Abstract
Adverse childhood experiences and healthcare delay among transgender and nonbinary adults in the US
APHA 2022 Annual Meeting and Expo
In the general population, adverse childhood experiences (ACEs) are correlated with a range of negative health outcomes in adulthood. Recent studies have found transgender and nonbinary (TNB) individuals to report higher rates of ACEs than their cisgender counterparts. ACEs may be one of several unique risk factors that exacerbate health and healthcare disparities TNB individuals face. This study aims to identify the direct and indirect relationships among ACEs and adulthood healthcare delay in an online convenience sample of 138 TNB adults in the United States conducted between 2017-2018. A series of regression and path analyses were conducted using STATA 16.1 assessing the direct association of summary scores of three domains of ACEs (i.e., abuse, neglect, and household dysfunction) on healthcare delay in the past year (yes/no), as well as the indirect association of ACEs on delay through a validated global mental health scale. After controlling for age, insurance status, sexual orientation, and gender identity, abuse (b=0.25, 95% CI: 0.43, 0.46) and neglect (b=0.25, 95% CI: 0.43, 0.46) were significantly directly associated with healthcare delay, but household dysfunction was not. Using generalized structural equation model estimation, the effects of abuse and neglect on healthcare delay were significantly mediated by global mental health (indirect effect=0.13, 95% CI: 0.03, 0.22 and indirect effect=0.22, 95% CI: 0.04, 0.41, respectively). Childhood emotional and physical abuse & neglect are prevalent among TNB populations, which may indirectly contribute to healthcare delay through exacerbated mental health problems. These findings highlight a need for multilevel interventions.