This study explored healthcare utilization among the Transgender and Gender Non-Binary (TGNB) population of Florida using Geographic Information Systems (GIS) to visualize and analyze the spatial distribution of unmet healthcare needs. The aim was to provide a clear comparison of unmet healthcare needs across various regions, highlight areas with the highest and lowest levels of unmet needs, and understand the demographic factors influencing these disparities. Utilizing survey data from the NIH-funded U=CARE study, which involved TGNB participants aged 18-26 from diverse racial/ethnic and socioeconomic backgrounds, the data were cleaned, geocoded, and analyzed within ArcGIS. Geocoded survey responses were linked to Florida Department of Transportation (FDOT) district boundaries. Choropleth maps were created to represent the percentage of respondents in each geographic unit reporting unmet healthcare needs, with color gradation indicating the intensity of these needs. Regional variations were found, with Northeast Florida and Northwest Florida showing the highest levels of unmet healthcare needs despite having the lowest participant counts, while Central Florida, which had the highest number of participants, also reported a substantial percentage of unmet healthcare needs. A demographic analysis indicated that younger participants, those with lower education levels, and individuals from diverse racial and ethnic backgrounds were more likely to report unmet healthcare needs. Districts with lower socioeconomic status (SES) showed higher levels of unmet needs, underscoring the critical role of socioeconomic factors in healthcare access. This study identifies specific regions and demographic groups with significant unmet healthcare needs, informing targeted healthcare interventions and policies. By integrating spatial and demographic analysis, it provides a comprehensive understanding of healthcare disparities among TGNB young adults in Florida, contributing valuable insights for improving health outcomes across diverse populations and addressing the specific healthcare challenges faced by this community.

Background: The COVID-19 pandemic disrupted access to healthcare services in Canada, but little is known about the magnitude of unmet healthcare needs and characteristics associated with increased risk of unmet needs in the adult population. Objectives: First, to describe unmet healthcare needs, including COVID-19 testing access, and to evaluate the association of the social determinants of health (SDOH) and chronic conditions with unmet healthcare needs. Secondly, to evaluate the association between symptoms of depression and anxiety with unmet healthcare needs, and test if the interaction was modified by sex. Methods: The data of 23,972 adults who completed the Canadian Longitudinal Study on Aging COVID-19 Questionnaire Study exit survey (Sept.–Dec. 2020) was analyzed. Three outcomes were evaluated: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. For objective 1, a prospective cohort study was conducted. For objective 2, a cross-sectional study was conducted. RESULTS: Overall, 25% of adults in Canada reported challenges accessing healthcare, 8% did not go to a hospital or see a doctor when needed, and 4% experienced barriers to COVID-19 testing. Several SDOH, including sex, immigrant status, racial background, education and income, were associated with unmet needs. The odds of reporting all three outcomes declined with age. Pre-pandemic unmet needs were strongly associated with higher odds of all three outcomes, while the presence of chronic conditions was associated with higher odds of the first two outcomes. Symptoms of depression and anxiety were strongly associated with all three outcomes. Interaction with sex was found for the first outcome, with stronger associations in females. Conclusions: This thesis identified groups that experienced difficulties accessing healthcare services during the pandemic. Future research may assess consequences of unmet needs, evaluate mechanisms that cause unmet needs and determine ideal interventions. / Thesis / Master of Public Health (MPH) / The COVID-19 pandemic in Canada affected how individuals were able to access healthcare services. To understand which groups experienced a greater level of difficulties, we examined the experience of unmet healthcare needs during the first year of the pandemic using a sample of 23,972 adults that had completed the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (Sept. – Dec. 2020). We found evidence that the experience of unmet healthcare needs varied by several sociodemographic characteristics, such as sex, immigrant status, racial background, education and income. Younger adults were more likely to report unmet needs. Individuals with chronic conditions and those had reported unmet healthcare needs prior to the pandemic were also more likely to report unmet needs during the pandemic. Individuals with symptoms of depression and anxiety were also more likely to report unmet healthcare needs. These results can be used to inform interventions that improve access to healthcare services for vulnerable groups.