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Stigma and Barriers in Health Care Among a Sample of Transgender and Gender-Diverse Active Duty Service Members. Med Care 2023; 61:145-149. [PMID: 36728493 DOI: 10.1097/mlr.0000000000001818] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness. METHODS We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank. RESULTS Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P =0.03), anxiety (β=0.21, P =0.03), stress (β=0.30, P =0.001), and poorer overall mental health (β=-0.23, P =0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician. CONCLUSIONS Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.
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Cotaina M, Peraire M, Boscá M, Echeverria I, Benito A, Haro G. Substance Use in the Transgender Population: A Meta-Analysis. Brain Sci 2022; 12:brainsci12030366. [PMID: 35326322 PMCID: PMC8945921 DOI: 10.3390/brainsci12030366] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
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Affiliation(s)
- Miriam Cotaina
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Marc Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Mireia Boscá
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Iván Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Ana Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain
- Correspondence:
| | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
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Somé NH, Shokoohi M, Shield KD, Wells S, Hamilton HA, Elton-Marshall T, Abramovich A. Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada. BMC Public Health 2022; 22:452. [PMID: 35255847 PMCID: PMC8899793 DOI: 10.1186/s12889-022-12779-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults. METHODS Successive waves of web-based cross-sectional surveys. SETTING Canada, May 2020 to March 2021. PARTICIPANTS 6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years. MEASUREMENTS Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement. RESULTS Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected. CONCLUSIONS Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.
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Affiliation(s)
- Nibene H Somé
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Mostafa Shokoohi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,World Health Organization/Pan American Health Organization Collaborating Centre in Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Samantha Wells
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Wolfe HL, Biello KB, Reisner SL, Mimiaga M, Cahill S, Hughto JM. Transgender-related discrimination and substance use, substance use disorder diagnosis and treatment history among transgender adults. Drug Alcohol Depend 2021; 223:108711. [PMID: 33866073 PMCID: PMC8114322 DOI: 10.1016/j.drugalcdep.2021.108711] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/15/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substantial research gaps exist regarding the relationship between transgender-related discrimination and substance use outcomes for transgender adults, with few studies accounting for other experiences of victimization. METHODS Transgender adults (N = 600) from Massachusetts and Rhode Island completed a survey online or in-person. Multivariable linear and logistic regression models examined the association between lifetime experiences of transgender-related discrimination using the validated 11-item Everyday Discrimination Scale (theoretical range = 0-44) and substance use outcomes: past 12-month substance use frequency, lifetime substance use disorder (SUD) diagnosis, and substance use treatment (SUTx) history. All models were adjusted for age, gender identity, race, survey modality, childhood physical/sexual abuse, intimate partner violence, and discrimination attributable to other reasons than being transgender. RESULTS The mean transgender-related discrimination score was 20.8 (SD = 9.6, range = 0-44). Overall, 11.8 % of the sample had a SUD diagnosis and 11.0 % had received SUTx. In separate multivariable models adjusted for sociodemographic and victimization experiences, the highest quartile of transgender-related discrimination was significantly associated with higher past 12-month substance use (B = 1.44; aR2 = 0.13; p = .009), SUD diagnosis (aOR = 3.64; 95 % CI = 1.46-9.07; p = .006), and lifetime treatment history (aOR = 3.93; 95 % CI = 1.50-10.21; p = .005). CONCLUSIONS There was a significant positive association between experiencing high levels of transgender-related discrimination and substance use outcomes among the transgender adults sampled. Longitudinal research is needed to understand the specific mediators driving these relationships and to address the implications of transgender-related discrimination on SUD treatment utilization.
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Affiliation(s)
- Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA 01730
| | - Katie B. Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI,Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903,Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215,General Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Matthew Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI,Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903,General Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA 90095
| | - Sean Cahill
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215,Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA
| | - Jaclyn M.W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI,Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02903,Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215
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Hernandez CJ, Trujillo D, Sicro S, Meza J, Bella M, Daza E, Torres F, McFarland W, Turner CM, Wilson EC. High hepatitis C virus seropositivity, viremia, and associated risk factors among trans women living in San Francisco, California. PLoS One 2021; 16:e0249219. [PMID: 33784365 PMCID: PMC8009419 DOI: 10.1371/journal.pone.0249219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/14/2021] [Indexed: 02/01/2023] Open
Abstract
Trans women have been understudied in the Hepatitis C virus (HCV) epidemic, yet data suggest they may be at elevated risk of the disease. Using data collected from the Centers for Disease Control and Prevention's (CDC) National HIV Behavioral Surveillance (NHBS) survey, we measured HCV seropositivity, viremia, and associated risk factors for HCV infection among trans women in San Francisco from June 2019 to February 2020. Respondent-driven sampling (RDS) was used to obtain a diverse, community-based sample of 201 trans women, of whom 48 (23.9%, 95% CI 17.9% - 30.0%) were HCV seropositive. HCV seropositivity significantly increased with increasing age (adjusted prevalence ratio [APR] 1.04 per year, 95% CI 1.01-1.07) and history of injection drug use (APR 4.44, 95% CI 2.15-9.18). We also found that many had HCV viremia as twelve (6.0% of the total sample, 95% CI 2.7% - 9.3%) were RNA-positive for HCV. Trans women are highly impacted by HCV and could benefit from access to regular and frequent HCV screening and treatment access. HCV screening could be offered regularly in trans-specific health services, in the community, in jails and prisons, and integrated syringe exchange programs where treatment access or referral are also available.
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Affiliation(s)
| | - Dillon Trujillo
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Sofia Sicro
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Joaquin Meza
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Mackie Bella
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Emperatriz Daza
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Francisco Torres
- Center for Public Health Research, San Francisco, CA, United States of America
| | - Willi McFarland
- Center for Public Health Research, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
| | - Caitlin M. Turner
- Center for Public Health Research, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
| | - Erin C. Wilson
- Center for Public Health Research, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
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6
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Hughto JMW, Quinn EK, Dunbar MS, Rose AJ, Shireman TI, Jasuja GK. Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults. JAMA Netw Open 2021; 4:e2036512. [PMID: 33538824 PMCID: PMC7862992 DOI: 10.1001/jamanetworkopen.2020.36512] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. OBJECTIVES To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. MAIN OUTCOMES AND MEASURES SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). RESULTS In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). CONCLUSIONS AND RELEVANCE In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.
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Affiliation(s)
- Jaclyn M. W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Health Promotion and Health Equity, Brown School of Public Health, Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Emily K. Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | | | - Adam J. Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Guneet K. Jasuja
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
- OptumLabs, Eden Prairie, Minnesota
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Reback CJ, Fletcher JB, Fehrenbacher AE, Kisler K. Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!). JMIR Res Protoc 2019; 8:e12837. [PMID: 31359867 PMCID: PMC6690158 DOI: 10.2196/12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/26/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID) DERR1-10.2196/12837
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc, Los Angeles, CA, United States
| | | | - Anne E Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kimberly Kisler
- Friends Research Institute, Inc, Los Angeles, CA, United States
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8
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Naseh M, Wagner EF, Abtahi Z, Potocky M, Zahedi L. Prevalence of and risk factors for substance use among Afghan refugees in Iran: An exploratory study. J Ethn Subst Abuse 2019; 20:34-59. [PMID: 30806180 DOI: 10.1080/15332640.2019.1571976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Afghan refugees may be a high-risk group for substance use problems. However, research is scarce in this area, specifically among Afghan refugees in one of their main host countries, Iran. This study aimed to estimate the prevalence of substance use among this population and explore the associated risk factors using a mixed-methods design. Findings suggest that 4.2% of the surveyed households had at least one adult member using illicit drugs. Moreover, results show that substance use among Afghans had statistically significant associations with illiteracy, lack of documentation, living in slum areas, and multidimensional poverty. Policy implications are discussed and recommendations provided.
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Affiliation(s)
- Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, Florida
| | - Eric F Wagner
- Community-Based Research Institute, Florida International University, Miami, Florida
| | - Zahra Abtahi
- Department of Anthropology, University of Tehran, Tehran, Iran
| | - Miriam Potocky
- Department of Anthropology, University of Tehran, Tehran, Iran
| | - Leila Zahedi
- Department of Computing and Information Science, Florida International University, Miami, Florida
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9
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Staples JM, Bird ER, Masters TN, George WH. Considerations for Culturally Sensitive Research With Transgender Adults: A Qualitative Analysis. JOURNAL OF SEX RESEARCH 2018; 55:1065-1076. [PMID: 28276930 PMCID: PMC7064308 DOI: 10.1080/00224499.2017.1292419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transgender (trans) individuals have historically been left out of research, and previous work has often conflated gender identity with sexual orientation. Furthermore, language used in psychology measures is often heteronormative and uses binary gendered language (e.g., "him"/"her"). The aim of the current study was to provide empirically derived guidance on conducting culturally sensitive research with transgender participants using qualitative data. We recruited trans individuals, ages 18 to 44, to participate in an anonymous, qualitative, national online survey as part of a quantitative study on the relationships among minority stress, sexual behavior, and mental health. The qualitative portion included four open-ended feedback questions. We identified four overarching themes regarding experiences with our survey: (a) emotional reaction; (b) insight gained; (c) being outside the box; and (d) value of the work. Research with trans adults should be more inclusive of diverse gender identities, sexual identities, and sexual behaviors. Steps in this direction may include soliciting feedback from community members regarding survey language and response options, allowing participants to contextualize their responses using open-ended questions, and clarifying language to distinguish between sexual behavior and sexual identity. A list of seven preliminary guidelines was proposed to aid scientists in conducting culturally sensitive research with trans individuals.
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Staples JM, Neilson EC, Bryan AEB, George WH. The Role of Distal Minority Stress and Internalized Transnegativity in Suicidal Ideation and Nonsuicidal Self-Injury Among Transgender Adults. JOURNAL OF SEX RESEARCH 2018; 55:591-603. [PMID: 29148860 DOI: 10.1080/00224499.2017.1393651] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Transgender people are at elevated risk for nonsuicidal self-injury (NSSI) and suicidal ideation compared to the general population. Transgender (trans) refers to a diverse group of people who experience incongruence between their gender identity and sex assigned at birth. The present study is guided by the minority stress model and the psychological mediation framework, which postulate that sexual minority groups experience elevated stress as a result of anti-minority prejudice, contributing to negative mental health outcomes. This study utilized these theories to investigate the role of internalized transnegativity-internalization of negative societal attitudes about one's trans identity-in the relationships of distal trans stress to suicidal ideation and NSSI. A U.S. national sample of trans adults (N = 237) completed a battery of online measures. Structural equation modeling (SEM) was used to compare models with mediation and moderation effects. Results suggested that internalized transnegativity acts as both a mediator and a moderator in the relationship between distal trans stress and suicidal ideation. Log likelihood comparisons suggested moderation models had the superior fit for these data. Results suggest that clinical interventions should directly target individuals' internalized transnegativity as well as societal-level transnegativity.
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Staples JM, Neilson EC, George WH, Flaherty BP, Davis KC. A descriptive analysis of alcohol behaviors across gender subgroups within a sample of transgender adults. Addict Behav 2018; 76:355-362. [PMID: 28903090 DOI: 10.1016/j.addbeh.2017.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/10/2017] [Accepted: 08/17/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Transgender (trans) adults are identified as an at-risk group for problem alcohol use. Descriptive empirical data examining alcohol behaviors among trans adults is limited. The present study investigates alcohol behaviors - quantity, frequency, alcohol-related problems, and drinking to cope motives - across sex assigned at birth, gender expression, and gender identity subgroups within a sample of trans adults. METHOD A total of 317 trans participants were recruited to complete a cross-sectional battery of online measures assessing alcohol use behaviors, alcohol-related problems, and drinking to cope. Gender identity was assessed through two methods: (1) an open-ended question in which participants wrote-in their primary gender identity; and (2) participants rated the extent to which they identified with 14 gender identity categories. RESULTS This sample had high rates of alcohol use, alcohol-related problems, and drinking to cope motives relative to the general population. Significant and meaningful differences in drinking frequency, alcohol-related problems and drinking motives were found according to gender expression, but not sex assigned at birth or gender identity. CONCLUSIONS Future work should examine alcohol behaviors among trans individuals, including investigation of predictors and causal pathways, to inform prevention and intervention work aimed at reducing trans people's risk for alcohol-related problems.
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Affiliation(s)
- Jennifer M Staples
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Elizabeth C Neilson
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - William H George
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Brian P Flaherty
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, United States.
| | - Kelly Cue Davis
- College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004, United States.
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Glynn TR, van den Berg JJ. A Systematic Review of Interventions to Reduce Problematic Substance Use Among Transgender Individuals: A Call to Action. Transgend Health 2017; 2:45-59. [PMID: 28861547 PMCID: PMC5549596 DOI: 10.1089/trgh.2016.0037] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work.
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Affiliation(s)
- Tiffany R. Glynn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
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Reback CJ, Ferlito D, Kisler KA, Fletcher JB. Recruiting, Linking, and Retaining High-risk Transgender Women into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned. Int J Transgend 2016; 16:209-221. [PMID: 27110227 DOI: 10.1080/15532739.2015.1081085] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Despite disproportionately high HIV prevalence rates and high risk for HIV acquisition and transmission, trans women in the United States are less likely than other high-risk populations to be aware of their HIV status or to perceive HIV infection as a serious health threat. Furthermore, concurrently high rates of unstable housing, few legal employment opportunities, lack of social support, and distrust of social service providers limit trans women's interest or ability to be recruited by, retained within, or linked into HIV prevention and care services. This article provides an overview of the barriers that prevent many high-risk trans women from being recruited, linked, and retained within HIV prevention and care services as well as accessing HIV testing services, and discusses several strategies for overcoming these barriers. Best practices in working with high-risk trans women include hiring trans women indigenous to the local trans communities, designing culturally specific recruitment and retention strategies including the creation of living "community maps" to ensure successful community outreach, the construction of a trans women-specific CAB to create dialogue with community stakeholders including consumers, and extensive cultural sensitivity training for staff and community collaborators to sensitize them to the specific needs of high-risk trans women participants.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., Los Angeles, CA 90028; David Geffen School of Medicine, Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA
| | - Dahlia Ferlito
- Friends Research Institute, Inc., Los Angeles, CA 90028; City of Los Angeles, AIDS Coordinator's Office
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Fletcher JB, Kisler KA, Reback CJ. Housing status and HIV risk behaviors among transgender women in Los Angeles. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1651-61. [PMID: 25190499 PMCID: PMC4214608 DOI: 10.1007/s10508-014-0368-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 05/23/2023]
Abstract
Due to social stigma, lack of social support, and minimal legal employment opportunities, transgender women (transwomen) face elevated rates of unstable housing. This study examined the association between housing status and HIV risk behaviors among 517 transwomen encountered through street outreach. Seven variables (including sociodemographics, HIV status, housing status, and sexual partner type) were used to estimate partial associations during multivariable analyses; housing status was coded trichotomously (housed, marginally housed, and homeless) for these analyses. Results demonstrated that homeless and marginally housed transwomen engaged in significantly higher rates of illicit drug use than housed transwomen; however, marginally housed and housed transwomen engaged in significantly higher rates of illegal hormone injections than homeless transwomen. Rates of sex work were high in the sample as a whole, though sex with an exchange partner was most common among the marginally housed transwomen. Multivariate logistic regression revealed that unstable housing moderated the association between HIV status and engagement in unprotected serodiscordant anal intercourse. The marginally housed transwomen exhibited the greatest risk profile for HIV acquisition or transmission.
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Affiliation(s)
- Jesse B Fletcher
- Friends Research Institute, Inc, 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA,
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Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, Becker J. Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study. Am J Public Health 2014; 104:2199-206. [PMID: 25211716 PMCID: PMC4202966 DOI: 10.2105/ajph.2014.302106] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women. METHODS We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links. RESULTS Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse. CONCLUSIONS Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population.
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Affiliation(s)
- Larry Nuttbrock
- At the time of this research, Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute/Columbia University, New York, NY. Larry Nuttbrock, Andrew Rosenblum, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Sel Hwahng is with Columbia University
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