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Wilson LC, Newins AR, Kassing F, Casanova T. Gender Minority Stress and Resilience Measure: A Meta-Analysis of the Associations with Mental Health in Transgender and Gender Diverse Individuals. TRAUMA, VIOLENCE & ABUSE 2024; 25:2552-2564. [PMID: 38160246 DOI: 10.1177/15248380231218288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Transgender and gender diverse (TGD) individuals are more likely to experience mental health difficulties than cisgender individuals due to unique stressors related to their stigmatized gender identity and/or expression. This meta-analysis examined the associations between gender minority stressors and resilience factors, as measured by the Gender Minority Stress and Resilience Measure (GMSR; Testa et al., 2015), and two types of mental health symptoms (i.e., depression and anxiety). A comprehensive literature search and study inclusion process following PRISMA guidelines identified 69 sources, representing 47 unique samples. Mean effect sizes revealed significant positive associations between all GMSR minority stress subscales and anxiety and depression symptoms (rs = .22 to .40) with larger correlations for proximal stressors compared to distal stressors. The GMSR resilience subscales were significantly negatively correlated with anxiety and depression symptoms (rs = -.07 to -.16). These findings highlight the robust relationship between gender minority stressors and mental health symptoms among TGD individuals and indicate a need for addressing these stressors both by reducing exposure to external stressors and by addressing the internalization of those stressors in clinical settings. The small effects for the resilience subscales suggest a need to examine additional resilience factors that may be more pertinent to mental health among TGD individuals.
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Rogers SM, Lopez RM, Crossway AK, Moffit DM, Sturtevant J, Hansen A. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I. J Athl Train 2024; 59:338-344. [PMID: 36735644 PMCID: PMC11064106 DOI: 10.4085/1062-6050-0311.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.
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Affiliation(s)
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
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Price MA, Hollinsaid NL, McKetta S, Mellen EJ, Rakhilin M. Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults. Soc Psychiatry Psychiatr Epidemiol 2024; 59:285-294. [PMID: 37165214 PMCID: PMC10171731 DOI: 10.1007/s00127-023-02482-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.
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Affiliation(s)
- Maggi A Price
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA.
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | | | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Emily J Mellen
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Marina Rakhilin
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA
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Zubizarreta D, Trinh MH, Reisner SL. Quantitative approaches to measuring structural cisgenderism. Soc Sci Med 2024; 340:116437. [PMID: 38000173 DOI: 10.1016/j.socscimed.2023.116437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
There is rapidly growing interest in understanding the impacts of structural cisgenderism on health and health inequities for transgender and nonbinary populations. This growing interest has led to an influx of novel measures of structural cisgenderism. In this commentary, we discuss and identify gaps in existing measures and offer considerations for the development of future measures. Developing and utilizing valid measures of structural cisgenderism is crucial to quantify its impacts on health and health inequities, and to inform public health interventions, laws, and policies to eliminate gender identity and modality-based health inequities.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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5
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Kcomt L, Evans-Polce RJ, Engstrom CW, Takahashi J, Matthews PA, Veliz PT, West BT, McCabe SE. Social Ecological Influences on Nicotine/Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults in the USA. Ann Behav Med 2024; 58:1-11. [PMID: 37983126 PMCID: PMC10729790 DOI: 10.1093/abm/kaad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Our study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. individuals. METHODS Data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (n = 33,197 U.S. adolescents and adults aged ≥14 years) and state-level gender minority policy data were used. Using multivariable logistic regression, the odds of past-30-day nicotine/tobacco use at W4 were estimated as a function of gender stability/variability, psychological distress, number of tobacco products used by family/friends, anti-tobacco marketing exposure, and change in gender minority-related policies from 2015 to 2017. RESULTS Gender-varying individuals had higher odds of nicotine/tobacco use compared with gender-stable individuals (AOR range = 1.7-2.3, p < .01). In the overall sample, positive change in gender minority policy protections (tallied from medium to high) was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use (AOR = 0.8, p < .05) compared to states with no change in their negative policies. Anti-tobacco marketing exposure was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no anti-tobacco marketing exposure (AOR = 0.9, p < .05). Higher psychological distress (AOR range = 1.7-2.4, p < .001) and an increasing number of tobacco products used by family/friends (AOR range = 1.1-1.3, p < .001) were associated with increased odds of nicotine/tobacco use. CONCLUSIONS Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals.
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Affiliation(s)
- Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI, USA
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Curtiss W Engstrom
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Phil T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
| | - Brady T West
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Gonzales G, Tran NM, Bennett MA. State Policies and Health Disparities between Transgender and Cisgender Adults: Considerations and Challenges Using Population-Based Survey Data. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:555-581. [PMID: 35576319 DOI: 10.1215/03616878-9978117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT The authors examined the association between state-level policy protections and self-rated health disparities between transgender and cisgender adults. METHODS They used data on transgender (n = 4,982) and cisgender (n = 1,168,859) adults from the 2014-2019 Behavioral Risk Factor Surveillance System. The authors estimated state-specific health disparities between transgender and cisgender adults, and they used multivariable logistic regression models to compare adjusted odds ratios between transgender and cisgender adults by state-level policy environments. FINDINGS Transgender adults were significantly more likely to report poor/fair health, frequent mental distress, and frequent poor physical health days compared to cisgender adults. Disparities between transgender and cisgender adults were found in states with strengthened protections and in states with limited protections. Compared to transgender adults in states with limited protections, transgender adults in states with strengthened protections were marginally less likely to report frequent mental distress. CONCLUSIONS Transgender adults in most states reported worse self-rated health than their cisgender peers. Much more research and robust data collection on gender identity are needed to study the associations between state policies and transgender health and to identify best practices for achieving health equity for transgender Americans.
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DuBois LZ, Juster RP. Lived experience and allostatic load among transmasculine people living in the United States. Psychoneuroendocrinology 2022; 143:105849. [PMID: 35797839 DOI: 10.1016/j.psyneuen.2022.105849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transgender and gender diverse people face significant stigma that can adversely affect their physical and mental health. However, the psychobiological link between lived experience and health has been underexplored in this population. We thus examine perceived distress, mental health, and physiological 'wear and tear' by indexing allostatic load (AL) and assess associations with a range of contextual and experiential factors from transmasculine people living in the United States. METHODS Sixty-five people who identified as transgender men or along a transmasculine spectrum, living in Massachusetts, Vermont, and Rhode Island participated in The Transition Experience Study (age: M=31.8, range 18-55), which examines lived experience of social and medical transition and embodied gender minority/marginalization stress among a sample of transmasculine people. Based on in-depth in-person interview and survey data and inspired by an ecological systems model, we created indices representing (1) perceived progressive geopolitical climate; (2) socio-demographic advantage; (3) social support and resources; (4) gender minority and marginalization stressors; and (5) health behaviors. The Perceived Stress Scale and psychological symptoms (depression, anxiety, insomnia) were also assessed. AL indexed 10 neuroendocrine, immune, cardiovascular, and metabolic biomarkers. RESULTS Regressions revealed that perceived stress and psychological symptoms were negatively correlated with progressive geopolitical climate (respectively B=-1.47, p = 0.19; B=-.77, p < .001) and positively correlated with gender minority and marginalization stressors (respectively B=1.51, p < .001; B =.38, p = .005). AL was negatively associated with perceived progressive geopolitical climate (B=-.55, p = .007) and socio-demographic advantage (B=-3.2, p = .001). DISCUSSIONS These findings underline the importance of assessing geopolitical context and indexing lived experiences and life domains along with biomarker sampling. Together, these enable the identification of psychobiological pathways to better nuance multi-level contributors to health and well-being and understand embodied inequalities. These analyses of embodied stigma inclusive of AL biomarkers thus provide a model to further research centering transgender people's health from youth through old age.
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Affiliation(s)
- L Zachary DuBois
- Department. of Anthropology, University of Oregon, 355 Condon Hall, Eugene, OR 97403, United States.
| | - Robert-Paul Juster
- Center on Sex⁎Gender, Allostasis, and Resilience, 7331 Hochelaga, Pavillon Fernand-Seguin, FS-145-12, Montreal, Quebec H1N 3V2, Canada; Department of Psychiatry and Addiction, University of Montreal, Researcher, Research Center of the Montreal Mental Health University Institute, 7331 Hochelaga, Pavillon Fernand-Seguin, FS-145-12, Montreal, Quebec H1N 3V2, Canada.
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8
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Pharr JR, Chien LC, Gakh M, Flatt J, Kittle K, Terry E. Serial Mediation Analysis of the Association of Familiarity with Transgender Sports Bans and Suicidality among Sexual and Gender Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710641. [PMID: 36078355 PMCID: PMC9518152 DOI: 10.3390/ijerph191710641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association. METHODS This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis. RESULTS The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults (p-value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained (p-value = 0.0106). CONCLUSION State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.
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Affiliation(s)
- Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Correspondence: ; Tel.: +1-(702)-895-2006
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Maxim Gakh
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Jason Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Krystal Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Emylia Terry
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
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Sweileh WM. Research Publications on the Mental Health of Transgender People: A Bibliometric Analysis Using Scopus Database (1992–2021). Transgend Health 2022. [DOI: 10.1089/trgh.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Clark KD, Lunn MR, Lev EM, Trujillo MA, Lubensky ME, Capriotti MR, Hoffmann TJ, Obedin-Maliver J, Flentje A. State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9916. [PMID: 36011548 PMCID: PMC9407724 DOI: 10.3390/ijerph19169916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018−2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.
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Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH 03824, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Eliot M. Lev
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | - Michael A. Trujillo
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | | | - Thomas J. Hoffmann
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine San Francisco, San Francisco, CA 94143, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA 94143, USA
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11
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Lynch KE, Livingston NA, Gatsby E, Shipherd JC, DuVall SL, Williams EC. Alcohol-attributable deaths and years of potential life lost due to alcohol among veterans: Overall and between persons with minoritized and non-minoritized sexual orientations. Drug Alcohol Depend 2022; 237:109534. [PMID: 35717789 DOI: 10.1016/j.drugalcdep.2022.109534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unhealthy alcohol use is disproportionally experienced by individuals with minoritized sexual orientations. Unlike the general US population, for whom the burden of alcohol as it relates to mortality is consistently monitored across time with national survey data, the impact of unhealthy alcohol use among veterans with minoritized sexual orientations, for whom addressing substance use is a national priority, is largely unknown. METHODS Using Alcohol Use Disorders Identification Test Consumption data from the Department of Veterans Affairs electronic health record and underlying cause of death from National Death Index from 2014 to 2018 we quantified alcohol consumption and related mortality among veterans with (n = 102,085) and without minoritized sexual orientations (n = 5300,521). Age adjusted rates of alcohol attributed deaths (AAD) per 100,000 persons and years of potential life lost (YPLL) were estimated by sexual orientation, sex, and sexual orientation stratified by sex. RESULTS Alcohol attributable deaths (n = 21,861) were higher among veterans with minoritized sexual orientations than veterans without after adjustment for age (486.5 deaths/100,000 versus 309.7 deaths/100,000, respectively). Veterans with minoritized sexual orientations also experienced more YPLL (13,772.8 years/100,000 versus 7618.9 years/100,000). Years of potential life lost per AAD was higher in women (33.2 years) than men (18.7 years). CONCLUSIONS Alcohol consumption results in substantial disability and death among veterans, particularly veterans with minoritized sexual orientations. Findings suggest need for increased alcohol-related services for all VA patients, and potential targeted approaches to for veterans with minoritized sexual orientations and women to offset risk for, and years of potential life lost from, alcohol attributable death.
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Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA.
| | - Nicholas A Livingston
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Jillian C Shipherd
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA; Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; LGBTQ+ Health Program, Veterans Health Administration, 810 Vermont Avenue NW, Washington, DC 20420, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Avenue NW, Seattle, WA 98195, USA; Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound 1660 S Columbian Way, Seattle, WA 98108, USA
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12
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Hughes LD, Gamarel KE, King WM, Goldenberg T, Jaccard J, Geronimus AT. State-Level Policy Stigma and Non-Prescribed Hormones Use among Trans Populations in the United States: A Mediational Analysis of Insurance and Anticipated Stigma. Ann Behav Med 2022; 56:592-604. [PMID: 34390573 PMCID: PMC9242548 DOI: 10.1093/abm/kaab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. PURPOSE We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured. METHODS We conducted analyses using data from the 2015 U.S. Transgender Survey. The analytic sample included trans adults using hormones (N = 11,994). We fit a multinomial structural equation model to examine associations. RESULTS Among trans adults using hormones, we found that healthcare policy stigma was positively associated with NPHs use and operated through insurance coverage and anticipating stigma in healthcare settings. The effect sizes on key predictor variables varied significantly between those who use supplemental NPHs and those who only use NPHs suggesting the need to treat NPHs use as distinct from those who use supplemental NPHs. CONCLUSIONS Our work highlights the importance of healthcare policy stigma in understanding health inequities among trans people in the USA, specifically NPHs use.
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Affiliation(s)
- Landon D Hughes
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristi E Gamarel
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M King
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, NY, USA
| | - Arline T Geronimus
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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13
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Tan KKH, Saw ATW. Prevalence and correlates of mental health difficulties amongst LGBTQ people in Southeast Asia: A systematic review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2089427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kyle K. H. Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Andrew T. W. Saw
- Labuan Faculty of International Finance, Univerisiti Malaysia Sabah, Sabah, Malaysia
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14
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Agénor M, Pérez AE, Solazzo AL, Beccia AL, Samnaliev M, Wu J, Charlton BM, Austin SB. Assessing Variations in Sexual Orientation- and Gender Identity-Related U.S. State Laws for Sexual and Gender Minority Health Research and Action, 1996-2016. LGBT Health 2022; 9:207-216. [PMID: 35297661 DOI: 10.1089/lgbt.2021.0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: We developed a multiyear database of sexual orientation- and gender identity-related U.S. state laws to advance sexual and gender minority (SGM) health research and practice and assessed variability in U.S. state laws from 1996 through 2016 across all U.S. states and D.C. Methods: Between 2014 and 2016, a multidisciplinary group of SGM health researchers and legal experts used secondary and primary legal sources and policy surveillance methods to systematically develop a state-level legal database of 30 sexual orientation- and gender identity-related U.S. state laws in 9 legal domains from 1996 through 2016. We calculated descriptive statistics and created maps to observe the distribution of these laws over both time and space. Results: Although progress has occurred in some domains, such as same-sex marriage, adoption, and employment discrimination, significant challenges to SGM rights remain, especially with regard to HIV criminalization, transgender rights, and discrimination in health care settings. Further, notable variation exists in the presence of protective lesbian, gay, bisexual, transgender, queer (LGBTQ) state laws across U.S. states and D.C. Conclusion: Efforts to repeal harmful U.S. state laws are needed, as are new laws, policies, regulations, practices, and norms that advance social justice and health equity for all SGM people.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Alexa L Solazzo
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ariel L Beccia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mihail Samnaliev
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Janson Wu
- GLBTQ Legal Advocates and Defenders (GLAD), Boston, Massachusetts, USA
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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15
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Rabasco A, Andover M. Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors. J Affect Disord 2021; 278:136-143. [PMID: 32961408 DOI: 10.1016/j.jad.2020.09.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/18/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Transgender and gender-diverse (TGD) people experience greatly heightened levels of suicidal ideation (SI) compared to the general population. Therefore, it is imperative to understand the risk and protective factors for SI within this population. METHODS The present study explored how victimization, discrimination, community connectedness, and pride impact SI cross-sectionally and longitudinally in a sample of TGD adults (N = 180, 55% transgender women, 76.7% Caucasian, M age = 26.01 years). RESULTS Cross-sectional results showed that experiencing more types of victimization and discrimination at baseline predicted higher SI severity at baseline, while community connectedness and pride at baseline were not predictive of SI severity at baseline. Longitudinal analyses showed that experiencing fewer types of victimization and discrimination during the 1-month follow-up period were associated with a decrease in SI severity from baseline to follow-up. Medium and high levels of community connectedness were also associated with a decrease in SI severity from baseline to follow-up. Pride was not associated with change in SI from baseline to follow-up. LIMITATIONS Limitations include the limited racial/ethnic diversity of the sample and that frequency of experiencing victimization and discrimination was not assessed. CONCLUSIONS These results suggest victimization and discrimination are strong predictors of SI severity within this population, and the factors of victimization, discrimination, and TGD-community connectedness impact change in SI severity across time. These findings provide evidence for the importance of anti-discrimination laws that apply to TGD people, as well as the utility of connecting TGD clients to the TGD community.
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Affiliation(s)
- Ana Rabasco
- Department of Psychology, Fordham University, United States
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16
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Rabasco A, Andover M. The Influence of State Policies on the Relationship Between Minority Stressors and Suicide Attempts Among Transgender and Gender-Diverse Adults. LGBT Health 2020; 7:457-460. [PMID: 33090075 DOI: 10.1089/lgbt.2020.0114] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state policies in a sample of transgender and gender-diverse (TGD) adults. Methods: TGD adults (n = 133) were recruited online and completed questionnaires. Results: Protective state policies moderated the relationship between minority stressors and SAs, with a significant positive association between minority stressors and SAs at low, but not medium and high, policy scores. Conclusion: A lack of protective state policies may be a risk factor in the relationship between minority stressors and SAs among TGD individuals.
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Affiliation(s)
- Ana Rabasco
- Psychology Department, Fordham University, New York, New York, USA
| | - Margaret Andover
- Psychology Department, Fordham University, New York, New York, USA
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17
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Jin H, Restar A, Goedel WC, Ogunbajo A, Biello K, Operario D, Kuhns L, Reisner SL, Garofalo R, Mimiaga MJ. Maternal Support Is Protective Against Suicidal Ideation Among a Diverse Cohort of Young Transgender Women. LGBT Health 2020; 7:349-357. [PMID: 32897809 DOI: 10.1089/lgbt.2020.0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: We assessed if young transgender women (YTW) with parents who are supportive of their transgender identity had lower odds of having suicidal ideation compared with YTW with unsupportive parents. Methods: This study analyzed baseline findings from a diverse sample of 297 sexually active, YTW 16-29 years of age who were enrolled in Project LifeSkills, a randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. Bivariate and multivariable logistic regression were used to assess if parental support was associated with a decreased odds of suicidal ideation. Results: Nearly one-fifth (18.9%) of YTW reported suicidal ideation at baseline. In our adjusted multivariable model, YTW with supportive mothers had 0.37 (95% confidence interval = 0.15-0.90) times the odds of having suicidal ideation compared with YTW with unsupportive mothers. Conclusion: This study found that the odds of suicidal ideation were lower among YTW who had mothers who were supportive of their transgender identity. Our results suggest that parent-focused interventions to improve the relationships between YTW and their parents may lower the odds of YTW having suicidal ideation. Clinical Trial Registration Identifier: NCT01575938.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - William C Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Katie Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Lisa Kuhns
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Garofalo
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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18
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GOLDENBERG TAMAR, L. REISNER SARI, W. HARPER GARY, E. GAMAREL KRISTI, STEPHENSON ROB. State-Level Transgender-Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender-Diverse People in the United States. Milbank Q 2020; 98:802-846. [PMID: 32808696 PMCID: PMC7482380 DOI: 10.1111/1468-0009.12467] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Policy Points Protective transgender-specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal documents) are associated with increased access to medical gender affirmation services (hormone treatment, therapy/counseling) for transgender and other gender-diverse people. Restrictive transgender-specific policies are associated with less access to these services. The relationship between race/ethnicity and use of medical gender affirmation services varies across states and is context specific, indicating that race/ethnicity also plays a role in access to these types of care across states. Advocacy is needed to prevent or overturn restrictive policies and promote protective policies for transgender and other gender-diverse people, especially for people of color. CONTEXT In the 2010s, the number of federal, state, and local transgender-specific policies increased. Some of these policies advanced protections for transgender and other gender-diverse (TGGD) people, and others were restrictive. Little is known about the relationships between these policies and use of medical gender affirmation services (eg, hormone treatment, therapy/counseling), or about how these associations may vary among different racial and ethnic groups. METHODS Multilevel modeling was used to examine the associations between state-level transgender-specific policies and the use of medical gender affirmation services among TGGD people in the United States. Data are from the 2015 U.S. Trans Survey of nearly 28,000 TGGD people. The medical gender affirmation services examined in this study were hormone treatment and therapy/counseling. The state policies we analyzed addressed discrimination, health insurance coverage, and changing legal documents; these policies were measured individually and as a composite index. Race/ethnicity was included in the multilevel regression models as a random slope to determine whether the relationship between race/ethnicity and the use of medical gender affirmation services varied by state. FINDINGS Individual policies and the policy index were associated with both outcomes (use of therapy/counseling and hormone treatment services), indicating that protective policies were associated with increased care. Broad religious exemption laws and Medicaid policies that excluded transgender-specific care were both associated with less use of therapy/counseling, whereas transgender-care-inclusive Medicaid policies were associated with more use of therapy/counseling. Nondiscrimination protections that include gender identity were associated with increased use of hormone treatment services. The relationship between race/ethnicity and medical gender affirmation services varied across states. CONCLUSIONS State-level transgender-specific policies influence medical gender affirmation service use and seem to affect use by non-Hispanic white TGGD people and TGGD people of color differently. Advocacy is needed to repeal restrictive policies and promote protective policies in order to reduce health inequities among TGGD people, especially people of color.
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Affiliation(s)
- TAMAR GOLDENBERG
- Carolina Population CenterUniversity of North Carolina at Chapel Hill
| | - SARI L. REISNER
- Harvard Medical School/Boston Children's Hospital
- Harvard T.H. Chan School of Public Health
- Fenway Health
| | | | - KRISTI E. GAMAREL
- University of Michigan School of Public Health
- Center for Sexuality and Health DisparitiesUniversity of Michigan
| | - ROB STEPHENSON
- Center for Sexuality and Health DisparitiesUniversity of Michigan
- University of Michigan School of Nursing
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19
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Goldenberg T, Reisner SL, Harper GW, Gamarel KE, Stephenson R. State Policies and Healthcare Use Among Transgender People in the U.S. Am J Prev Med 2020; 59:247-259. [PMID: 32417021 PMCID: PMC7384261 DOI: 10.1016/j.amepre.2020.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The introduction and passing of restrictive and protective transgender-specific state policies have increased during the past decade. These policies are critical for the health of transgender and other gender diverse people; however, little is known about the relationship between these policies and healthcare use, and the role that race/ethnicity plays in this relationship. METHODS Analysis was conducted in 2018-2019 using multilevel modeling and data from the 2015 U.S. Trans Survey (conducted by the National Center for Transgender Equality among nearly 28,000 transgender and other gender diverse people across the U.S.) to explore associations between transgender-specific state policies and healthcare avoidance because of fear of mistreatment. State policies included those related to experiences of discrimination, health insurance coverage, and changing legal documents. Restrictive and protective policies were measured individually and as a composite index. The relationship between race/ethnicity and healthcare use was also examined to determine whether there were differences in the association between race/ethnicity and healthcare avoidance by state. RESULTS None of the individual policies were associated with healthcare use, but the composite index was significant, such that living in states with more protective policies was associated with reduced odds of avoiding health care because of fear of mistreatment. The relationship between race/ethnicity and health care also varied across states. CONCLUSIONS Findings suggest the importance of advocating for more protective transgender-specific policies to improve healthcare access for transgender and other gender diverse people in the U.S., particularly for transgender and other gender diverse people of color.
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Affiliation(s)
- Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sari L Reisner
- Division of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Fenway Health, Boston, Massachusetts
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan; Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
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20
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Walton HM, Baker SL. Treating Transgender Individuals in Inpatient and Residential Mental Health Settings. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2017.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Trauma Recovery in the Transgender and Gender Diverse Community: Extensions of the Minority Stress Model for Treatment Planning. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2019.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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22
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Gamarel KE, Sevelius JM, Reisner SL, Coats CS, Nemoto T, Operario D. Commitment, interpersonal stigma, and mental health in romantic relationships between transgender women and cisgender male partners. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2019; 36:2180-2201. [PMID: 31086428 PMCID: PMC6510026 DOI: 10.1177/0265407518785768] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The goals of this study were to: (a) examine associations between interpersonal stigma and psychological distress among a sample of transgender women and their cisgender male partners; and (b) identify whether commitment moderates the association between interpersonal stigma and psychological distress. To address these aims, 191 couples consisting of transgender women and their cisgender male partners completed a one-time survey. Actor-partner interdependence models (APIM) were fit to examine stigma, commitment, and their interaction on psychological distress. More frequent experiences of interpersonal stigma were associated with elevated psychological distress for both partners. For transgender women, higher commitment was associated with lower psychological distress. There was a significant interaction effect such that the association between interpersonal stigma and psychological distress was attenuated by greater commitment for transgender women, but not for their cisgender male partners. Findings provide preliminary support for associations between interpersonal stigma and mental health of both partners, and identify commitment as a potential stress buffer for transgender women.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Jae M. Sevelius
- Department of Family & Community Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| | | | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
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23
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Kidd JD, Dolezal C, Bockting WO. The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health. LGBT Health 2019; 5:401-411. [PMID: 30334686 DOI: 10.1089/lgbt.2018.0103] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and medical/surgical interventions for gender transition. METHODS Data came from an Internet-based survey of U.S. trans-feminine (n = 631) and trans-masculine (n = 473) individuals. We used multivariable logistic regression to investigate the relationship between past 3-month tobacco use and legal document gender-marker change, hormone use, and gender-affirming surgery controlling for demographic covariates and enacted and felt stigma. RESULTS Compared to trans-feminine participants, trans-masculine individuals reported significantly higher rates of lifetime (74.4% vs. 63.5%) and past 3-month tobacco use (47.8% vs. 36.1%), and began smoking at an earlier age (14.5 vs. 15.5 years). Trans-feminine smokers reported significantly more frequent and heavier use. Adjusting for demographic covariates and enacted and felt stigma, legal document gender-marker change was associated with lower tobacco-use odds among trans-feminine individuals, whereas gender-affirming surgery predicted lower smoking odds among trans-masculine individuals. There were no significant differences in tobacco use by hormone use status. CONCLUSION In this study, trans-masculine individuals were more likely to smoke and trans-feminine individuals reported heavier use. It is concerning that individuals receiving hormones did not report lower smoking rates, given the elevated CV risk of this combination. This is a missed opportunity to intervene on a major public health issue and highlights the need for smoking cessation interventions in this population.
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Affiliation(s)
- Jeremy D Kidd
- 1 Division on Substance Use Disorders, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York.,2 New York State Psychiatric Institute , New York, New York
| | - Curtis Dolezal
- 2 New York State Psychiatric Institute , New York, New York.,3 Division of Gender, Sexuality, and Health, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York
| | - Walter O Bockting
- 2 New York State Psychiatric Institute , New York, New York.,3 Division of Gender, Sexuality, and Health, Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, New York.,4 Columbia University School of Nursing , New York, New York
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Morrison MA, Bishop CJ, Morrison TG. What is the best measure of discrimination against trans people?: A systematic review of the psychometric literature. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1484798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - CJ Bishop
- Department of Psychology Saskatoon, University of Saskatchewan, SK, Canada
| | - Todd G. Morrison
- Department of Psychology Saskatoon, University of Saskatchewan, SK, Canada
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25
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Ritterbusch AE, Correa Salazar C, Correa A. Stigma-related access barriers and violence against trans women in the Colombian healthcare system. Glob Public Health 2018; 13:1831-1845. [PMID: 29583079 DOI: 10.1080/17441692.2018.1455887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Drawing from qualitative research conducted in a participatory action research framework with 28 transgender women in Colombia, this paper presents the stigma-related barriers to healthcare experienced by trans women and their experiences of multi-level violence within the healthcare system. The authors also discuss how advocacy work was conducted as part of the research process and how trans community leaders were involved throughout the project in order to promote policy-relevance and community-based implementation of findings. The paper concludes with a discussion of how the experiences of violence and stigmatisation within the health care system is linked to broader processes of structural stigma reproduced within Colombian society.
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Affiliation(s)
- Amy E Ritterbusch
- a School of Government , Universidad de los Andes , Bogotá , Colombia
| | - Catalina Correa Salazar
- a School of Government , Universidad de los Andes , Bogotá , Colombia.,b Community Health and Harm Reduction Center (Community-Based Organization) , Bogotá , Colombia
| | - Andrea Correa
- c Trans Community Network (Community-Based Organization) , Bogotá , Colombia
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26
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Beyond Depression and Suicide: The Mental Health of Transgender College Students. SOCIAL SCIENCES 2017. [DOI: 10.3390/socsci6010020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Bauermeister JA, Connochie D, Jadwin-Cakmak L, Meanley S. Gender Policing During Childhood and the Psychological Well-Being of Young Adult Sexual Minority Men in the United States. Am J Mens Health 2016; 11:693-701. [PMID: 27903954 PMCID: PMC5393921 DOI: 10.1177/1557988316680938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hegemonic masculinities (i.e., sets of socially accepted masculine behaviors and beliefs within a given time and culture) may affect the well-being of sexual minority men, yet quantitative relationships between these masculinities and well-being remain largely unexplored. Using data from a national cross-sectional survey of young sexual minority men ( N = 1,484; ages 18-24 years), the current study examined the relationship between parental gender policing during childhood and adolescence and subsequent substance use and psychological distress. Over one third of the sample (37.8%) reported their parent(s) or the person(s) who raised them had policed their gender, including the use of disciplinary actions. Using multivariable regression, this study examined the relationship between parental gender policing and psychological well-being and substance use, after adjusting for age, race/ethnicity, educational attainment, and current student status. Gender policing during childhood and adolescence was associated with recent substance use behaviors and psychological distress in multivariable models. A linear association between substance use behaviors and psychological distress and the number of disciplinary actions experienced during childhood and adolescence was also observed. Parents' attempts to police their sons' gender expression were associated with markers of distress among young sexual minority men. The relationship between parental gender policing during childhood and adolescence and distress among young sexual minority men are discussed.
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