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Afiya Sajwani Receives Award for Poster on Medical Mistrust

My hope is that this work can highlight avenues for medical professionals and health researchers to target to improve health disparities for youth, especially Black, transgender, and non-binary youth.”

Afiya Sajwani

Afiya Sajwani standing next to poster

ISGMH staff member and graduate student Afiya Sajwani received three awards for their poster titled "Factors Associated with Medical Mistrust Among Sexual and Gender Minority Youth," which was presented at the 2023 Society of Pediatric Psychology’s Annual Conference. They received the 2023 Diversity Poster Award in addition to awards from the Gender Health and Adolescent and Young Adult Health Special Interest Groups at the conference.

Under the mentorship of Michael Newcomb, PhD, Sajwani used an existing data set to analyze medical mistrust among sexual and gender minority (SGM) youth designated female at birth. Their project looked at factors that are predictive of medical mistrust, defined as the tendency to distrust either medical professionals individually or the larger medical system due to personal, historical, or vicarious experiences of discrimination. In this study, Black, transgender,  and nonbinary youth reported higher levels of medical mistrust compared to white, cisgender, and sexual minority youth. Therefore, Sajwani would like their work to serve as a catalyst for change within the medical system.

“If we want young people to feel affirmed in medical spaces, the onus is directly on clinicians, medical providers, hospitals, and the medical system at large—not the young people experiencing these harms. In today’s climate, that means going beyond publishing position statements, although that may be a helpful first step, and to move into the areas of activism and organizing against some of the very harmful legislature being introduced.”

Sajwani’s project found that poor self-reported physical health, recent STI testing, experiences of victimization, and low family support predict greater medical mistrust. These findings indicate that medical mistrust among SGM youth is not necessarily a “personality trait,” but a cumulative result of socialization and past experiences. Sajwani wants to stress that these factors aren’t related to the individual, but rather about what is happening to that individual. These findings implicate the families, communities, and spaces an individual occupies rather than the individuals themselves. They are optimistic that their findings identify these same environments as avenues for future intervention to increase utilization of health services.

“It’s vital to look at all the different ways researchers and healthcare professionals can support SGM youth. My hope is that this work can highlight avenues for medical professionals and health researchers to target to improve health disparities for youth, especially Black, transgender, and non-binary youth. We know from research that this intersection experiences the most health disparities, and my goal with this research is not to simply add another problem to that list, but to begin to identify avenues for how those disparities can be addressed,” said Sajwani.

The Award-Winning Research Poster

Factors Associated with Medical Mistrust Among Sexual and Gender Minority Youth (Northwestern University and ISGMH Logos) Afiya Sajwani, BA, Sarah W. Whitton, PhD, Gregory Swann, MS, Michael E. Newcomb, PhD  INTRODUCTION • Medical mistrust (MM) = tendency to distrust medical professionals and systems due to direct or vicarious experiences of marginalization.  • MM is associated with health disparities. • Little is known about MM among transgender and non-binary (TNB) youth who experience greater health disparities compared to their cisgender peers. • Hypothesis: Two theorical frameworks will predict MM: (1) exposure to health services and self-perceptions of health. (2) minority stressors and resilience factors.   METHODS • Measures: Demographics, SGM-specific MM.  • Framework 1 with all participants: Recent STI testing and perceptions of physical health. • Framework 1 with TNB participants: Recent STI testing, history of gender-affirming hormones, and perceptions of physical health. • Framework 2: Victimization, internalized stigma, social support, and resilience • Analysis: Hierarchical multiple linear regressions used to test two frameworks  RESULTS • Participants: N=421; Ages 18-33 years (M=22.4, SD=3.5), 27% White, 136 TNB; all designated female at birth • Table 1 shows results of Framework 1 with all participants. Table 2 shows results of Framework 1 with only TNB participants.  • Table 3 shows results from Framework 2.  DISCUSSION • Greater engagement with healthcare services with poor perceived physical health resulted in higher MM. • Distal (instead of proximal) minority stressors were associated with MM (e.g., victimization and lack of family support).  • Both individual and structural approaches are needed to target MM, specifically among Black and TNB youth.  Black, transgender, and non-binary youth reported greater medical mistrust than cisgender sexual minority youth. Other factors predicting medical mistrust: • (down arrow) perceived physical health and recent STI Testing • (up arrow) victimization and (down arrow) family support    (QR code) Take a picture to download the poster (image of the Twitter bird) @afiyasajwani  (image of an envelope)  Table 1: Exposure to Health Services and Self-perceptions of Physical Health (Framework 1) With All Participants.   Estimate SE t-value Intercept 3.224 0.236 13.671*** STI Testing 0.004 0.002 1.916^ Perceived Physical Health -0.016 0.005 -3.496*** TNB Identity 0.414 0.073 5.642*** Race/Ethnicity - Asian -0.197 0.157 -1.253 Race/Ethnicity - Black 0.250 0.087 2.883** Race/Ethnicity - Latine 0.058 0.092 0.628 Race/Ethnicity - Multi-racial 0.133 0.142 0.941 Race/Ethnicity - Other -0.298 0.247 -1.203 R2=.14, F(8, 404)=8.32, p<.000 *** = p<0.000, ** = p<0.001, ^ = p<0.1         Table 2: Exposure to Health Services and Self-perceptions of Physical Health (Framework 1) with TNB Youth Only.   Estimate SE t-value Intercept 4.017 0.377 10.66*** STI Testing 0.006 0.003 2.091* Perceived Physical Health -0.022 0.008 -2.842** History of GAH 0.031 0.122 0.253 Race/Ethnicity - Asian -0.340 0.194 -1.748^ Race/Ethnicity - Black -0.016 0.151 -0.107 Race/Ethnicity - Latine -0.093 0.141 -0.656 Race/Ethnicity - Multi-racial 0.280 0.217 1.288 Race/Ethnicity - Other -1.257 0.453 -2.776 R2=.18, F(8, 127)=3.41, p<.01 *** = p<0.000, ** = p<0.001, ^ = p<0.1          Table 3: Minority Stress and Resilience (Framework 2) With All Participants.  Estimate SE t-value Intercept 2.851 0.244 11.70*** Victimization 0.377 0.155 2.433* Internalized Stigma 0.027 0.068 0.399 Resilience -0.008 0.005 -1.665^ Support from Family -0.064 0.024 -2.676** Support from Friends 0.009 0.031 0.289 Support from Partner 0.0004 0.027 0.013 TNB Identity 0.411 0.075 5.496*** Race/Ethnicity - Asian -0.170 0.160 -1.064 Race/Ethnicity - Black 0.231 0.891 2.598** Race/Ethnicity - Latine -0.075 0.094 0.805 Race/Ethnicity - Multi-racial 0.083 0.145 0.568 Race/Ethnicity - Other -0.115 0.245 -0.469 R2=.15, F(12, 399)=5.963, p<.000 *** = p<0.000, ** = p<0.001, * = p<0.05, ^ = p<0.1

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