Authors: Karishma Chainani & Dr. Annie Sondag

Title: An Assessment of the Health Needs of the Transgender Community in Montana

Introduction:

Transgender people are highly stigmatized. According to the Presidential Advisory Council on HIV/AIDS (2012), transgender individuals confront discrimination in a wide array of settings including healthcare, housing, employment, education, and legal recognition. While issues regarding stigma and discrimination are well documented in the literature, most of the information about transgender people has been gathered in urban settings. In fact, information about the lives of transgender people living in rural areas is rare. The purpose of this study, therefore, is to explore factors that influence quality of life and risk of infection with HIV/HCV/STD’s among transgender people living in Montana. This information will help create awareness of the issues facing the transgender population so that health programs can be tailored to meet their needs. Prior to implementation, this study received approval from the Institutional Review Board at the University of Montana.

Methods:

This study represents the second phase of a two-phase study aimed at assessing quality of life issues and HIV/HCV/STD prevention needs among transgender people living in Montana. The first phase of the study utilized a grounded theory approach (in-depth interviews and Photovoice methods) to establish the framework for the second phase which is described below.

This second phase of the study involved the development of a questionnaire and utilized a cross-sectional design. Cross sectional studies typically use a one-time data collection effort and a self-report format. This design was chosen because it can be used to assess the burden of disease or health needs of a population- in this case, the needs of the transgender population in Montana, and is particularly useful in informing the planning and allocation of health resources.

The questionnaire was developed after a thorough review of the literature, a review of existing surveys, and careful consideration of the qualitative information gathered during phase one of this study. The final draft of the questionnaire consists of six sections. The sections include: demographic information, HIV/HCV/STD status and testing information, transition experience, perceptions of stigma and discrimination, mental health status and access to culturally competent health care. The questionnaire was reviewed by a panel of experts and pilot tested with a small sample of the transgender population. After multiple revisions, the questions were entered into an online survey platform called Qualtrics. Qualtrics ensures that the participants of this study remain anonymous. The link to the questionnaire was sent to various social media websites-Twitter, Tumblr, Google +, Facebook and Pink Essence. It was also posted on the Gender Expansion Project website, as well as the Gender Expansion Conference website, the Gay Men’s Task Force website, the Western Montana Community Center website, the FTM Magazine website, the WPATH listserve, the Ingersoll Gender Center listserve and website, and the Centerlink listserve and website. In addition, the questionnaire link was sent out in an email to individuals who are either transgender, or work in communities with transgender people.

Two types of analyses will be used in this study- descriptive and analytical. A descriptive analysis will be used to describe the demographic characteristics of the participants, assess the frequency and distribution of specific risk behaviors, describe the prevalence of health related conditions such as HIV/STDs/HCV, and examine perceptions regarding stigma and discrimination. An analytical cross-sectional approach will be used to investigate the association between risk factors and specific health outcomes.

Results:

Data collection is on-going and anticipated to be completed by March 31^st. Data will be analyzed using SPSS. We will report basic descriptive statistics, frequencies, and measures of central tendency. The Pearson’s r correlation will be used to test the relationship between two common variables. In this study, we will focus on the relationships between participants’ HIV/HCV/STD status and their sexual behaviors, substance abuse behaviors, mental condition and access to culturally competent health care providers. Information obtained will be widely distributed via websites listed above, conference and professional meeting presentations and scholarly publications in an effort to increase understanding and awareness of the challenges faced by transgender people living in rural states like Montana.

Conclusion:

Results from this study will provide a first glimpse into the lives of transgender people living in Montana. The Montana Department of Public Health and Human Services and other health care organizations will use this information to create interventions that are tailored to the unique needs of this population.

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Does a democracy improve environmental quality? Albert Gore, the 2007 Nobel Peace Prize winner, has said that “an essential prerequisite for saving the environment is the spread of democratic government to more nations of the world.”[1] This topic is important because a democracy has been conceded as one of potential determinants of good environmental quality.

As compared to an autocracy, there are several theoretical reasons why a democracy may improve environmental quality. Democratic citizens have more access to information regarding environmental quality (Schultz and Crockett 1990; Payne 1995), and more freedom of speech and organization allowing them to organize then appeal to their governments (Kotov and Nikitina 1995; Payne 1995). As a result, these governments can be held accountable for their ignorance of environmental quality if there is a noticeable degradation of environmental quality (Payne 1995).

What are the effects of political institutions on environmental quality comprised of global air quality, land quality and natural resources, and sustainable development policies? Since past research addressing this topic has provided mixed results, this paper offers a fresh perspective by incorporating three different types of composite indicators consisting of a revised combined Polity score, an institutionalized autocracy and an institutionalized democracy that form political institutions. Furthermore, this paper implements four different component variables comprised of a competitiveness of executive recruitment, an openness of executive recruitment, executive constraints and a competitiveness of political participation that form an institutionalized democracy, which is one of the aforementioned three composite indicators. These composite indicators and component variables are named and managed through the Polity IV Project by the Center for Systematic Peace.

In a hope of finding some important relationships between political institutions and environmental quality, a panel data set covering periods from 1990 to 2010 for 127 countries is used. However, instead of using yearly data as other past research has done, since political institutions are less likely to vary over short periods of time, a panel data set for periods with a 5-year interval (i.e., the years 1990, 1995, 2000, 2005 and 2010) is used.

For global air quality, CO₂ emissions (kt) is used. For land quality and natural resources, a negative annual change rate of the forest area (1,000 ha) and terrestrial protected areas (% of total land area) are used. For the sustainable development policies, improved water sources (% of population with access) is used. GDP per capita - PPP (constant 2011 international $) and its squared value, manufacturing - value added (% of GDP), trade (% of GDP), total population, and urban population (% of total) are used as controls to verify the results. Furthermore, for an estimation methodology, a country- and year-fixed effects model is implemented to mitigate unobserved characteristics in each of the 127 countries and the 5 different time periods.

The results using the three composite indicators suggest that a revised combined Polity score worsens land quality and natural resources by decreasing terrestrial protected areas, but improves sustainable development policies by increasing improved water sources. An institutionalized autocracy increases terrestrial protected areas, but decreases improved water sources. An institutionalized democracy increases improved water sources. The results using the four component variables suggest that a competitiveness of political participation decreases terrestrial protected areas, but increases improved water sources. Finally, executive constraints increase improved water sources.

The positive associations among the two composite indicators representing a democracy (henceforth, democratic indicators), the four component variables and improved water sources agree with the findings by Yoon (2014), who find that a democracy improves sustainable development policies. However, there are negative associations among the two democratic indicators, the four component variables and terrestrial protected areas. These results agree with the findings by Mark and Lew (2011), who find that a democracy increases deforestation damage. The researchers explain their findings by stating that more tightly controlled (autocratic) governments may be better at managing land quality and natural resources if the governments receive some benefits from managing these environmental quality. The researchers also state that autocratic countries do not necessarily improve global air quality because they do not usually receive benefits, but incur costs from reducing emissions. This last explanation might explain insignificant associations among the three composite indicators, the four component variables, and CO₂ emissions.

The results by this paper may have some important policy implications. Furthermore, since variables implemented in this paper are related to economics, environmental studies and political science, the results from this paper may be informative and hope to act as bridges among these important disciplines.

[1] Gore 1992, 179.

People who meet criteria for Borderline personality disorder (BPD) typically experience a pattern of instability in interpersonal relationships, self-image, emotional experience, and have marked impulsivity (American Psychiatric Association, 2013). The disorder affects approximately 2% of the general population, and is seen in 10% of outpatients and 20% of inpatients (APA, 2013). A core feature of BPD is emotion dysregulation: an inability to efficiently regulate emotions (APA, 2013). Such dysregulation leads to emotions spiraling out of control, hindering reason, and leading to out-of-control maladaptive behaviors (Conklin, Bradley, Westen, 2006). People with BPD also tend to experience self-hatred, intense shame, and negative self-schemas. Invalidating environments, coupled with biologically based emotional vulnerability, are thought to account for the development of BPD (Linehan, 1993). Self-compassion (SC) involves extending kindness toward oneself, having an understanding of common humanity (rather than feeling isolated) and being mindful (Neff, 2003). This study proposed that SC may be related to a decrease in BPD features as it relates to emotional dysregulation. It was hypothesized that SC would moderate the relationship between emotion dysregulation and BPD characteristics, such that those with higher levels of SC will have lower BPD characteristics, and those with lower levels of SC will have higher BPD characteristics, in the context of emotion dysregulation. Methods. Undergraduate University students, over the age of 18, enrolled in Psychology courses completed surveys during designated dates throughout the Spring, Summer, and Fall 2014 semesters (age: M=21.6, SD=5.5 , 82% White, 88% Heterosexual, 73% female). Participants completed the following measures: a demographic questionnaire, Difficulties in Emotion Regulation Scale (DERS), Affect Intensity Measure (AIM), Self-Compassion Scale (SCS), Rosenberg Self-Esteem Scale (RSES), and the Borderline Symptom List (BSL). Simultaneous multiple regression was conducted to test two hypothesized models. In the first model, self-compassion (SCS) was tested as a moderator of the relationship between the predictor, emotion dysregulation (DERS), on the criterion, BPD characteristics (BSL). In the second model, self-compassion (SCS) was tested as a moderator of the relationship between the predictor, affect intensity (AIM), and the criterion, BPD characteristics (BSL). For exploratory purposes, self-esteem (RSES) was similarly independently tested as a moderator of the relationship between emotion regulation (DERS) and BPD characteristics (BSL), and of the relationship between affect intensity (AIM) and BPD characteristics (BSL). Results. Results from this study were in partial support of the stated hypotheses. Self-compassion (SCS) served as a moderator in the relationship between emotion dysregulation (DERS) and BPD characteristics (BSL), and this explained 38.2% of the variance, F(3, 286) = 60.483, p < 0.05. Self-esteem (RSES) served as a moderator in the relationship between emotion dysregulation (DERS) and BPD characteristics (BSL), and this explained 41.5% of the variance, F(3, 286) = 67.330, p < 0.05). The models utilizing AIM as a predictor were marginally significant or not significant. Conclusions. Self-compassion may help individuals who have a tendency toward emotion dysregulation from developing BPD symptoms. When a person who has a tendency toward emotion dysregulation experiences a difficult life experience, for example, if he/she has the ability to respond to that experience with self-compassion, he/she may be less likely to resort to impulsive or self-destructive behaviors. Self-esteem also served as a moderator such that those with higher, versus lower, levels of self-esteem reported lower levels of BPD characteristics. Self-esteem in this context should be studied further as Neff (2011) distinguishes between self-esteem and self-compassion in that self-esteem relies on self-evaluations and drawing social comparisons with others, both of which can be harmful in the long-run. Implications. Inclusion of the teaching of self-compassion practices into existing treatments may be useful for those with emotion dysregulation and/or BPD, or those with characteristics of BPD.

Keywords: Borderline personality disorder, emotion regulation, self-compassion