grounded in the Andersen healthcare utilization model, this study examined how enabling resources, predisposing characteristics, and access-related barriers relate to coronary heart disease (CHD) prevalence and mortality. Methods: This ecological analysis included 418 counties across Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Using Local Indicators of Spatial Association (LISA) and multivariable linear regression, we tested three theory-based hypotheses and assessed the spatial clustering of CHD outcomes, while identifying key structural and sociodemographic predictors. Results: Counties with greater rurality and fewer healthcare providers exhibited significantly higher rates of CHD prevalence and mortality. Primary care provider availability and higher household income were protective factors. Digital exclusion, measured by lack of access to computers or mobile devices, was significantly associated with higher CHD prevalence and mortality. Spatial analysis identified the counties with better-than-expected cardiovascular outcomes despite structural disadvantages, suggesting the potential role of localized resilience factors and unmeasured community-level interventions. Conclusions: The findings affirm the relevance of the Andersen model for understanding rural health disparities and highlight the importance of investing in both digital infrastructure and healthcare capacity. Expanding telehealth without addressing provider shortages and social determinants may be insufficient. Local policy innovations and community resilience mechanisms may offer scalable models for improving cardiovascular health in disadvantaged areas. Full article

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care. Full article

Research on access to healthcare for transgender populations in California remains mostly focused on the major city centers, leaving out many rural and poorer areas of the state. Understanding the barriers to gender-affirming healthcare in a largely rural, agricultural, and low-income area is critical in creating effective policies and programs to address significant gaps in transgender healthcare. This is especially true in regions like Fresno County, which sits within the heart of the Central Valley of California, that are mostly rural and agricultural. This study conducted a community health assessment using a mixed-methods approach, focusing on transgender communities’ experience of accessing healthcare and gender-affirming healthcare in Fresno County and on the various existing barriers and critical needs. The study reveals the critical deficits in accessing gender-affirming healthcare in Fresno County, especially regarding doctors providing gender-affirming care, as well as the larger implications this has on the health and well-being of transgender individuals living in the Central Valley. Full article