Thursday, December 24, 2015

Substance Use to Cope with Stigma in Healthcare among U.S. Female-to-Male Trans Masculine Adults

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.

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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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