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Eating Disorders: Not Just for Cisgender, Heterosexual Women

by Kait Scalisi | May 20, 2015 | News, Sex Stories

By Kait Scalisi, MPH

Most conversations about eating disorders focus on women, specifically those who are cisgender and heterosexual. This group, however, may not be at the highest risk. New data from the most recent American College Health Association’s National College Health Assessment (ACHA-NCHA) highlight the intersections of sexuality, gender identity, and eating disorders.

The most recent iteration of the ACHA-NCHA surveyed over almost 300,000 students at 233 US colleges and universities. Data collection took place between Fall 2008 and Fall 2011. All data was collected anonymously. For this analysis/study, only data from the first semester that each institution participated in ACHA_NCHA. This ensured all responses were unique.

To study connections among gender identity, sexuality, and eating disorders, the researches classified individuals into the following seven categories.

transgender
cisgender sexual minority (SM) men
cisgender unsure men
cisgender heterosexual men
cisgender SM women
cisgender unsure women
cisgender heterosexual women (reference)

Individuals in the last category were used as the reference group since most eating disorder research has been conducted on them, providing a rich data set to make comparisons to. “Sexual minority” included individuals identified as gay or bisexual.

Eating disorder status was assessed by asking individuals if they had been diagnosed or treated for an ED in the last 12 months and whether they had vomited, taken laxatives, or taken diet pills in the last 30 days. Covariates assessed included race/ethnicity, smoking frequency, binge drinking frequency, stress level and participation in athletics.

Rates of ED diagnosis or behaviors were highest among transgender individuals and lowest among cis, hetero males. Of the transgender students, those who were unsure of their sexual orientation had the highest rates of eating disorder diagnosis and use of laxatives, diet pills, and vomiting. That being said, rates of these outcomes for all subgroups of transgender folks were higher than any other group. Cisgender SM males also had elevated rates of eating disorder diagnosis.

The authors list several possible reasons for these heightened rates. These include:

Using eating disorder behaviors to suppress or accentuate particular gendered feature.
Experiencing minority stress.
Having a greater likelihood of contact with mental health professionals due to both the heightened rates of mental health issues among SM and the fact that most transgender individuals must receive therapy in order to have gender-affirming surgery.

Most likely, the truth is some combination of the above along with genetic risk factors highlighted in previous research.

One major critique of the study is that it excluded questions about binge eating disorder, a diagnosis only recently added to the DSM but which is thought to affect as many if nor more individuals that anorexia and bulimia. Another limitation is the inability of the researchers to distinguish among the different groups of transgender individuals (e.g. male-to-female, female-to-male, and gender-queer). Like any group, transgender people are not a monolith. They are all individuals with different risk factors and lived experiences, some of which may vary depending on which subgroup of transgender they fall into.

Despite these limitations, this was the first ACHA-NCHA with enough transgender individuals to make statistically significant comparisons to other gender identities. This is hugely important as much research excludes this population due to either low response rates or oversight on the researcher’s behalf. Such lack of representation in the literature means that we cannot create quality health education programs or policy to meet transgender individuals’ unique needs.

Overall this study is groundbreaking in what it adds to our understanding about the intersections of gender identity, sexual orientation, and eating disorders. It provides health educators with new learning objectives for their programs and researchers, a jumping off to point to study additional underlying factors, risk facts, and outcomes for anyone dealing with an eating disorder.

Other Sexual Health News This Week

Newer Types of Birth Control Pills Confirmed to Raise Blood Clot Risk (Los Angeles Times)

Health Buzz: How the Herpes Virus Can Kill Cancer (US News)

New Tuscon Nonprofit Focuses on Women Living with HIV or AIDS (Tuscon News Now)

ACLU Asks Hollywood To Support Gender Equality; Will They? (Forbes)

Lack of Sexual Health Knowledge Among Young Males (PR Newswire)

A Seattle High School is Taking Birth Control Access to the Next Level (Grist)

Upcoming Conferences

AASECT 47th Annual Conference, June 3-8

2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, June 4

Philadelphia Trans Health Conference, June 4-7

Center for Research and Education on Gender and Sexuality(CREGS) 2015 Summer School, June 19-26

RSOL National Conference, June 25-28

International Conference on HIV Treatment and Prevention Adherence

Texas Prevention Summit, Jun 29- Jul 1

Women Targeted on Twitter

by Kait Scalisi | May 18, 2015 | News, Sex Stories

By Kait Scalisi, MPH

Towards the end of 2014, Women, Action, Media (WAM), a nonprofit dedicated to building a robust, effective, inclusive movement for gender justice in media, became an authorized reporter on Twitter. This status allowed them to monitor, report, and follow-up on instances of harassment experienced on the platform. From over 800 reports of harassment, WAM discovered disturbing patterns in online behavior and Twitter’s response. They published their findings and recommendations this week.

Women experience significantly more and more severe forms of online harassment. WAM sought to quantify this data with a pilot study assessing the types and frequency of harassment. In three weeks, WAM processed over 800 reports and sent over 300 to Twitter. From there, Twitter took action on 161.

Examining the nearly 400 genuine harassment reports led to some interesting findings. These include

Bystanders play a huge role in reporting online harassment. Over 50% of reports received were submitted by someone other than the person being harassed. Most of these reports mentioned only one receiver of harassment.
Ongoing harassment is a problem. Nearly one-third of reports dealt with on-going harassment and over two-thirds mentioned having reported this problem to Twitter in the past. However, most harassing accounts were reported only once, indicating there’s a lot of jerks out there.
Hate speech and doxxing (releasing someone’s private information) were the most common forms of harassment. Together they accounted for nearly half of all reports. An additional 19% of reports did not fall neatly into any category.
Twitter took action in 55% of reported cases. In most cases, accounts were suspended. Only one account was deleted.
Twitter was more likely to take action on reports of hate speech. Twitter was much less likely to take action for other forms of harassment though they showed no favoritism towards longstanding accounts.
The reporting process is complicated. Harassment receivers must provide URLs, not screenshots. This makes it difficult to capture instances of harassment in which the perpetrator “tweets and deletes.” Reviewing reports involves in-depth communication and may be triggering to reviewers.
There are four major challenges of proving harassment. These include: context, interpretation, mode, and format of evidence.

Taken together these conclusions highlight the need for more oversight and accountability for alleged harassers as well as updated policies. As a result of the results, WAM also made six specific suggestions.

More broadly and clearly define what constitutes online harassment and abuse.
Update the abuse reporting interface, using researched and tested trauma-response design methods.
Develop new policies which recognize and address current methods that harassers use to manipulate and evade Twitter’s evidence requirements.
Expand the ability for users to filter out abusive mentions
Hold online abusers accountable for the gravity of their actions.
Diversify Twitter’s leadership.

The report itself may not be super surprising if you’ve paid attention to online harassment incidences over the last few years. REgardless, the report is vital as its the first piece of well-researched evidence quantifiying how online harassment is going down- and what to do about it.

Other Sexual Health News This Week

While the FDA recommends lifting the lifetime ban on gay men donating blood (HuffPost Politics), the CDC dedicates $185M to prevent HIV among trans individuals and MSM. (Edge Boston)

Patients More Likely to Get HPV Vaccine After Electronic Health Record Prompts

Millennials More Tolerant of Premarital Sex, But Have Fewer Partners (Time)

Survey Says Teens Skip Birth Control Because They Fear Parental Judgment (CNN)

Military Sexual Assault Claims: 1 in 20 Lead to Jail Time (Military Times)

Illinois Legislature Advances Gender Identity Protection Bill (HRC)

Campus Sexual Assault Rates Are Up, But It’s For a Good Reason: More Victims are Coming Forward (Slate)

Upcoming Conferences

The following conferences take place in May. Click on each name for more information and to register.

2015 Women of Color National Call to Action Summit and Conference, May 20.

American College Health Association 2015 Annual Meeting, May 26-30.

Talking About This One Topic Can Reduce Teen STIs and Pregnancy

by Kait Scalisi | May 1, 2015 | News, Sex Stories

By Kait Scalisi, MPH

Beyond containing complete, medically accurate information and discussing condoms and contraception, comprehensive sex education programs vary widely in their content. A new review in the journal International Perspectives on Sexual and Reproductive Health sought to determine whether these differences matters. By evaluating 22 programs, the author determined that the inclusion of one specific topic—gender and power dynamics—made a big difference in programs’ efficacy in reducing pregnancy and STIs in adolescents.

Adolescents have a higher risk of both STIs and unplanned pregnancy. When these data are broken down further, vast gender and race disparities emerge. Therefore, to successfully reduce this risk, curricula must address these disparities. While comprehensive sex education has come a long way, there is still room for improvement. Currently, only 13 states require that sex education be medically accurate. Beyond this, individual programs vary quite a bit in the topics they discuss. Additionally, much of the research conducted on these programs has relied solely on adolescents’ self report, giving less insight than desired into why the program worked.

Any study that provides insight into what makes curricula effective is kind of a big deal. This particular review, inspired by decades of conversations about gender and power, sought to determine whether teaching about these topics is a key component of effective curricula.

The review evaluated 22 programs that:

were group- and curriculum-based
assessed effects on adolescents 19 or younger
were published between 1990 and 2012
used rigorous study designs
had a sample size of at least 100
measured the effect of the intervention on health outcomes including STIs and pregnancy
were not abstinence-only
were not conducted among special populations (e.g., MSM).

To qualify as addressing gender and power inequalities, curricula had to include at least one lesson, topic, or activity covering an aspect of gender or power in sexual relationships.

The studies varied in location, study design, sample size (n=148-9000), gender, setting where the curriculum was conducted (e.g., school, community, or clinic), and content included in the curriculum. Ten studies showed significant decreases in STIs and/or pregnancy, and eight of them included information on gender and power.

Of the many program characteristics examined, only a few had a clear impact on whether the programs were effective. These included:

being a randomized control trial
follow-up lasting at least one year
being evaluated in 2000 or more recently
being conducted in a clinic
including content on gender and power.

Inclusion of gender and power content led to significant decreases in STIs and/or pregnancy. Of the programs that included this content 80% saw the desired outcomes along with several additional positive effects. On the contrary, of the programs without at least one lesson on gender and power, only 17% led to these outcomes. In a recent article about the study, The Atlantic magazine staffer Julie Beck writes:

Teaching about power and gender roles was a consistent predictor of better health outcomes, even when [researchers]accounted for other variables like sample size and whether the studies were longitudinal. The Atlantic, April 27, 2015

Unsurprisingly, the programs that addressed gender and power and saw positive results had common characteristics. These included:

explicit attention to gender or power in relationships
fostering critical thinking about how gender norms or power manifest and operate
fostering personal reflection
valuing oneself and recognizing one’s own power.

Teaching health information alone is not enough. We need to take a more intersectional approach. This shouldn’t come as too big of a surprise. Just a few weeks back we shared two studies examining the various intersections of gender, violence, and contraceptive use. The Atlantic piece links to several more studies looking at HIV and STI rates and condom use. Lastly, we know that pregnancy and STI concerns are not top of mind for adolescents deciding to have sex. Instead, they worry about whether they will get in trouble for having, whether it will feel pleasurable, and what their peers will think of them.

Furthermore, bringing these conversations into sex education curricula opens up space for discussions of sexuality and gender identity. Adherence to gender norms play a huge role in the increased rates of bullying and harassment that LGBTQ individuals experience; therefore, addressing these gives schools one more opportunity to address the bullying and provides further support for bullied students.

Like all systemic reviews, this study has its limitations. Eligible studies could be missed and confounding variables could be overlooked. In my opinion, these don’t make the study any less of a big deal. By unlocking another key to what makes comprehensive sex education programs successful, the study gives educators their next step. The Atlantic‘s Beck puts it best:

There are emotions and social pressures at play, and it seems that when teachers address them, sex ed gets a little closer to being truly comprehensive. The Atlantic, April 27, 2015