Sampling, definitions, and heart attacks

So, back in October, I had an entry with some discussion of sampling for research purposes.  That topic covered two weeks in the course, actually, but since we had a paper due that week, there was no reading response due, and this is me just finally coming back to it.

The paper involved exploring various types of sampling used on the population we’d identified an interest in, selecting one specifically, and critiquing it.  During some of the early class discussions, somehow I’d honed in on the question of whether the symptoms of acute coronary events (aka heart attacks) experienced by transgender women were more like those we think of for cisgender men (crushing chest pain) or those associated more with cisgender women (back pain, indigestion) (Barouch, n.d.) and what that might tell us about the reasons for those differences (estrogen exposure, center of gravity, psychosocial factors, who knows?).  So, my “target population” became transgender women.

Of course, I’ve subsequently learned that this idea of gendered differences in acute coronary symptoms is losing traction, though I can’t find the article I read on that at the moment.  So maybe the bottom line in terms of patient education is to make sure everyone of every gender knows what the range of possible symptoms are.

Barouch, L. (n.d.) Heart disease: Differences in men and women. Retrieved December 30, 2015 from *

Herbst, J.H., Jacobs, E.D., Finlayson, T.J., McKleroy, V.S., Neumann, M.S., and Crepaz, N. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS & Behavior 12(1), 1-17.
So, as a systematic review, this article looks at a number of articles and reports over a long period of time.  In this instance, the time frame is 1988-2006 and what they’re looking at are reports of incidence and prevalence of HIV infection among transgender persons, risk behaviors around HIV for transgender persons, and contextual factors associated with risk behaviors. That makes this something of a must-read for anyone looking at HIV and the transgender population, both for the analysis of what they found and for the extensive reference list.

Keatley, J, Deutsch, M, Sevelius, J, and Gutierrez-Mock, L. (2015). Creating a foundation for improving trans health: Understanding trans identities and healthcare needs. In Makadon, H., Mayer, K., Potter, J., & Goldhammer, H. (2015). The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health (2nd ed.). Philadelphia, PA: American College of Physicians.
The main reason I ended up referencing this chapter in this paper is for some definitions, as I needed to talk about distinctions along the transgender spectrum, including terms like genderqueer and genderfluid.  That said, there is far more to this chapter than just the definitions it provides.  This book is one of the most important in this field, in my opinion, and this chapter provides exactly what it says: a solid foundation for understanding the needs of trans-identified people.

Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2014). Gender abuse, depressive symptoms, and substance use among transgender women: A 3-year prospective study. American Journal of Public Health, 104(11), 2199-206.
This is the study whose approach I chose to critique.  They actually did a great job exploring this topic, and the limitations I noted around the definition of transgender women and sampling methods chosen were imposed on these researchers by the larger study from which they drew their sample.  Also, for all the apparent limitations, they do note that transgender or gender-variant persons were involved in all stages of this study.  So, if transgender women and other gender-variant persons were involved in deciding that “assigned male at birth but not identifying as male in all roles or situations” was a valid working definition, who am I as a ciswoman to say it isn’t? 

Sell, R.L. and Petrulio, C. (1996). Sampling homosexuals, bisexuals, gays and lesbians for public health research: A review of the literature from 1990-1992. Journal of Homosexuality 30(4), 31-47.
This seems like a really limited time-frame for a lit review, but considering the timing, it makes a lot of sense.  The study of queer health was shifting gears as a result of the AIDS epidemic, so looking at how these early studies conceptually defined and then sampled LGB people was necessary.  It’s unfortunate that it took until 1996 to be published (I presume it was done in 1993-4 or so, one of the drawbacks of academic publishing schedules is you do see this type of a lag) but made some important critiques that one hopes others took note of.

*Note: I would not normally use a URL in a bibliography, but the first several attempts at pasting in the full URL ranged from annoying (only part of it pasted in) to disastrous (the rest of this post got erased). So I caved.  Also, seriously, Johns Hopkins, no date?  At least give me a “last updated” date somewhere on the page. *pouts*


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