302972
Experiences of Stigma in Healthcare Among U.S. Trans Masculine Adults: A Gender Minority Stress Model of Substance Use to Cope with Mistreatment
Methods: The U.S. National Transgender Discrimination Survey is a large, convenience sample of transgender adults purposively sampled in 2008 who completed a cross-sectional survey. Enacted stigma (having been refused care by a healthcare provider) and anticipated stigma (delaying needed medical care when sick/injured or delaying routine preventive care) were examined in relation to self-reported substance use to cope with mistreatment among trans masculine respondents (n=2,578). Missing data were multiply imputed and multivariable logistic regression models estimated Risk Ratios(RR) and 95% Confidence Intervals(95%CI).
Results: Overall, 14% reported being refused healthcare by a provider, 33% delayed needed medical care when sick/injured, and 39% delayed routine preventive care. Being refused care was significantly associated with both delaying needed medical care when sick/injured (RR=5.34;95% CI=4.11,6.93) and delaying routine preventive medical care (RR=5.73; 95%CI=4.33,7.60). Enacted stigma by providers was associated with self-reported substance use to cope with mistreatment (RR=1.73; 95% CI=1.35, 2.23). Controlling for anticipated stigma, delays in needed or preventive care were significantly associated with substance use (p<0.05), and attenuated the effect of enacted stigma (RR=1.38;95% CI=1.06,1.79).
Conclusions: Findings indicate a gender minority stress framework is pivotal to understanding the health and wellbeing of trans masculine adults. Gender-related stressors should be integrated into public health prevention and intervention efforts with this underserved population, including for substance use.
Learning Areas:
EpidemiologyPublic health or related research
Social and behavioral sciences
Learning Objectives:
Evaluate the prevalence and correlates of enacted and anticipated stigma in healthcare among a large national sample of U.S. trans masculine adults. Identify associations between stigma experiences in healthcare and substance use to cope with mistreatment. Discuss findings using a gender minority social stress model to inform public health efforts.
Keyword(s): Health Disparities/Inequities, Behavioral Research
Qualified on the content I am responsible for because: I am a Postdoctoral Research Fellow in the Department of Epidemiology at Harvard School of Public Health and a Research Scientist at The Fenway Institute at Fenway Health. My research focuses on health disparities in LGBT populations, with a focus on local, national, and global transgender and gender nonconforming health; the epidemiology of infectious diseases in marginalized, underserved populations; psychiatric epidemiology with a focus on mental health disparities and resiliencies in youth and young adults.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.