Transgender and nonbinary (TNB) people in the U.S. navigate significant employment and economic inequities. Gaps in knowledge about their workplace experiences limit our broader understanding of how social inequality is interactionally constructed through employment contexts. We conducted and analyzed interviews with 26 TNB young adults. Routine hiring processes and structural constraints made participants vulnerable to interactional stigmatization and subsequent discrimination, with deleterious consequences for employment as well as mental health. Participants deployed a variety of strategies to avoid or resist anticipated stigma, including exiting the workforce or changing careers. One's ability to avoid stigmatization at work was partially shaped by structural and managerial support, organizational form, and one's gender and gender conformity. Beyond contributing to economic inequality by limiting job and career options, our findings suggest that these social processes comprise minority stressors that diminish the well-being of TNB participants and exacerbate their economic marginalization. In contributing empirical insight into the experiences of TNB people, we demonstrate the salience of stigmatization and stigma avoidance strategies for social closure within organizations and thereby advance sociological understanding of the relational generation of inequality at work.

The most constant physical feature of women with Turner syndrome (TS) is that they are short.However, women with TS usually have other problems as well—estrogen deficiency, pubertal delay, and infertility. All of these are secondary to a chromosomal abnormality. Although TS in children has been quite carefully studied, the effects of these difficulties on adult psychological adjustment are largely unknown.

Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14–19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females ( n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5–12 peer-authored quotes. We inserted the final images into Instagram®. Additional females ( n = 39) found the images “relatable,” “super-realistic,” and “educational.” Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.

Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user‐informed, theory‐based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED.

Purpose: Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). Methods: We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). Results: We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation f 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). Conclusions: Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females. (C) 2020 Society for Adolescent Health and Medicine. All rights reserved.

The question of the role of prenatal sex hormones in human psychosexual differentiation originated in the clinical context of intersexuality and its management problems. Sex hormones affect the size of certain cell clusters, shapes of dendritic trees, and types of synapses; such sex-dimorphic structures have been localized in several areas of the brain, particularly in the hypothalamus and the preoptic area. The use of sex hormones in the treatment of problem pregnancies was first introduced in the 1940s, after it had become known that successful initiation as well as maintenance of pregnancy depended, on hormones produced by the mother as well as by the feto-placental unit. Thus, the available observations suggest that prenatal sex hormones contribute to the development of behavioral differences between the sexes in general as it has been demonstrated in animal research. The tendencies are likely to facilitate or inhibit certain behavior effects of the sex-typing pressures that the developing individual encounters in the social environment.

In the United States, ~1.4 million individuals identify as transgender. Many transgender adolescents experience gender dysphoria related to incongruence between their gender identity and sex assigned at birth. This dysphoria may worsen as puberty progresses. Puberty suppression by gonadotropin-releasing hormone agonists (GnRHa), such as leuprolide, can help alleviate gender dysphoria and provide additional time before irreversible changes in secondary sex characteristics may be initiated through feminizing or masculinizing hormone therapy congruent with the adolescent’s gender experience. However, the effects of GnRH agonists on brain function and mental health are not well understood. Here, we investigated the effects of leuprolide on reproductive function, social and affective behavior, cognition, and brain activity in a rodent model. Six-week-old male and female C57BL/6J mice were injected daily with saline or leuprolide (20 μg) for 6 weeks and tested in several behavioral assays. We found that leuprolide increases hyperlocomotion, changes social preference, and increases neuroendocrine stress responses in male mice, while the same treatment increases hyponeophagia and despair-like behavior in females. Neuronal hyperactivity was found in the dentate gyrus (DG) of leuprolide-treated females, but not males, consistent with the elevation in hyponeophagia and despair-like behavior in females. These data show for the first time that GnRH agonist treatment after puberty onset exerts sex-specific effects on social- and affective behavior, stress regulation, and neural activity. Investigating the behavioral and neurobiological effects of GnRH agonists in mice will be important to better guide the investigation of potential consequences of this treatment for youth experiencing gender dysphoria.

Over 18 million adolescents use the emergency department (ED) each year. High risk of unintended pregnancy is associated with frequent use of the ED and lack of a primary care provider, making the ED visit an important potential site for intervention. With few adolescent preventive health interventions being implemented and evaluated in the ED setting, the description of the rigorous development of an ED-based pregnancy prevention intervention can guide future adolescent emergency medicine researchers. The objective of this study is to describe a systematic approach, intervention mapping, to develop a theory-based, user-informed, digital intervention aiming to increase contraception use among adolescent female ED patients at high risk of unintended pregnancy. We followed the 6 iterative steps of intervention mapping to create a blueprint for designing, implementing, and evaluating an ED-based, digital, pregnancy prevention intervention: (1) Developed a Logic Model of the Problem—teen pregnancy in the ED setting—based on a needs assessment; (2) Stated the outcomes and objectives of our intervention via a Logic Model of Change, including our theoretical framework; (3) Developed the pregnancy prevention curriculum and plan, including the digital strategy and brand; (4) Produced the intervention, including designing the branched-logic texting algorithms, website, videos, and cartoons; (5) Planned program use, such as implementation strategies in the ED setting; and (6) Developed an evaluation plan. Using the process of intervention mapping, we developed Dr. Erica (Emergency Room Intervention to improve the Care of Adolescents). Dr. Erica is a relatable, empathetic, straightforward and reliable virtual female doctor who sends 10 weeks of personalized and interactive evidence-based text messages that aim to promote healthy sexual behaviors and decrease teen pregnancy risk. Texts are based on key stakeholder input, participatory design, and the Social Cognitive Theory as well as incorporate social media, relatable characters and Motivational Interviewing techniques. Following the outline of intervention mapping led to the development of a theory-based, user-informed, digital pregnancy prevention intervention. Outlining this method may be helpful to future investigators interested in designing and evaluating adolescent preventive health interventions in both the acute and outpatient setting.

Transgender and gender non-conforming (TGNC) people have gained visibility in public discourse leading to greater awareness, understanding, and social change. However, progress made in policies to combat stigma and improve public accommodation and healthcare for this minority population has been targeted for reversal, particularly since the 2016 presidential election. This study investigated the impact of changes in sociopolitical climate on perceptions of vulnerability and resilience among participants of a longitudinal study of transgender identity development. We randomly selected 19 TGNC participants in New York, San Francisco, and Atlanta and conducted in-depth interviews about their perceptions of societal progress and setbacks, community engagement, and desired future change. The participants ranged in age from 18 to 68; half (47.4%) identified their gender identity along the feminine spectrum (male assigned at birth) and the other half (52.6%) along the masculine spectrum (female assigned at birth). Content analysis revealed that greater media visibility was perceived as both positive (improved awareness of needs) and negative (increased vulnerability to stigma). Setbacks included concerns about personal safety, the safety of others (particularly those with multiple stigmatized identities), healthcare access, and policies regarding public accommodation and non-discrimination protections. Coping strategies included social support, activism and resistance, and an enduring sense of optimism about the future. TGNC Americans, in spite of a long history of adversity, are resilient. The participants demonstrated unwavering motivation to create a better future for themselves, other minorities, and society. Research is needed to quantify the impact of policy changes on health and well-being and identify moderators of resilience amenable to intervention.

Purpose: Personalized and interactive text messaging interventions may increase participant engagement; yet, how to design messages that retain adolescent attention and positively affect sexual health behaviors remains unclear. The purpose of this study was to identify the characteristics of sexual health text messages perceived as engaging by sexually active adolescent females. Methods: We conducted semistructured, open-ended interviews with sexually active females aged 14-19 in one urban emergency department. Participants received automated sexual health information sent via an interactive, two-way texting format. The 343 messages viewed by participants were based on key stakeholder input, relevant theoretical models, and existing evidence-based guidelines. Interviews elicited feedback. Enrollment continued until saturation of themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. Results: Participants (n = 31) were predominantly Hispanic (28; 90%), insured (29; 94%), and recently sexually active (24; 77%). Themes were as follows: (1) Tone: messages should be direct, factual, entertaining, and respect adolescent autonomy; messages should not be intrusive, presumptive, or preachy. ( 2) Emotion evoked: participants preferred messages that provoked thought, validated feelings, and empowered. Messages from a reliable source felt comforting, making participants feel cared for and special. (3) Interactivity: participants favored messages that offered choices, such as a mini-conversation. (4) Personalization: messages should look similar to adolescent digital preferences but be individually tailored with relatable characters. Conclusions: This study informs the tone, structure, and style of sexual health text messages directed toward adolescent females in the emergency department. Future work should consider these characteristics when designing digital interventions to engage adolescent females. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.

The risk of intersex-related stigma often serves as social indication for “corrective” genital surgery, but has not been comprehensively documented. In preparation for the development of an intersex-specific stigma assessment tool, this qualitative project aimed to explore stigma in girls and women with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. As part of a comprehensive follow-up project, 62 adult women with classical CAH (age range 18–51 years) took part in an open-ended retrospective interview focusing on the impact of CAH and its treatment on various aspects of girls’ and women’s lives. Deductive qualitative content analysis (Patton, 2014) of de-identified transcripts involved categorization of three types of stigma: experienced, anticipated, and internalized. Two-fifths of the participants reported CAH-related stigma in romantic/sexual situations. Stigma enactment by romantic partners occurred in reaction to both genital and non-genital sex-atypical features of CAH and sometimes included explicit questioning of the women’s true gender. Stigma anticipation by the women and their related avoidance of nudity, genital exposure, and romantic involvement altogether were frequent. Internalization of stigma occurred as well. In conclusion, the data suggest that many women with CAH experience, anticipate, and/or internalize intersex-related stigma in the context of their romantic/sexual lives.

Findings are presented on a study of 40 gay father families created through surrogacy and a comparison group of 55 lesbian mother families created through donor insemination with a child aged 3-9years. Standardized interview, observational and questionnaire measures of stigmatization, quality of parent-child relationships, and children's adjustment were administered to parents, children, and teachers. Children in both family types showed high levels of adjustment with lower levels of children's internalizing problems reported by gay fathers. Irrespective of family type, children whose parents perceived greater stigmatization and children who experienced higher levels of negative parenting showed higher levels of parent-reported externalizing problems. The findings contribute to theoretical understanding of the role of family structure and family processes in child adjustment.

Stigma defined as "undesired differentness" (Goffman, 1963) and subtyped as "experienced" or "enacted," "anticipated," and "internalized" has been documented for patients with diverse chronic diseases. However, no systematic data exist on the association of stigma with somatic intersexuality. The current report concerns women with classical congenital adrenal hyperplasia (CAH), the most prevalent intersex syndrome, and provides descriptive data on CAH-related stigma as experienced in the general social environment (excluding medical settings and romantic/sexual partners) during childhood, adolescence, and adulthood. A total of 62 adult women with classical CAH [41 with the salt-wasting (SW) variant and 21 with the simple-virilizing (SV) variant] underwent a qualitative retrospective interview, which focused on the impact of CAH and its medical treatment on many aspects of women's lives. Deductive content analysis was performed on the transcribed texts. The women's accounts of CAH-related stigma were identified and excerpted as vignettes, and the vignettes categorized according to social context, stigma type, and the associated features of the CAH condition. Nearly two-thirds of women with either variant of CAH provided stigma vignettes. The vignettes included all three stigma types, and most involved some somatic or behavioral feature related to sex or gender. Stigma situations were reported for all ages and all social contexts of everyday life: family, peers, colleagues at work, strangers, and the media. We conclude that there is a need for systematic documentation of stigma in intersexuality as a basis for the development of improved approaches to prevention and intervention.

A sample of 100 heterosexually active men were recruited from STD/health clinics and social networks in urban neighbourhoods in New York City to participate in a qualitative interview about their perceptions of the scripts guiding their courtship, romantic, and sexual experiences with women. Men's narratives revealed tension between their desire for emotional versus sexual intimacy; and their desire for emotional and sexual immersion versus their fear of being emotionally vulnerable. Men's narratives also revealed gender role and gender script uncertainty as they attempted to understand and internalize changing societal norms. Developmental trends were evident, reflecting men's transition from viewing sex as an endpoint to viewing sex as a component of emotional intimacy. Findings are discussed in the light of developmental, dyadic, and cultural influences on men's heterosexual behaviour.

The escalating HIV/AIDS epidemic worldwide demands that on-going prevention efforts be strengthened, disseminated, and scaled-up. System-level interventions refer to programs aiming to improve the functioning of an agency as well as the delivery of its services to the community. System-level interventions are a promising approach to HIV/AIDS prevention because they focus on (a) improving the agency's ability to adopt evidence-based HIV prevention and care programs; (b) develop and establish policies and procedures that maximize the sustainability of on-going prevention and care efforts; and (c) improve decision-making processes such as incorporating the needs of communities into their tailored services. We reviewed studies focusing on system-level interventions by searching multiple electronic abstracting indices, including PsycInfo, PubMed, and ProQuest. Twenty-three studies out of 624 peer-reviewed studies (published from January 1985 to February 2007) met study criteria. Most of the studies focused on strengthening agency infrastructure, while other studies included collaborative partnerships and technical assistance programs. Our findings suggest that system-level interventions are promising in strengthening HIV/AIDS prevention and treatment efforts. Based on our findings, we propose recommendations for future work in developing and evaluating system-level interventions.