Purpose: Enacted
and anticipated stigma exist within healthcare settings for transgender people,
but research has yet to examine the effects of these forms of stigma on the
substance use behaviors of female-to-male (FTM) trans masculine people.
Methods: Data
were analyzed from the cross-sectional U.S. National Transgender Discrimination
Survey, a convenience sample of transgender adults purposively sampled in 2008.
Trans masculine respondents (n=2,578) were identified using a two-step
method: Step 1, Assigned birth sex; Step 2, Current gender identity. A gender
minority stress model of substance use was tested to examine the relation of
enacted and anticipated stigma with substance use to cope with mistreatment.
Results: Overall,
14.1% of the sample reported having been refused care by a provider (enacted stigma), 32.8% reported delaying needed
medical care when sick/injured, and 39.1% delayed routine preventive care (anticipatedstigma).
Having been refused care was significantly associated with avoidance of
healthcare, including delaying needed medical care when sick/injured and
delaying routine preventive medical care. Substance use to cope with
mistreatment was self-reported by 27.6% of the sample. Enacted stigma by providers was associated with
self-reported substance use to cope. Delays in both needed and preventive care
(anticipated stigma)
were highly associated with substance use, and attenuated the effect of enacted stigma.
Conclusion: Gender
minority-related stressors, particularly enacted and anticipated stigma in healthcare, should be integrated
into substance use and abuse prevention and intervention efforts with this
underserved population.
Purchase full article at: http://goo.gl/lgxnCd
By: Sari L. Reisner, MA, ScD,1,2 Seth T.
Pardo, PhD,3 Kristi E. Gamarel, PhD, EdM,4 Jaclyn
M. White Hughto,MPH,2,5 Dana J. Pardee,2 and Colton
L. Keo-Meier, PhD6,7
1Department of Epidemiology, Harvard School
of Public Health, Boston, Massachusetts.
2The Fenway Institute, Fenway Health, Boston,
Massachusetts.
3The Rockway Institute, Alliant
International University, San Francisco, California.
4Department of Psychiatry & Human Behavior, Alpert
Medical School of Brown University, Providence, Rhode Island.
5Chronic Disease Epidemiology, Yale School
of Public Health, New Haven, Connecticut.
6Michael E. DeBakey VA Medical Center and
Menninger Department of Psychiatry, Baylor College of Medicine, Houston,
Texas.
7Department of Psychology, University of Houston,
Houston, Texas.
Address correspondence to:
Sari L. Reisner, MA, ScD
The Fenway Institute
Fenway Health
1340 Boylston Street, 8th Floor
Boston, MA 02215
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