Session
Let's Talk About Sex . . . & Disability: Moderated Discussion on Access, Education, Reproductive Health & More (organized jointly with the SRH section)
APHA 2022 Annual Meeting and Expo
Abstract
Disparities in Cervical Cancer Screening among Women with Disabilities in the United States
APHA 2022 Annual Meeting and Expo
Objectives
To estimate the prevalence of cervical cancer screening with the HPV test and associated risk factors among women with and without disabilities.
Method
Using a sample of 189,795 women (25-64 years) from 2018-20 Behavior Risk Factor Surveillance System (BRFSS) survey data, we conducted a descriptive analysis to estimate the prevalence of routine cervical cancer screening (with HPV test) within the recommended timeframe according to the American Cancer Society 2020 guideline. Multivariate logistic regression analysis was used to examine the likelihood of routine screening by disability types and associated risk factors. Disability was defined as difficulty with vision, hearing, cognitive, ambulatory, self-care, and independent living disability.
Result
Women with disabilities were less likely to receive routine screening compared to non-disabled women (50.2% vs. 54.8%). Routine screening was more frequent among women with independent living disability (59.6%) and cognitive disability (55.9%), while less frequent among women with ambulatory (45.9%), and vision disability (48.5%). The likelihood of routine cervical cancer screening was marginally lower (OR=0.96, p<0.05) among disabled women compared to those without disabilities. Furthermore, women with ambulatory disability (OR=0.82, p<0.05), and multi-disabilities (OR=0.88, p<0.05) had lower odds, whereas women with an independent living disability have higher odds (OR=1.71, p<0.05) of screening when compared to non-disabled women.
Conclusion
Our findings suggests that women with disabilities have a lower prevalence of routine cervical cancer screening and are less likely to receive one, indicating persistent health disparity. In addition to disability status, prevalence greatly varies by demographics, socioeconomic, and healthcare characteristics.
Abstract
Receipt of healthy and respectful relationship education among students with disabilities and the association with experiences of sexual abuse
APHA 2022 Annual Meeting and Expo
Background: Teens with disabilities are more likely to experience sexual abuse than their peers without disabilities. A lack of education about healthy and respectful relationships can contribute to vulnerability by leaving teens with disabilities unprepared to recognize abuse and seek help.
Methods: Data were from a state-wide representative sample of 11th grade students who participated in the 2019 Oregon Healthy Teens survey. We used multivariable regression to compare teens with and without disabilities on self-reported receipt of school-based instruction about healthy and respectful relationships (N = 10,992) and measure associations between healthy relationship education and sexual abuse experiences among teens with (N = 3,736) and without (N = 7,256) disabilities.
Results: Students with disabilities were 41% more likely than students without disabilities to say they had never received healthy and respectful relationship education in school (adjusted prevalence ratio [aPR] 1.41, 95% confidence interval [CI]: 1.25–156). Experiences of sexual abuse were more common for all students who did not receive healthy and respectful relationship education, but the association was stronger among students with disabilities. Among students with disabilities, 34.1% of students who did not receive healthy relationship education reported abuse, compared to 21.6% of those who received education (adjusted prevalence difference [aPD] 0.12, 95% CI 0.08–0.16).
Conclusions: Students with disabilities are less likely to receive education about healthy and respectful relationships than their peers without disabilities. Receiving this education is associated with a decreased prevalence of sexual abuse for all students, with a greater difference for students with disabilities.
Abstract
Measuring functioning and self-perceived health status among sexual and gender minority adults with disabilities: Findings from The PRIDE Study
APHA 2022 Annual Meeting and Expo
Introduction: People with disabilities face health disparities related physical functioning and mental health. Research gaps remain about the health of sexual and gender minority (SGM) people with disabilities. We describe the physical functioning and self-perceived health status of SGM people with disabilities.
Methods: Participants (n=4,961) were classified into four disability categories – physical, mental, intellectual, and other – based on self-reported disability. All participants completed the 12-item WHO Disability Assessment Schedule (WHODAS) and the 10-item PROMIS Global Health 2.0 measures to assess functional limitations and self-perceived physical/mental health, respectively. Generalized linear models were calculated of the mean WHODAS and PROMIS scores with disability type as the predictor.
Results: SGM people with physical disabilities (mean 16.20), mental disabilities (mean 15.47), intellectual disabilities (mean 14.82), and other disabilities (mean 17.22) reported significantly higher WHODAS scores compared to those without disabilities (mean 3.95; all p<0.0001); all disability types had notable impairments in functioning.
The mean PROMIS physical health T-scores of SGM people with physical disabilities (41.06), mental disabilities (43.09), intellectual disabilities (44.49), and other disabilities (41.73) were significantly lower (poorer health) compared to those without disabilities (51.91) (all <0.0001). Similarly, the mean PROMIS mental health T-scores of SGM people with physical disabilities (40.0), mental disabilities (38.54), intellectual disabilities (39.54), and other disabilities (39.15) were significantly lower compared to those without disabilities (47.10; all p<0.0001).
Conclusions: We found differences in physical functioning, independence, and mental health for SGM people with disabilities. Future research should qualitatively explore these self-reported differences to better understand SGM disability health.
Abstract
Inequitable access to sexual and reproductive health services by disability status
APHA 2022 Annual Meeting and Expo
Background: People with disabilities experience disproportionally high rates of reproductive cancers and contraceptive non-use yet have lower utilization of preventative sexual and reproductive health (SRH) services. The purpose of this study was to assess the prevalence and types of barriers people with disabilities experience accessing SRH services.
Methods: We fielded a national probability survey from December 2021-January 2022 with 7,016 individuals assigned female at birth ages 15 to 49, and asked participants to indicate whether they had experienced SRH barriers in the past 3 years. We classified disability status based on self- report of “a lot of difficulty or “cannot do at all on five domains (seeing, hearing, walking or climbing steps, communicating, self-care) from the Washington Group Short Set on Functioning. We conducted chi-square tests to estimate differences in experiencing barriers by disability status.
Results: Overall, 9% of participants reported disabilities. Individuals with disabilities were significantly more likely to report experiencing any barriers accessing preventative SRH services (50% vs. 34%, p<.001) and each type of barrier compared to non-disabled participants. Top barriers to care included: finding a health facility where they felt comfortable with providers (45% vs. 23%, p<.001), getting time of work/school (39% vs., 23%, p<.001), finding a provider who accepts their insurance (34% vs. 15%, p<.001), transportation (31% vs. 9%, p<.001), cost (30% vs. 16%, p<.001).
Conclusions: SRH services are difficult to access for people with disabilities which may exacerbate reproductive health disparities. Patient-centered approaches which improve the inclusivity of healthcare settings and address structural barriers are needed.
Abstract
Lightning Can Strike Twice: A National Partnership Promoting Breast Health among Women with Disabilities
APHA 2022 Annual Meeting and Expo
Background: Women with disabilities are less likely to receive recommended screenings for breast cancer, which is often related to lack of knowledge about screening. Lightening Can Strike Twice was a project aimed at understanding barriers and improving knowledge about breast cancer screening among this population in the National Capital Region (NCR).
Objectives: We describe a partnership between national organizations and an academic institution that provided educational workshops and coaching sessions to increase knowledge of breast cancer screening among this population in this region.
Methods: Twenty-two workshops and 56 coaching sessions were offered from 2017-2019. Pre-session surveys were used to collect data on participant demographics and barriers and post-session evaluations were used to determine improved knowledge and likelihood of scheduling a future screening.
Conclusions: A total of 299 women attended the workshops and 56 women were coached over the two-year project period. Pre-workshop surveys assessed demographics and barriers among workshop participants and highlighted the need for education on obtaining a screening. Post-workshop evaluations showed that most participants strongly agreed that their understanding of the benefits of screening had increased and that they were more likely to schedule a screening. The national partners were able to address the lack of knowledge of breast cancer risks and screening among this population and identify future opportunities within the targeted community.
Abstract
Foundations for supporting innovative and inclusive sexual wellness for youth with disabilities to garner buy-in from stakeholders
APHA 2022 Annual Meeting and Expo
In order to ensure that youth with disabilities receive access to sexual health information, it is critical to have the buy-in from many types of organizations and stakeholders. The Disability-inclusive Sexual Health Network (DSHN) partnered with 11 organizations across the state of Virginia to create and test innovative approaches for sexual health education programming. Partners are engaging a variety of stakeholders, including youth with intellectual and developmental disabilities (IDD), parents and caregivers, educators, and medical professionals. Organizations were encouraged to think creatively and reimagine new ways to approach sexual health education for youth with IDD. DSHN will describe the innovative approaches organizations embarked upon while creating their interventions.
It can be difficult to do innovative work. Generating and developing new ideas takes dedicated time and staff. This can be challenging in organizations that are already operating with smaller numbers of staff and full schedules. Beyond logistical barriers, there are barriers to including sexual health education programming within spaces and organizations that have previously not embraced the topic. DSHN will discuss ways to identify barriers to implementing sexual health education for youth with IDD by sharing lessons learned from our partner organizations as they have begun incorporating sexual health education into their programming.
DSHN staff will introduce session attendees to policies and best practices that support sexual and reproductive wellness for young people with disabilities. Participants will consider what policies may impede sexual wellness within their own organization and how they can be reimagined to best support sexual wellness. Attendees will identify who at their organization creates and enforces policy and what identities, professions, and experiences are missing from that decision making body. Participants will leave with achievable action steps for creating a more inclusive and innovative space.
Abstract
Contraceptive use and non-use in deaf and hard of hearing people: Findings from the reproductive health experiences survey
APHA 2022 Annual Meeting and Expo
Background: Those who are deaf or hard of hearing (DHH) often experience barriers accessing the healthcare system. Some barriers DHH people face include lack of communication accommodations at healthcare appointments, sharing of information not in their preferred language (American Sign Language or ASL), and insufficient education about family planning in the classroom and at home. The study’s primary aim is to compare DHH and hearing people with uteruses’ experiences in obtaining reproductive healthcare services.
Methods: Since April 2021, our online survey has been collecting information about people with uteruses’ reproductive health experiences in the United States of America. Preliminary data from 145 participants shows 89% of participants identified as women, 13% as BIPOC, 55% as DHH, and 40% as hearing. Using SPSS, we conducted univariate and bivariate analyses, comparing DHH and hearing participants, to evaluate use of contraception, preferred method of contraception, and when applicable, why participants could not access their first choice of contraception.
Results: From our preliminary sample of 145 respondents, 56 used contraception for any reason (28 DHH and 28 hearing). There was a significant difference (p > .02) between DHH and hearing respondents’ reasoning for contraception non-use; DHH participants cited same-sex partners, not minding if they got pregnant, or concerns about side effects, while hearing participants were not sexually active. There was no significant difference for the types of contraception used. In both groups, the most used methods were IUDs and contraceptive pills. However, 31 respondents reported not being on any contraception because they were not able to access their desired method. While not significant, a higher proportion of DHH people (six vs. two) reported that they did not know why they could not access their preferred method, while hearing respondents (four vs. two DHH respondents) cited financial reasons.
Conclusions: Some results, such as not understanding why they were not able to access their preferred form of contraception or citing worries of side effects as a reason for non-use, support previous reports that DHH people often face barriers when seeking healthcare services. These barriers could be related to poor communication between the doctor and deaf patient, lack of an ASL interpreter, or insufficient time taken to explain their reasoning to the patient. This finding underscores the importance of honoring DHH people's communication preferences for healthcare appointments, whether that be using an ASL interpreter, communicating via pen and paper, reading lips, or other strategies.
Abstract
Formative Research for the Creation of Learning Tools for Youth with Intellectual Disabilities
APHA 2022 Annual Meeting and Expo
Ensuring that youth with intellectual disabilities (ID) receive developmentally appropriate sex education is impeded by various barriers, including the lack of accessible educational tools for multiple cognitive and emotional learning styles, and content that goes far beyond safety and consent content. As a result of limited sexual and reproductive health (SRH) education, people with ID often lack vital information and skills needed for decision making and access to SRH care. We created a multidisciplinary network of experts, including self-advocates, to develop and test innovative sexual health educational tools for youth aged 16-24 years with mild to moderate ID. An additional advisory board of self-advocates (including youth) with ID and caregivers of people with ID was created to provide ongoing input and accountability. Together these groups make up the Sexual Health Innovation Network for Equitable Education - Project SHINE. Prior to creating new tools, we conducted a year of exploratory, formative research to gather input from a racially, culturally, and economically diverse group of youth with ID, guardians, and professionals in New York City. We gathered data from focus groups with youth with ID (3 groups, n=14), guardians (3 groups, n=16), and professionals (3 groups n=36). Two groups with guardians were conducted in Spanish, and one in English. Professionals included licensed/credentialed direct service professionals (social workers, nurses, teachers), non-licensed direct service providers (case managers, supportive care specialists, residential care line staff), and program administrators. We will present findings related to: (1) SRH topics of greatest interest, (2) teaching tools and methods that would be most helpful for varied learning styles and access needs, and (3) the need for ancillary guardian education and professional training to enable them to better help youth learn SRH information and gain access to health care. We will discuss how these findings are being used to guide the development of an innovative learning toolkit, which will be followed by testing of prototypes prior to finalization.
Abstract
From Exclusion to Inclusion: Adapting Evidence-Based Practices to Enhance Sexual Health Education for Youth with Intellectual and Developmental Disabilities
APHA 2022 Annual Meeting and Expo
Introduction: Adolescents with intellectual and developmental disabilities (IDD) are sexual beings. However, they are less likely than their non-disabled peers to receive sex education, leaving them ill-equipped to navigate relationships and exercise their sexual and reproductive autonomy. Notably, individuals with IDD are up to eight times more likely to experience sexual abuse. The provision of tailored comprehensive sex education is necessary to promote the wellbeing of this population and achieve health equity.
Methods: New York City Teens Connection (NYCTC) is a multi-component program of the NYC Department of Health and Mental Hygiene working in collaboration with citywide partners to improve adolescent sexual and reproductive health. NYCTC collaborated with educators of youth with IDD to promote safer sex practices and more comprehensive messages, while also supporting clinic partners to better address the needs of the youth and integrate adaptations into their practices.
Results: Between the resources provided to the educators and the adaptations to NYCTC’s Clinic Linkage Model, NYCTC was able to reach 50 youth with IDD across eight classrooms during the first semester. NYCTC was also able to conduct clinic tours for all the classes, ensuring access to comprehensive sex education and health services for youth.
Conclusions: The creation of tools addressing the diversity of learning styles of youth with IDD should be examined. Further guidance in the usage of concrete language and more relatable activities in evidence-based sex education is needed. Policy changes valuing youth with IDD and sexuality education that dispels common myths is recommended for supportive adults.
Abstract
How much do Clinicians know about Intellectual and Developmental Disabilities? A Sexual Health Perspective
APHA 2022 Annual Meeting and Expo
The intellectually and/or developmentally disabled (IDD) community experiences higher rates of sexual violence, while also being more likely to identify as LGBTQIA+. Additionally, most IDD people report having little to no sex education and many struggle navigating sexual health and identity because of this lack of education. Using family medicine as an avenue for sex education, this study aims to 1.) determine how competent the University of Kansas family medicine providers are with treating IDD patients, 2.) interview and survey KU family medicine residents on their education surrounding IDD and sex healthcare, and 3.) develop an educational module to teach future residents on how to disseminate sex education to IDD patients. In regards to the first aim, a REDCap survey was used and it was found that KU’s family medicine providers self-reported that they were not confident giving medically necessary care to IDD patients as they would non-IDD patients, and they reported that the greatest barrier to giving quality care to IDD patients was a lack of confidence/knowledge on IDD. Semi-structured interviews with residents further supported these results as most of the residents expressed discomfort in working with IDD patients, and also shared their little to no formal education on IDD in medical school and residency. The findings of this study reveal a greater need for educating residents on general IDD healthcare over sexual healthcare. The study produced a 3-part lecture series on IDD healthcare and an IDD panel of self-advocates, family members, and providers for residents.