Amy Hillier

Racial segregation is a recognized cause of racial health disparities. One factor that has contributed to racial segregation is municipal zoning policies that exclude people of color and those of low income from advantaged residential neighborhoods. Few studies have explicitly explored the relationship between zoning policies and health. Using data on zoning policies in Chicago in 1923 and 2012, we examined inequities in life expectancy across census tracts in relation to the proportion of land in each tract zoned for specific purposes. For each Chicago census tract, we obtained data on historical and current zoning policies and current health outcomes and life expectancy. Using regression analysis and structural equation modeling, we examined the relationship between zoning policies and life expectancy and possible mediators of this relationship. Life expectancy across 694 census tracts in Chicago varied from a low of 59.9 years to a high of 90.0 years. The greatest predictor of differences in life expectancy across census tracts was the degree of racialized economic advantage. Zoning policies in both 1923 and 2012 were significantly related to life expectancy, and this relationship was mediated by differences in racialized economic advantage. The structural equation model had a root mean square error of approximation of 0.064, a Tucker-Lewis index of 0.960, a confirmatory fit index of 0.973, and a standardized root mean square residual of 0.048. Zoning policy is significantly related to life expectancy, a relationship mediated by racialized economic advantage. Both past and modern-day exclusionary zoning policies appear to be associated with current health outcomes. These findings suggest that zoning reform could be one possible mechanism for redress if it gives specific attention to decreasing concentrated advantage and creating opportunities for Black households to build wealth.

Providing support for transgender and gender nonconforming children's identity before puberty has been shown to improve mental health outcomes. This study aimed to determine the acceptability of population-based screening for gender identity with parents of young children. A national sample of parents with children ages 3-12 completed an online survey about their child's gender and their own feelings about answering such questions. Multivariate linear regression models identified significant predictors of acceptability among parents and children. A racially/ethnically and geographically diverse sample of parents (N=2680) completed the survey during August 2022. Most (94.2%) reported their child's gender was consistent with their sex assigned at birth; 2.3% reported their child identified as the opposite gender and 3.4% reported their child was nonbinary. Most parents found the questions to be acceptable; 87.8% indicated they did not find the questions offensive and 87.4% indicated they would be comfortable answering the questions with a pediatrician. A small minority of parents (7%) expressed strong resistance to answering the questions, referencing religious and moral objections, a belief that young children cannot understand and should not be encouraged to think about gender identity, that such questions sexualized children, and that gender was a private issue to be kept within the family. Screening for gender identity with parents of young children is largely acceptable and may provide opportunities for normalizing discussions about gender and linking families in need to gender-affirming psychosocial and medical support.

Using a phenomenological framework, we interviewed gender nonconforming, nonbinary, and binary transgender (GNBT) youth and young adults on the topic of disclosing non-cisgender identities within families of origin. We found that before a formal conversation and declaration takes place, there are subtle and unconscious in/formal hints of identifying as something beyond the bounds of cisgenderism. We call these precursors “breadcrumbs.” These crumbs of gendered truths function to consciously test the relational waters while simultaneously subconsciously understanding familial gendered expectations. While there are some positive reactions from family to these breadcrumbs, GNBT youth often experience conflict, disappointment, and moments of rejection as they test the boundaries of what is possible within their families’ understanding of gender norms.

Youth participatory action research (YPAR) provides a model for youth leadership in research aimed at tangible improvements to their lives. We employed YPAR with queer and trans young adults in a qualitative study about trans high school youth. In this paper, we highlight the importance of relationships, dialog and reflexivity to ensuring ongoing critical reflection on the ethical nature of what often appear as methodological and operational issues. Our research underscores the tensions, contradictions, and limitations of sharing power that emerge in collaborations across age, race, educational attainment, and lived experience.

Without clear federal mandates protecting the rights of transgender and gender nonconforming people, local governments are drafting their own legislation that either protects or limits these populations’ rights. This leaves street-level bureaucrats situated in between competing auspices, conflicting mandates, and a constrained sense of self-determination when they are tasked with applying emerging legislation in a policy gray area. This paper considers the policy logic of an intersectional approach to LGBTQ policy, as well as the implementation barriers street-level bureaucrats may face when operationalizing LGBTQ policy in a politically complex environment. First, we use a piece of local legislation designed by transgender and LGB youth as an implementation case study focused on policy logic and policy triggers. Second, we employ thematic analysis for analyzing open-ended responses to 281 surveys completed by teachers and other school staff after training around implementation of a new district-wide policy anchored in an intersectional approach. Beyond normative, protracted implementation timelines, even when front-line workers were in full support of LGBTQ rights, tension still surfaces around the internalization of bureaucracy, fear of disciplinary sanctions, a perception of competing rights, and ambivalence with mediating between personal, familial, and youth agency. Even when using equity-focused policy approaches, stakeholders can expect to encounter implementation barriers with street-level bureaucrats (SLBs) while trying to influence higher orders of government through local advocacy and action. Altering the discourse on gender identity remains difficult in the current political environment surrounding LGBTQ rights.

Research on the experiences of trans youth has generally emphasized their disparate risk for negative educational, housing, and health outcomes. While drawing attention to very real vulnerabilities, these depictions can represent trans youth as one-dimensional passive victims. Some recent research draws on resiliency theory and offers a strengths-based perspective highlighting the strategies trans youth employ and the resources they draw upon in the face of challenging circumstances. In this study, we look to the concept of situated agency as a way to understand how risk and resilience simultaneously characterize the high school experiences of trans youth. Through hearing their own accounts of daily life in a large urban public school district, we seek to understand their attitudes, behavior, and choices as strategies for coping, surviving and resisting the bureaucratic structures that create conflict by upholding traditional binary gender norms. In so doing, we seek to redirect the spotlight on the practices and systems that constrain trans youth agency—rather than the trans youth, themselves—as the most appropriate focus for intervention.

Purpose: Parent support is considered crucial for the health of transgender and gender-nonconforming (trans/GNC) children, yet little research has focused on how to support parents and caregivers. This study considered the experience of participation in a support group for parents of transgender children on families. Methods: Online surveys were conducted with parents whose children were receiving clinical care at a gender specialty clinic and who participated at least once in a monthly support group. Close-ended questions addressed the importance of participation and open-ended questions addressed the specific ways it was helpful, how it impacted them and their trans/GNC child, and if they faced barriers to participating. Results: The majority of the 48 participants (77.1%) identified as female. The mean age of their trans/GNC child was 13.9 years (standard deviation 5.1, range 5–22 years); just over half ( n =25) of their trans/GNC children identified as male. Participants overwhelmingly reported positive experiences with the support group, with 72.9% reporting that the group was either important or critically important to them and 66.7% reporting that it was important or critically important to their trans/GNC child. Perceived benefits included the opportunity to learn about legal, medical, and school issues and receive emotional support. Conclusion: Support groups provide an important complement to specialized clinical care for families with trans/GNC children. Logistical challenges, lack of age peers, and lack of people of color all served as limitations of the group. Further research is needed to understand the experiences of fathers and to determine if the support group model would be effective with racially/ethnically and economically diverse populations.

Research evaluating the impact of new food stores in “food deserts” have reported limited impact on eating and health outcomes of residents who live nearby. Few studies have reported on shoppers' food store choices and experiences in these new stores. This study focused on residents' experience with a new non-profit food market in Chester, PA and analyzes spatial patterns regarding who did and did not choose to shop at the new store. Phone surveys (n = 135) and in-person interviews (n = 13) were conducted with the primary food shopper for households living in Chester 1–2 years, respectively, after the opening of a store. Participants who shopped at the new market reported positive experiences in regard to convenience, customer service, food quality, and prices and believed that the new market had a positive impact on the community. But most participants had not shopped at the new market, citing many of the same factors in their decision to shop at supermarkets outside the city. Our findings underscore the need to combine new food retail strategies with community engagement and other interventions, such as in-store promotions and health education programs, to maximize the number of people who shop at new food outlets designed to improve access to healthful foods.