Walsh Alison R, Spiars Devon E, Loder Charisse, Dove-Medows Emily, Kalpakjian Claire, Hess Andrea, Postler Kelsey, Munro-Kramer Michelle L, Ernst Susan
Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
University of Michigan College of Literature, Science, and Arts, Ann Arbor, Michigan, USA.
LGBT Health. 2025 May-Jun;12(4):295-305. doi: 10.1089/lgbt.2023.0373. Epub 2024 Oct 10.
Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.
不恰当、不尊重或强制性的医疗保健（IDCH）与患者年龄、性取向和性别认同（SOGI）相关，并且会影响医疗保健参与度和治疗结果。成年早期是建立对医疗保健信任的关键时期，但对于大学生的IDCH经历却知之甚少。本研究评估了大学生样本中IDCH的患病率，并确定了IDCH与SOGI之间的关联。利用横断面IDC调查（2021年）的数据，我们对3403名大学生样本中18项IDCH项目的终生患病率进行了量化。使用卡方检验和克鲁斯卡尔-沃利斯检验来评估IDCH项目与SOGI之间的双变量关联。我们使用逻辑回归对人口统计学特征与两种类型的提供者性不当行为之间的关联进行建模。在分析的17项IDCH项目与SOGI之间发现了具有统计学意义的关联。自我报告的IDCH经历在性取向和性别认同少数群体学生中比异性恋顺性别学生更为普遍，包括接受不恰当/有害的治疗以及提供者的轻视或有偏见的沟通。与异性恋顺性别男性相比，性别少数群体和顺性别性少数群体的男女学生在考试期间被不当触摸的几率显著更高（调整后的优势比[95%置信区间]：分别为3.07[1.59 - 5.93]、2.34[1.24 - 4.41]和1.85[1.16 - 2.90]）。SOGI与经历提供者的性侵犯没有显著关联。历史上性取向和性别认同少数群体的大学生可能特别容易遭受IDCH经历；需要开展研究以了解性取向和性别少数群体亚群中的不同经历。对患者和提供者进行医疗保健规范和以创伤为中心的护理教育可能会减少IDCH及其危害。
