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Background As transgender identification rises in younger generations, it is imperative that colleges and universities account for the health and wellbeing of this growing subset of the student body. Previous research indicates that transgender populations experience unique barriers to accessing healthcare, including socioeconomic barriers and a lack of healthcare providers experienced in transgender medicine. These barriers contribute to low rates of healthcare utilization and significant health disparities in transgender populations. Methods A community health assessment of transgender and gender-nonconforming (TGNC) students at the University of Central Florida was conducted in order to assess: (1) students' access to and experiences with healthcare on-campus at Student Health Services and off-campus with other healthcare providers, (2) barriers affecting healthcare accessibility for TGNC students, and (3) the overall mental and physical health-related quality of life (HRQOL) of this population. These measures were assessed utilizing a 15-minute online survey administered via Qualtrics distributed during the Fall 2023 semester. Results TGNC students' HRQOL was found to be substantially poorer than the general population, particularly with regard to mental health. The most significant socioeconomic barriers identified were related to financial dependence and insurance. Although students generally reported positive experiences with Student Health Services (SHS), respondents frequently reported lacking confidence or being unsure of their providers' knowledge of transgender medicine. Additionally, recent legislation in the state of Florida affecting the provision of transgender medicine was also identified as a significant barrier to accessing transition-related care. Conclusion This research reveals significant structural barriers to transgender healthcare which require large-scale, policy-level changes to fully rectify. However, simple interventions such as a workshop, training, or lecture on transgender health for providers may serve to produce more inclusive healthcare experiences for transgender students in the meantime.

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Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide recommendations. Aims 1 and 2 were informed by an adapted SDOH framework, which comprised of upstream structural determinants, and downstream intermediary determinants. Aim 1 was achieved via a scoping review of studies across three databases following the PRISMA-SCR checklist. Aim 2 was achieved via a cross-sectional analysis of data from adult respondents to the 2019 Behavioral Risk Factor Surveillance System, with self-reported hypertension. Bivariate and Multiple Logistic regression analyses were conducted. Aim 3 involved a literature scan on policy concerning SMBP, highlighting the policy implications of findings from the empirical study, and providing recommendations for policy/practice. For aim 1, findings suggest that research studies examined the relationship of relatively more structural determinants, than the few, but highly significant intermediary determinants, with SMBP. For aim 2, looking at the structural determinants, males and those who identify as Black and other minority racial groups were more likely to report SMBP. For intermediary determinants, respondents who consumed fruits, vegetables, and exercised were likely to report SMBP, while those who smoke, who drink, and those with poor mental health days were less likely to report SMBP. Respondents with health coverage and whose provider recommended SMBP were likely to report SMBP use. Those ≥65 years were more likely to report SMBP. For aim 3, I recommend that the Centers for Medicare and Medicaid Services lead policy efforts on SMBP reimbursements. Also, healthcare practices should strengthen their technological infrastructure e.g., telehealth to promote access, and Electronic Health Records to promote efficient data collection and tracking.

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