Published and Approved USTS Projects

This page contains information about projects for which use of the 2015 U.S. Transgender Survey dataset has been approved. Please check back here for the most current information about approved projects prior to submitting a data request.

As a note, researcher names and affiliations for approved projects in progress are not listed for privacy reasons. If you are interested in connecting with a researcher about a project listed below, please submit your inquiry to ustsdata@transequality.org, and we will connect you with the researcher if possible.

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Published PROJECTS

A Closer Look: Bisexual Transgender People - An analysis of bisexual USTS respondents by Movement Advancement Project, NCTE, BiNet USA, Bisexual Organizing Project, and Bisexual Resource Center

 

 

Approved Projects in Progress

Family Matters: Trauma and Resilience in Trans Communities

The majority of trauma exposure in the United States is chronic, and takes place in the context of compromised caregiving. Moreover, transgender/gender non-conforming (TGNC) status is significantly associated with elevated exposure to early life trauma. One possible mechanism is that withdrawal of family support exposes TGNC youth to risk of maltreatment from individuals outside the family. The proposed study would utilize cluster analysis to identify clusters of community support the 2015 U.S. Transgender Survey data. This cluster analysis would identify various forms of social support (e.g., family, community, significant other) in the sample population. These clusters would then be used to predict exposure to traumatic stressors through group-based regression analysis. Past evidence with sexual minority populations suggest that the sample will vary significantly by cluster. Moreover, past data suggest that the primary predictor of elevated exposure to traumatic stressors will be low family support, even in a cluster with low family and high "other" support. However, this pattern has not been explored in a sample of TGNC individuals. Additionally, factors of intersectional identity have not been included in past analyses. This study proposes modeling race, ethnicity, age cohort, religious background, and socio-economic status as integral components of the model.

Intersection of Gender, Ethnoracial, and Class Stigma and HIV Testing Patterns among Transgender Women of Color

The disparate rates of individual and structural discrimination faced by transgender women of color is embedded in misogyny, transphobia, racism, and classism. There is scant research examining the interconnected processes of gender, race/ethnicity, and class discrimination towards transgender women of color. This study will explore the social processes—forms of oppression producing health disparities—of discrimination based on gender, race/ethnicity and class targeting transgender women of color aware and unaware of their HIV status. Moreover, it will examine the relationship between intersecting processes of discrimination and HIV testing patterns. Addressing the link between discrimination and reasons to not get tested for HIV is necessary to improve awareness of HIV status and subsequent engagement in care and/or engagement in prevention efforts.

The Effect of Gender Transition-Related Health Care Utilization on Suicidal Thoughts and Behaviors: Findings from the 2015 U.S. Transgender Survey

Prior research suggests a higher prevalence of suicidal thoughts and behaviors among transgender people compared to the U.S. general population. There is an urgent need to identify effective interventions to improve mental health outcomes for trans people. Meta analyses and clinical research suggests that hormone therapy and surgical care are effective in alleviating gender dysphoria. Prior research has also found that hormone therapy, along with surgical care for transition, has resulted in significant improvements in suicidal thoughts and behaviors. This study will examine the effects of medical gender affirmation (hormones and/or surgery) for gender transition on risk of suicidal thoughts and behaviors using a large, non-clinical sample of trans people. The study uses USTS data on lifetime and past-year suicidal thoughts and behaviors, including age at onset and recurrence of suicidal behaviors, as well as age at onset of hormone therapy, and age at first receipt of surgical care for transition. Findings have implications for public health and health policy, including delivery of transition-related health care and future intervention research to mitigate trans mental health disparities.

The Role of Identity, Discrimination, and Safety in the Political Attitudes and Behavior of the Transgender Population

In recent years, the debate over the rights of transgender people has become a dominant issue in political discourse with an impact in the legislative, executive, and judicial branches of government at the state and federal levels. This undoubtedly has an effect on the political behavior of transgender people. Given the salience of issues impacting transgender people, it is important to gain an understanding of factors that influence the political attitudes and behavior of transgender people. This research seeks to fill gaps in the literature and provide vital information about the political attitudes and behavior of transgender people by examining several forms of political participation among transgender people as assessed in the USTS. Measures of political attitudes and behavior include political efficacy, voting, and other forms of political participation. The study examines factors that may impact political attitudes and behavior, including identity and discrimination. The study explores various aspects of transgender identity to determine how identity impacts political attitudes and behavior. Additionally, through the development of a discrimination scale and the analysis of several variables related to an individual's sense of safety, this research examines how discrimination affects the political attitudes and behavior of transgender people. This study will provide an in-depth analysis of factors that impact the political attitudes and behavior of transgender people and much-needed information about political participation in the transgender population.

Patterns of Suicide Risk in Transgender Adults: a Latent Class Analysis

Previous studies of transgender and other gender minority individuals have linked suicidal behavior to a wide range of personal characteristics, behaviors, and stressful life experiences, notably gender identity-related rejection, discrimination, and victimization. Although suicide risk is a complex multidimensional phenomenon, research in this area has largely focused on identifying the association of single risk factors to suicide-related outcomes, rather than examining patterns of simultaneously-occurring factors that can likely explain these outcomes in a more comprehensive and holistic manner. This study uses USTS data to identify and describe distinct groups of respondents who evidence common patterns of suicide risk. Specifically, the study aims to identify “latent classes” of survey respondents, describe these classes using distributions of demographic/personal characteristics, and examine how class membership is associated with past-year suicidality.

Childhood & Adolescent Experiences with Gender-related Medical Care and Depressive Symptomatology in Adulthood

The field of pediatric gender identity has evolved substantially over the past several years. New research suggests that cross-gender identification is prevalent (approximately 1% of youth). These young people suffer disproportionately high rates of anxiety, depression, and suicidality. These internalizing mental health conditions are thought to be secondary to rejection by family and peers, minority stress, and dysphoria related to one’s body developing in an incongruent fashion to one’s gender identity. Emerging data have shown that affirmative medical treatment protocols may improve the high rates of mental health difficulties seen among these youths. These affirmative protocols, as outlined by the World Professional Association for Transgender Health and the Endocrine Society include consideration of pubertal blockade with gonadotropin-releasing hormone analogs at the onset of puberty and gender-affirmative hormone therapy with estrogen or testosterone as early as age fourteen. Family and peer support is vital throughout this process, and emerging data shows that transgender youth who experience family and peer rejection suffer worse mental health outcomes. This study aims to examine recalled experiences in childhood and adolescence among adults who identify as transgender. The first project will examine if access to gender-affirming hormonal interventions in adolescence is correlated with lower rates of suicidality and depressive symptomatology among transgender adults. The second will examine if childhood exposure to conversion/reparative therapy is correlated with higher rates of suicidality and depressive symptomatology among transgender adults. The final study will examine the correlations between parent and peer rejection in childhood and depressive symptomatology and suicidality in adulthood.

Performative Partisanship: Investigating the Partisan Gender Gap in the Transgender Community

One of the more fundamental findings in the gender and politics literature is the existence of a "gender gap" in terms of partisan affiliation: that is, women have been consistently found to be more likely to identify as Democrats than are men. Our project intends to investigate whether or not this pattern exists within the transgender community. Although this sort of research, due to limited individual-level data, has been difficult to conduct in the past, we have been able to recover a sample of 1041 transgender individuals from the 2016 Cooperative Congressional Election Study. Preliminary results suggest that the partisan gender gap is indeed represented in the transgender population. We theorize that this is the case due to the political content of gender and thus the potential for a performative aspect to one's politics.

State-Level Discrimination Laws, Violence Victimization, and Self-Harm among Transgender and Gender-Nonconforming People

Little research to date has investigated violence victimization and self-harm in transgender and gender-nonconforming (GNC) populations. Evidence indicates that legal climates, such as the presence or absence of state-level gender identity nondiscrimination laws, may have a significant effect on the health and safety of transgender and GNC individuals. This analysis will use data from the U.S. Transgender Survey (USTS) to assess the relationship between state-level discrimination laws and violence victimization and self-harm reported by USTS participants. We hypothesize that a lack of state-level nondiscrimination laws inclusive of transgender and GNC populations creates environments that sanction discrimination and ultimately foster violence against transgender and GNC people. The analysis will be a multi-level logistic regression using a mixed effect regression model, which allows for the use of both fixed and random effects to model observations with intracluster correlations. A two-level model will be used to specify random effects for the site clusters and adjust for any unobserved individual- or state-level confounding. We will specify person at level one and state at level two (i.e. the state in which the participant current resides) and will focus on experiences of violence within the last 12 month. Outcomes of interest will include suicidal ideation, suicide attempt(s), physical violence victimization, verbal harassment, and unwanted sexual contact. Individual-level covariates (level 1) will include variables frequently associated with violence in transgender or GNC populations, such as race and socioeconomic status. At the state level (level 2), the main relationship of interest will be between experiences of violence and whether the state has any state-level statutes or regulations prohibiting discrimination on the basis of gender identity. Other descriptive analyses will be conducted to complement the findings, including frequency of violence, perpetrators, and access to care and services following violence victimization or self-harm.

Syndemic Dynamics: Modeling Mental Health and Substance Use Risks and Resiliencies in a Large U.S. National Non-Probability Sample of Gender Minority Adults

In the U.S., mental health distress and substance use behaviors cause significant mortality and morbidity and have been shown to disproportionately burden gender minorities (transgender, non-binary, other gender non-conforming people; herein trans) compared to cisgender populations. Epidemiological studies are urgently needed to identify those factors which increase vulnerability to adverse mental health and substance use outcomes for trans people, especially early-life experiences which shape life-long health trajectories. Factors affecting mental health and substance use often co-occur and synergistically interact to exacerbate risk of poor outcomes. It is critical to identify these synergistic epidemics to design effective and responsive targeted interventions and programs to improve trans health. In addition, alongside risks, there is a need to characterize salutogenic, health-promoting factors which can be leveraged for future public health efforts to enhance the resiliency and wellbeing of trans people. This study aims to conduct a secondary analysis of U.S. Transgender Survey data (N=27,715) to: 1) characterize the prevalence and distribution of mental health distress (e.g., depression), substance use (e.g., alcohol and drug use), and their co-morbidity among trans adults in the U.S., 2) identify and model syndemic vulnerabilities that increase risk (e.g., violence victimization, discrimination) and resiliencies (e.g., family support, community connection) that decrease risk for mental health and substance use outcomes. A key methodological challenge for epidemiology is how to best model risks and protective factors simultaneously. This research will test several analytic methods to address this challenge, including latent class analysis, cluster analysis, additive and multiplicative effect modification, and causal inference models. The study will contribute to increased methodological rigor of trans health research and provide “best practices” for understanding syndemics generally, and in trans populations specifically. Findings will inform future public health and clinical care research, programming, education, interventions, and advocacy to improve trans mental health and wellbeing.

Exploring the Role of Spirituality/Religion in the Lives of Trans-Spectrum People

Over the past two decades, scholars have placed increasing focus on the spirituality and religious identity and its influence on various health & wellness outcomes. The research highlights the value that individuals place on this aspect of their life, along with a wide range of positive personal outcomes. Even so, there is sparse research exploring the spirituality and religion of queer spectrum people. More notably, current studies all but exclude the specific voices of non-cisgender individuals, due, in part, to small sample sizes. This study explores the role of spirituality/religion in the lives of trans spectrum people. Specifically, it focuses on trans spectrum spirituality/religion (section 5) and outcomes including suicidal ideation (section 16), resiliency, and the Kessler 6 (questions 12.2 and 12.3). To more fully illuminate across-group differences and allow for investigation of age-specific experiences, it will also examine demographic (sections 1 and 2) and college experience (section 26) data.

Transgender Military Inclusion: Transgender Service Members’ Health and Well-being at the Brink of Open Service

In 2015 the U.S. Armed Forces effectively halted discharges for transgender service members as the Department of Defense initiated a study on open transgender service. At the time of USTS data collection, service members’ experiences were highly dependent upon the support of their military leadership and medical providers.  Using a minority stress theoretical framework, the proposed study will investigate the impact of command support and access to transition-related care on the health and wellbeing of transgender Service Members.  Researchers have demonstrated that experiences of minority stressors (such as gender-based trauma, expectation of rejection, experiences of discrimination, social rejection, etc.) predict poor health and mental health outcomes for transgender persons. However, critics of open transgender service continue to cite mental health disparities experienced by the transgender community in order to challenge the psychological and medical fitness of transgender service members. This study seeks to provide a more nuanced understanding of how systemic supports and barriers impact the health and wellbeing of transgender military personnel.

Gender Identity Documents and Voting: The Relationship among Identification Cards, State Policies and Transgender Voting Habits

It has been proposed that voter identification laws may depress the turnout of transgender populations. Further, state policies vary in the ease to which identity documents may be changed. Both of these items suggest that state policies may depress the political engagement of transgender people. This study seeks to match the USTS respondents to the state policies they have in place. We will examine the relationship between policies and turnout, controlling for standard measures of political behavior (e.g., age, education, income and employment, partisanship, and race or ethnicity).

Examining Risk Factors and Health Consequences of Intimate Partner Violence among Transgender People: Findings from the 2015 U.S. Transgender Survey

Studies on transgender people’s experiences of violence report high levels of partner-related acts of physical, sexual, emotional, or financial harm known as intimate partner violence (IPV).  Data from the 2015 U.S. Transgender Survey (USTS) indicates that transgender respondents, particular those of color, are more likely than the U.S. population to experience IPV. IPV is a major public health concern given its numerous risk factors and its resulting negative health outcomes, including HIV and other sexually transmitted infections, depression, suicidal behavior, and even death. However, little research to date have investigated the risk factors and health consequences of IPV among transgender populations. Using the 2015 USTS data, this study aims: (1) to examine the risk factors like substance and alcohol use, gender norms, history of childhood victimization, and history of sex work that may predict experiences of IPV, and (2) to analyze how IPV may relate to acquisition of HIV/STI and negative mental health outcomes like psychological distress, depression, and suicidal attempts among this racially diverse sample of transgender respondents. Public health implications from the findings include developing intervention strategies to reduce experiences of IPV, acquisition of HIV/STI, and negative mental health outcomes.

The Effect of Discriminatory Health Care Encounters, Forgone Care, and Informal Care Networks on Mental Health Outcomes among U.S. Transgender Care-Seekers

Transgender individuals are at increased risk for experiencing depression compared to their cisgender counterparts due to chronic exposure to stressors, such as discrimination. These elevated rates of depression render access to effective treatment as imperative; however, transgender communities often remain under-served in health care environments and report unmet mental health (MH) needs. Proposed are two interrelated studies that will assess the influence of health care access on MH outcomes among transgender individuals. Study 1 will use Latent Class Analysis (LCA) to examine discriminatory health care encounters among transgender help-seekers. LCA can help elucidate population heterogeneity within observed data through the identification of underlying subgroups of individuals. Study 1 will: 1a) Identify clusters of discriminatory events that respondents confront in health care environments; 1b) Use multinomial logistic regression to investigate demographic predictors of class membership, and 1c) Employ multinomial logistic regression to assess the association between latent class membership and MH outcomes, including depressive symptoms and suicidal ideation. Given barriers to care, Study 2 will examine if transgender respondents of the 2015 U.S. Transgender Survey who experience depressive symptoms can attain wellness through the reliance on informal care networks when they do not seek care for reasons when needed (e.g., for reasons related to cost or anticipated discrimination). Study 2 will: 2a) Identify respondents who have meaningful levels of depressive symptoms; 2b) Compare suicide outcomes (e.g., thoughts, plans, attempts) between respondents who do and do not receive care, and; 2b) Examine access to a supportive network as a potential protective influence against the deleterious effects of forgone care on suicide outcomes.

Faith Community Rejection and Transgender Well-being

Research has begun to document the negative impact of family rejection on the mental health and wellbeing on transgender individuals. However, little is known about the impact of religious community rejection for this same population. This study seeks to explore potential relationships between faith community rejection/disaffirmation and mental health and wellbeing for transgender individuals. This study will utilize the religious affiliation/history data from the USTS to explore experiences of faith community acceptance and rejection among transgender individuals. In order to isolate the impact of faith community rejection, family acceptance and rejection data will be used as control variables along with basic demographic data. Additionally, this study will explore possible relationships between faith community rejection and family rejection using data from the two sections described above. Outcome variables will be pulled from the mental and physical health data including suicidality and attempts, risk behaviors, substance abuse, and The Kessler Psychological Distress Scale. Regression analyses will be conducted using R and/or IBM SPSS. Results will contribute to the field of LGBT research by demonstrating the nature of the connections between faith community rejection, family rejection, and mental health and well-being for transgender individuals.

Impact of time between personal realization and stages of transition on well-being on transgender individuals

Transgender individuals experience poor mental health outcomes that we know are related to discrimination, internalized negative feelings and poor access to healthcare. Many trans individuals experience a social and medical transition in which they must disclose their identity and make medical decisions to live a life more authentic with their gender identity. This time of transition is an under researched stressor that is likely exacerbated by experiences of discrimination and access to healthcare. Being able to identify the impact of the length of time between certain stages of transition have on health long after a person has transitioned can help us understand the significance of transition (a time of varying lengths for individuals, and a notable stressor in a transgender person’s life) with their overall well-being.
The proposed research will explore the relationship between time to transition (based on when a person thought they were trans, started to tell people, started living full time, and started taking HRT) and current distress, mental health, and suicidality among binary transgender individuals living full-time in the gender different from their gender assigned at birth. Analyses will be conducted separately by age cohorts to account for historical/political shifts in trans awareness in society (cohorts will be determined after exploring the sample age distributions) and primary gender identity. This work will provide a foundation for understanding the role of time in transition stages with long-term mental health, taking into account current life stressors (losing a job, housing eviction, dropping out of school, and new health diagnoses) for binary transgender men and women. More importantly, results will inform us on how significant the transition time is in overall well-being among binary transgender individuals who live full-time as a gender different from the gender assigned at birth.

Suicide Thoughts and Attempts among Transgender Adults

This study seeks to increase understanding of suicidal thoughts and behaviors among transgender people through an analysis that aims to identify key characteristics and experiences that are correlated with suicide thoughts and attempts in the USTS sample as a whole, and to examine how suicide thoughts and attempts vary among different groups of transgender people, based on both demographics and experiences. This includes examination of factors that are known risks for suicide thoughts and attempts among the general population, such as certain demographic profiles, substance use, experiences of interpersonal trauma, and psychological distress, to understand how these known risk factors correlate with suicide thoughts and attempts among USTS respondents. The study also assesses risk factors that uniquely impact transgender populations, including experiences related to minority stress, such as discrimination, victimization, and lack of access to transition-related health care. 

Experiences of Health Care Discrimination Among Transgender People of Color in the USTS

Although prior studies have noted the negative experiences within health care settings transgender and gender non-conforming (TGNC) individuals may encounter, there is still a paucity of research on the unique experiences of TGNC people of color (POC) in the health care system. Specifically, within-group differences in experiences of health care discrimination among TGNC POC are rarely examined. This study seeks to use latent class analysis to identify mutually exclusive subgroups of individuals based on their responses to observed binary variables, including: having to teach one's doctor or other health care provider about trans people to receive appropriate care, being refused trans-related care, being refused other health care, having a doctor use harsh or abusive language when being treated, having a doctor be physically rough or abusive when treated, being verbally harassed in a health care setting, being physically attacked in a health care setting, or experiencing unwanted sexual contact in a health care setting. We also plan to examine the association of demographic and health indicators including being "out" in health care settings, health insurance status, and undergoing transition-related procedures with latent class membership.

The Influence of Psychological Distress and Substance Use on Suicide Ideation Among Transgender People Over Four Age Cohorts

Guided by theories of minority stress and transgender-related stigma and using an intersecting identities lens, this study investigates the constructs of psychological distress and substance use as risk factors for suicide ideation among four age cohorts of transgender people. The study examines which demographic characteristics are associated with suicidal ideation and how psychological distress and substance use are associated with suicide ideation. The study methodology employs SEM analysis to determine the unique effect of various demographic characteristics on projected outcomes mediated by the construct of psychological distress and substance use. 

Adherence to HIV Care and Medication among trans men, women and nonbinary individuals: Findings from the US Trans Survey

Adherence to antiretroviral therapy (ART) can improve health outcomes, extend the lives of people living with HIV, and decrease or eliminate HIV transmission. Achieving an undetectable viral load requires that people living with HIV fully engage in the HIV continuum of care by learning their HIV status, linking to care, and adhering to treatment and ART.  Transgender people, especially trans women, are at high risk for contracting HIV and less likely to adhere to HIV care and medication. Existing research on HIV care and adherence is limited by small numbers of trans people, little research on trans men, and virtually no research on people who identify as non-binary. However, understanding how HIV medication adherence is related to transgender specific barriers and facilitators is important for improving healthcare for transgender persons living with HIV. The US Trans Survey offers a unique dataset, with a large enough sample, to explore medication adherence patterns among trans people living with HIV. The purpose of this analysis is to examine the relationship between outness, hormone therapy, provider discrimination, social support and adherence to care and medication among trans people living with HIV. These relationships will be tested separately across men, women, and non-binary to see if these factors differentially affect medication adherence across gender. Follow up analyses will examine race/ethnicity and geographic region. This analysis will provide important information about variables influencing care and adherence among trans populations that can be used to tailor intervention strategies to these groups.

The Healthcare Experiences of Transmasculine Adults: Differences by Sociodemographic Characteristics and the Importance of Access to a Transgender-Competent Healthcare Provider

This project will focus on the healthcare experiences of transmasculine respondents of the USTS. First, this project would explore which transmasculine adults are at highest risk for not having access to a trans-competent healthcare provider or for experiencing mistreatment in healthcare settings (discrimination, blatant abuse/harassment/assault); specifically, differences would be examined by factors such as a person’s geographic region, distance traveled to a doctor, race/ethnicity, income, education, sexual orientation, disability, and mental health (depression, suicidality). Secondly, this project would examine whether having access to a transgender-competent healthcare provider (either routine or trans-specific) will mediate the relationship between mistreatment in a healthcare setting and mental health (depression, suicidality) and delaying needed medical care due to anticipated stigma. Thirdly, this project would investigate whether the mediating role of having access to a transgender-competent provider differs based on a transmasculine person’s geographic region (e.g., Northeast, Southeast, etc.), distance traveled to a healthcare provider, and household income. Knowledge gathered through this project could help inform future efforts to improve healthcare for transmasculine adults, including information about the importance of access to trans-competent healthcare providers and the differing experiences in healthcare based on geography and sociodemographic characteristics.

Connecting the invisible dots: A look into the intersectionality of transgender undocumented persons

Being an immigrant often means operating within two identities: one that is hoping to hold on to a culture of an origin country and another that is tirelessly attempting to assimilate to the new land. Throughout this process, immigrants can feel as though there is rarely a space that is specific to them and the idea of citizenship is blurry. Another group of individuals that face this double consciousness are members of the LGBTQ community. One way that immigrants, specifically undocumented immigrants, and LGBTQ individuals lose a sense of control over their private rights is when their bodies are under the power of the public government. Undocumented immigrants use their bodies as a way to physically move from one space to another, crossing borders in order to gain better opportunities. Transgender individuals also attempt to take control over their bodies by making the decision to become seen as who they are while crossing gender lines. Relying on Michel Foucault’s definition of biopower, this paper investigates the challenges that trans-undocumented individuals face and how healthcare accessibility is a focal point in their move but the lack thereof in the US creates for a continued dangerous setting.

Together We Rise: The Role of Community Socialization in Transgender Citizens’ Levels of Civic Engagement

In the academic debate on civic engagement, many variables have been considered as predictors, among them socio-economic status, race and ethnicity, and age. One understudied variable is community socialization and connectedness. Particularly for disadvantaged communities, however, community connectedness may be an important source of political socialization. This study will investigate the role of community in levels of civic engagement, considering political self-efficacy as a key moderator of that relationship. Specifically, the study predicts that community connectedness increases political self-efficacy, which in turn drives civic engagement. Moreover, as both the practice and study of the American transgender rights movement advances, it is important to understand the factors that drive transgender Americans’ political participation. This study would helpfully contribute to our understanding of one potentially meaningful factor—connection to other trans people, as measured in the USTS.

Predictors of Non-Medical Prescription Drug Use Among Transgender and Gender Nonconforming Adults: Findings from the 2015 U.S. Transgender Survey

In light of the current opioid use epidemic, we propose to examine non-medical prescription drug use among the USTS sample. Based on current knowledge about the predictors of non-medical prescription drug use among the general population, we will test whether such drug use is related to physical health, lack of housing stability, race/ethnicity, and socioeconomic status. In addition, we will test a number of predictors particularly relevant to the TGNC population, such as stigma, gender affirmation (both social and medical), and participation in sex work.

Transgender Identity Development Across the Lifespan: Findings from the 2015 U.S. Transgender Survey

Recent studies of transgender and gender nonconforming (TGNC) people indicate that, in addition to minority stress, stress associated with the process of identity development affects health, psychosocial adjustment, and wellbeing. Many TGNC individuals adapt successfully to the related challenges and develop resilience over time. This study will examine associations between stage of identity development, operationalized through such proxy variables as age, status and time passed since relevant developmental milestones (e.g. disclosure, social transition, medical transition), perceived stigma and outcomes of mental health and wellbeing.

Suicide Prediction in Transgender Adults: A Machine Learning Approach

Suicide attempts occur at alarmingly high rates in transgender individuals in comparison to the general population. Suicide, in the words of Antoine Leenars, is a "multidimensional malaise” of “biological, psychological, intrapsychic, interpersonal, social, cultural, and philosophical elements." Standard probabilistic techniques are prone to overfitting high dimensionality data in the attempt to capture its full complexity. Machine learning (ML), however, imposes no assumptions or constraints, actively learning from the data. This study will train a ML classifier with the USTS dataset which produces a set of predictive algorithms for suicide attempt in the last 12 months and lifetime. The algorithms rank and weigh each variable’s global influence on suicide risk, revealing the strongest universal predictors for suicide attempt across a highly heterogeneous population. The predictive accuracy of the algorithm can be directly measured, a powerful feature of this type of analysis. Furthermore, the estimated rate of new suicide attempts in the next 12 months or thereafter can also be calculated from the dataset. The same methodology will be applied to the 2008 USTS dataset to determine the stability of predictive factors across time and changing sociopolitical climate. Our findings have direct clinical impact, including the development of a transgender-specific suicide risk calculator to facilitate routine screening in a variety of healthcare settings and improve early intervention.

Associations of Prejudice and Health Among Gender Minority Youth with Binary and Non-Binary Gender Identities

Compared to binary individuals, non-binary individuals may be at increased risk for substance use and adverse mental health due to stigma related to being non-binary. The proposed research integrates Minority Stress Theory and Intersectionality Theory to propose that non-binary gender minority (GM) individuals, particularly those with other minority identities, may experience prejudice across different settings, which may adversely affect their health. Examining associations between prejudice and health among binary and non-binary GM youth is critical to identifying protective factors that moderate the adverse effects of prejudice on substance use and mental health. These associations will be examined via secondary analysis of quantitative data from binary and non-binary GM young adults, age 18-25 years, from the 2015 U.S. Transgender Survey (N=27,715). The aims of this proposal are to: 1) Compare the prevalence of prejudice experienced in three settings between binary and non-binary GM young adults, and examine differences in exposure to prejudice at the intersections of gender identity and sex assigned at birth, race/ethnicity, and sexual orientation. We hypothesize that non-binary GM young adults will experience more prejudice in each setting than binary GM young adults (H1), and that GM youth who hold other minority statuses will experience more prejudice than GM youth who do not hold other minority statuses (H2). 2) Investigate the impact of minority stressors on substance use and mental health outcomes, and examine protective factors as moderators among binary and non-binary GM young adults. We hypothesize that minority stressors will be associated with increased substance use and adverse mental health (H3), and that protective factors will moderate the adverse effects of minority stressors on substance use and mental health (H4). Findings from this study will inform interventions to reduce adverse effects of prejudice on health among binary and non-binary GM youth to better ensure development into healthy adulthood.

Contrasting preferences for gender transition procedures between transgender and gender non-binary individuals: An analysis of the 2015 USTS database

Procedures for gender transition remain in a binary framework, despite our recognition of a wide spectrum for gender identity and sexual orientation. The expectation that a linear set of procedures can treat all variants of gender dysphoria may be inappropriate and potentially detrimental. This study seeks to analyze the USTS database for any difference in preferences among transgender and gender non-binary individuals when choosing procedures for gender transition. Other variables to be included in the analysis are sexual orientation, history of hormone therapy, and history of sexual contact. Information obtained from this study will serve as a basis for further studies to refine surgical indications and technique to maximize postoperative outcomes in gender dysphoria and sexual well-being.

Impact of Pro-LGBT Legislation on the Social and Health Disparities Experienced by Transgender People

Studies and reports have shown transgender populations to report high levels of discrimination and distress. To address this, advocates and others seek to establish legislative protections against discrimination and violence. Currently, there are 16 states and 400 cities and counties with nondiscrimination legislation targeting discrimination against people's sexual orientation and gender identity, and 17 with anti-LGBT hate crime legislation. Using data from the 2015 U.S. Transgender Survey, this study will examine the difference between states and cities/counties with legislative protection and those without to examine the protective effects of such legislation. Do these legislative remedies benefit transgender people by reducing their experiences with discrimination, or reduce their distress and provide benefits to their health and well-being.

Transgender Intimate Partner Violence in a National U.S. Sample

Intimate partner violence (IPV) among transgender individuals is under-studied. Transgender IPV (T-IPV) research to date has been limited to small youth samples (e.g., transgender N < 30; Dank et al., 2014; Zweig et al., 2013), small adult samples (e.g., transgender N < 10; Turell, 2000), highly unique sub-populations (e.g., only sex workers, see Nemoto et al., 2011; only those contacting IPV agencies, see Waters, 2017), or non-U.S.-based samples (e.g., Australia, see Pitts et al., 2006; Scotland, see Roch, Ritchie, & Morton, 2010). Beyond T-IPV prevalence analyses of the U.S. Transgender Survey (James et al., 2016), no publication has ever examined statistically significant risk factors and outcomes of T-IPV with a representative U.S. sample of transgender individuals. The proposed paper will fill this gap in the literature by examining covariations between lifetime IPV victimization (intimate partner physical, sexual, and coercive controlling abuse, as well as being pressured by an intimate partner to de-transition) and the following: (1) demographic factors (gender identity, gender identity relative to gender assignment at birth, transition status, number of years since transitioning, sexual orientation, age, race-ethnicity, U.S. citizenship status, personal income, poverty, employment status, homelessness, having children), (2) potential risk factors associated with cisgender IPV that remain largely untested for T-IPV, including family violence victimization, non-IPV sexual violence victimization, and discrimination-related factors (frequency of being perceived as a transgender person by others, outness, absence of supportive family behaviors, and experiencing negative treatment both generally as well as in regard to school, work, housing, and public accommodations), and (3) potential outcomes that remain untested in T-IPV research, including substance use, health (general health rating, serious psychological distress, suicidal ideation or attempted suicide, HIV status), and seeking IPV victim services (seeking help from victim services in the past year). Implications for future research, services, and policy will be discussed.

Legal gender recognition, psychological distress, and suicide risk among transgender adults in the United States

Legal (or administrative) gender recognition is important to the well-being, safety, and dignity of trans people. However, few studies have examined the impacts of access to legal name and/or gender changes on mental health outcomes. A Canadian study found that having at least one identity document with a sex marker concordant with lived gender was associated with reductions in past-year suicidal ideation and attempts, with the potential to prevent 90 cases of ideation per 1,000 trans persons and 230 attempts per 1,000 with ideation. This is a finding with important implications for public policy advocacy, particularly if replicated and extended in a different population. Therefore, this project will ask:

(1) is legal gender recognition associated with psychological distress and suicide risk among trans people in the U.S.?
(2) are legal name changes associated with psychological distress and suicide risk among trans people in the U.S.?
(3) are these relationships moderated by non-binary identification?
(4) are these relationships mediated by exposure to harassment, discrimination, or violence related to non-concordant identity documents?

Syndemic Dynamics: Modeling Mental Health and Substance Use Risks and Resiliencies in a Large U.S. National Non-Probability Sample of Gender Minority Adults

In the U.S., mental health distress and substance use behaviors cause significant mortality and morbidity and have been shown to disproportionately burden gender minorities (transgender, non-binary, other gender non-conforming people; herein trans) compared to cisgender populations. Epidemiological studies are urgently needed to identify those factors which increase vulnerability to adverse mental health and substance use outcomes for trans people, especially early-life experiences which shape life-long health trajectories. Factors affecting mental health and substance use often co-occur and synergistically interact to exacerbate risk of poor outcomes. It is critical to identify these synergistic epidemics to design effective and responsive targeted interventions and programs to improve trans health. In addition, alongside risks, there is a need to characterize salutogenic, health-promoting factors which can be leveraged for future public health efforts to enhance the resiliency and wellbeing of trans people. This study aims to conduct a secondary analysis of U.S. Transgender Survey data (N=27,715) to: 1) characterize the prevalence and distribution of mental health distress (e.g., depression), substance use (e.g., alcohol and drug use), and their co-morbidity among trans adults in the U.S., 2) identify and model syndemic vulnerabilities that increase risk (e.g., violence victimization, discrimination) and resiliencies (e.g., family support, community connection) that decrease risk for mental health and substance use outcomes. A key methodological challenge for epidemiology is how to best model risks and protective factors simultaneously. This research will test several analytic methods to address this challenge, including latent class analysis, cluster analysis, additive and multiplicative effect modification, and causal inference models. The study will contribute to increased methodological rigor of trans health research and provide “best practices” for understanding syndemics generally, and in trans populations specifically. Findings will inform future public health and clinical care research, programming, education, interventions, and advocacy to improve trans mental health and wellbeing.

Examining Race Differences in the Relationship Between State-Level Stigma-Related Policies and Transgender Health

State-level policies can be either protective (e.g., state-level non-discrimination policies) or harmful (e.g., bathroom bills, religious exemptions) for transgender and gender diverse communities. These policies may contribute to experiences of interpersonal stigma (e.g., discrimination and victimization), resilience (e.g., through social support), mental and physical health, and healthcare use. Furthermore, building on an intersectionality framework, these relationships between state-level policies and experiences of stigma, resilience, and health may vary across racial groups. This study will use the 2015 USTS to examine how state-level stigma-related policies (e.g., state-level non-discrimination policies, bathroom bills, religious exemptions) are associated with mental health (measured as psychological distress), physical health (measured as self-reported physical health), and healthcare use among transgender and gender diverse people.  We will fit three separate multilevel multinomial regression models (one for each outcome) with the state as the random effects term (to understand the relationships of individuals grouped by state) and race as the random slope (to determine if the relationship between state-level policies and health vary by race).  This analysis will control for individual experiences of stigma (e.g., discrimination and victimization across multiple settings) as well as individual experiences of resilience (e.g., social support) and will examine differences in states across multiple state-level policies related to transphobic stigma (e.g., state-level non-discrimination laws, bathroom bills, religious exemptions).

Intimate Partner Violence in Transgender Population; Identity, Risk, and Health Impact

Emerging evidence suggests intimate partner violence (IPV) is as prevalent or more prevalent against transgender individuals as compared to cisgender individuals. Trans individuals may be more vulnerable to IPV as they may face discrimination in accessing domestic violence shelters or rape crisis centers, and abusers may be able to leverage societal transphobia to control their partner (e.g. threatening to "out" their partner as blackmail). Little is known about IPV disparities within the trans community and which segments of the community may be most vulnerable to IPV. The USTS report had some analysis of how IPV prevalence varied by race, but further analyses examining how IPV prevalence varies by different intersectional identities is needed. We propose to examine how physical and sexual IPV prevalence vary by different factors such as trans masculine or trans feminine spectrum, genderqueer/non-binary or binary identities, age, disability, and race. Using USTS data, we hope to look at associations of IPV with health outcomes included in the survey, including alcohol and drug use, HIV testing behavior, and suicidality.

Gender Identity Documents and Voting: The Relationship among Identification Cards, State Policies and Transgender Voting Habits

It has been proposed that voter identification laws may depress the turnout of transgender populations. Further, state policies vary in the ease to which identity documents may be changed. Both of these items suggest that state policies may depress the political engagement of transgender people. This study seeks to match the USTS respondents to the state policies they have in place. We will examine the relationship between policies and turnout, controlling for standard measures of political behavior (e.g., age, education, income and employment, partisanship, and race or ethnicity).

Gender Identity Profiles and Trans-Related Health Care Seeking

Gender identity can be conceptualized as a latent, multi-dimensional construct with contributions from an individual's personal identification, interactions with others, and timelines of gender development. The USTS survey gives individuals the opportunity to identify in multiple, complex ways. Latent profile analyses can be used to be begin to cluster identity trajectories together and correlate them with treatment seeking behaviors and intentions. Such a nuanced analysis allows for a better understanding of how stated gender identity characteristics fit with treatment needs and creates an opportunity to examine norms in treatment and insurance coverage for treatment and how those things are or are not attuned to individual identity profiles.

Affirmation, Mental Health, and Physical Health Among Non-Binary and Genderqueer Individuals: Findings from the 2015 USTS Survey

Non-binary and genderqueer people make up over one-third of the population of individuals whose gender is different than assumed at birth. However, little is known about unique gender-based stressors which impact the group’s wellbeing. While non-binary and genderqueer individuals’ experiences of victimization are comparable to binary transgender individuals experiences, knowledge regarding forms of non-binary invalidation is sparse. Given the disproportionate rates of violence experienced by transgender individuals broadly, specific acts of mistreatment, including forms of invalidation that apply specifically to non-binary and genderqueer individuals, and their effects on health must be examined. This knowledge will help to inform practitioners and policy makers better understand community needs and advance non-binary affirming practices and policies. Therefore, this study will examine the effects of interpersonal and structural non-affirmation on the mental and physical health as well as the role of support among non-binary and genderqueer individuals.

Rates of Polyvictimization Among Non-Binary Individuals: A Comparison of Individuals Assigned Male and Assigned Female at Birth

Despite the increase in knowledge and public awareness of binary transgender experiences, there remains a dearth of research literature on non-binary and genderqueer people. Given that over one-third of the population of individuals whose gender is different than assumed at birth are non-binary or genderqueer, it is important to gain a deeper understanding of multiple forms of victimization faced by this population. Forms of victimization include harassment, physical assault, and unwanted sexual contact. This research seeks to fill knowledge gaps regarding similarities and differences between individuals assigned male at birth (AMAB) and assigned female at birth (AFAB) who are non-binary or genderqueer. Therefore, this study will examine the rates of polyvictimization and the effect of these victimization experiences on mental health among non-binary AMAB and AFAB individuals.

Gender Affirmation Interventions, Social Transition, and Suicide Risk in Transgender Adults With and Without History of Military Service

Data is requested to produce scholarly publications that investigate disparities in healthcare utilization and access to comprehensive gender affirmation care in transgender adults with and without a history of military service. This work will also analyze how these disparities relate to mental health symptoms, quality of life, and current and historical suicide risk in this population. The UTST data set is ideal to test these relationships as the large sample size will allow for us to test these relationships across the transgender/gender non-conforming spectrum, across stages of medical and social transition, and within ethnic and racial minority/majority veterans and non-veterans. We believe data from this project will have important implications for clinical and policy efforts that look to provide comprehensive gender affirmation and suicide prevention care for transgender veterans and civilians without history of service.

The Labour Market Outcomes of Transgender, Gender Non-Conforming and Genderqueer Individuals

To date, there has been a remarkable lack of appropriate econometric analysis exploring the labour market outcomes and discrimination faced by transgender individuals in the economic literature. This research project aims to address part of this research deficit. This analysis will cover the following areas:

1. Quantifying the levels of wage discrimination faced by different sections of the diverse transgender community. For example, there is a well-established literature exploring the cisgender pay-gap. Controlling for productivity, demographic, health and other determinants of wages, do trans women experience an earnings penalty compared with trans men?

2. Exploring the differing labour market returns to human capital across multiple gender identities. For example, can transgender individuals partly shield against labour market discrimination through increasing their human capital levels? If so, is this effect uniform across minority identities?

3. Exploring the intersectional effect on earnings from identifying with a minority gender identity and a minority sexual orientation. In other words, is there a compounding negative effect on earnings from identifying with multiple minority categories?

This paper explores the labour market outcomes of different gender minorities by building on econometric techniques previously employed in the study of racial discrimination. I will primarily use interval regression analysis - ideal when survey data provides income data in intervals/bands. It is a generalisation of censored regression, estimated using maximum likelihood estimation.

Exploring the Relationship of Religion and Spirituality in Trans/GNC Students' Likelihood to Enroll and Persist in Postsecondary Education

A significant period of identity, belief and community formation and conflict—including one’s religious or spiritual worldview identity and understanding—happens in college (Astin, Astin, & Lindholm, 2010; Mayhew, Rockenbach, Bowman, Seifert, & Wolniak, 2016).  Without proper, intentional engagement of religious diversity, campus communities can fracture and further oppress people of marginalized religious and spiritual identities (Nash, 2001). This study will look at religion and spirituality measures (section 5) of trans/gender non-conforming (GNC) identified people and their relationship to one’s decision to leave college (questions 26.8, 26.9) or attend at all (coded by using demographic data under the assumption that high school/GED must be completed and they have not attended at least some college despite being of “typical college age”).  We will also investigate this difference for people who reported attending graduate and/or professional school in comparison to those who did not.   In order to control for covariate variables, we are also requesting access to demographic data (sections 1 and 2) since race, class, sexual orientation, and other identities have been found to uniquely interact both with one’s religious and spiritual life (i.e., Mayhew, Rockenbach, & Bowen, 2016) and one’s trans/GNC identity (i.e., Nicolazzo, 2016).  In addition, we would like to include in our model other factors known to influence college recruitment and persistence in trans/GNC identified people such as trans kinship (Nicolazzo, 2015; questions 3.4, 4.11-4.12, and 12.21 related answers), a person’s level of “outness” (Garvey & Rankin, 2015; questions 1.13-1.14, 2.3_2-2.3_3, 3.1-3.3, 4.1, 4.3, 4.5, and 26.1-26.3), and familial support (Oswald, 2001; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010; questions 4.1-4.9, and 12.21).

When Health Care Isn't Actually Care: An Intersectional Look at Discrimination and Barriers to Trans Affirming Health Care

Transgender and non-binary (trans/NB) individuals experiences higher rates of discrimination, harassment, and barriers to culturally responsive care than their cisgender counterparts, with those who have multiple marginalized identities having even increased differential rates of challenges to trans affirming health care. This study aims to look at how these barriers to care (such as cost, fear of discrimination, and lack of an available trans inclusive provider) and actually experiences of discrimination have changed in the trans/NB community since the passing and incremental roll out of the Affordable Care Act (ACA) in the United States. Specifically, using an intersectional lens as coined by Black feminist scholar Kimberle Crenshaw, we aim to explore how various socioeconomic identities and factors (disability, race/ethnicity, age, income, education, gender identity, sexual orientation, and being insured) may further affect some of the post vulnerable members of the trans/NB community. We will use these findings to push for the requirement of information about transgender/non-binary communities to be included in medical trainings for providers, and to move forward the effort to facilitate more accessible, trans affirming care for all members of the trans/NB community.

The Asian American experience as transgender in the U.S.: A Mixed Method Analysis

Despite indications of substantial health disparities, violence, poverty, and other challenges faced by transgender Asian Americans, there lacks significant understanding about their experiences. The purpose of this study is to conduct mixed-methods analyses using explanatory sequential protocol. The first part of the study will use USTS data to understand the intersectionality of how key areas of social determinants, such as poverty, homelessness, insurance status and coverage, comfort with speaking to health care professionals, family dynamics, and exposure to violence (including at workplace and by family), impact health outcomes of transgender Asian Americans; data will be further disaggregated by available sub-ethnic groups. This analysis will be conducted by multivariable logistic regression as well as structural equation modeling to evaluate the interplay between each variable. The next phase of the study will involve conducting focus groups in order to further explore barriers this population faces, with emphasis on the social determinants identified in part 1. The primary research questions to be addressed are as follows:

  1. What is the impact of exposure to violence on mental health status (suicidal ideation and serious psychological distress) among transgender Asian Americans, after accounting for sociodemographic characteristics?
  2. What is the impact of communication and experiences with health providers on health outcomes (HIV status, suicidal ideation, psychological distress) among transgender Asian Americans, after adjusting for sociodemographic characteristics?
  3. Are there differences between these relationships among transgender women as compared to transgender men in the Asian American population? Does family support mediate this relationship?

Transgender Men and Women in 2015: Employed, Unemployed or Not in the Labor Force

This study will examine the percentages of transgender individuals who are employed, unemployed, and not in the labor force, and compare the rates for men versus women. In addition, I will perform logit analysis to explore the relationships between labor force status and other variables such as education, age, racial/ethnic identity, disability status, partnership status, presence of children, perceived gender incongruity (that is, whether people can tell that the individual is a transgender person even if not told), and whether the individual lives in a state that has an employment non-discrimination law covering gender identity.

Barriers and Facilitators to Health Care Utilization Among Transgender People Living in the U.S.

The goal of this study is to understand the impact of gender conformance, demographic factors (education, race/ethnicity, age, income), psychological distress, physical distance to see a health care provider (HCP), health insurance status, health care costs, HCP knowledge, and perceived HCP behavior on whether transgender individuals utilize health care in a large, ethnically diverse, national sample of U.S. transgender individuals. This proposed study will use structural equation modeling (SEM) to test the relationships among several potential factors that may impact whether transgender people decide to participate in the health care system. Mediation and moderation analyses will provide understanding into how environmental factors, perceived HCP behavior, and educating HCPs are potentially important for utilization of health care. The advantages of using SEM are to enable multiple indicators of the constructs to be measured; to allow for multiple ways to test the overall goodness of fit for the conceptual model; and to take into account measurement error in the conceptual model.

Radical Reproductive Justice Accompliceship: Following the Lead of Trans BIPoC

Reproductive justice analyses have detailed the varying state and interpersonal mechanisms that continue to be used against women of color through the control of their bodies, their children, and their families. However, there is little documentation that highlights the experiences of trans and nonbinary Black, Indigenous, and people of color (BIPoC) in relation to their reproductive health. In this study, we call for a continued movement within the sociological understanding and analyses of reproductive justice. Focusing solely on white, cisgender women's bodies and needs within reproductive justice neither alleviates the burden of trans exclusionary, able-bodied healthcare nor recognizes the history of racialized violence toward bodies of color. Therefore, we seek to analyze secondary data from USTS participants to assess reproductive health disparities with transgender and nonbinary people of color. We intend to analyze racial and ethnic disparities (primarily between Black people, Indigenous people, and other people of color) between adverse health experiences with practitioners, sexual health, access to hormone replacement therapy, HIV meds, and other related health care while incarcerated and/or detained, access to insurance, educational attainment, levels of poverty, and other variables. We place a theoretical focus on how potentially statistically significant disparities in these variables are related to reproductive injustice. Additionally, we place an emphasis on data reported from the state of Georgia to further inform a more community-based approach for future research.

The Lives of Trans Millennials

This study will use qualitative data from the USTS to examine differences between the participants who were 35 years old or younger at the time they completed the survey. Specifically, it will consider responses to the last question, “Please tell us anything else that you would like to tell us about your experiences of acceptance or discrimination so we can better understand your experiences.” The study will focus on the different experiences the respondents discussed in response to that questions and the language they used in discussing these experiences.

Educational Attainment of Transgender Adults: Does the Timing of Transgender Identity Milestones Matter?

Adolescence is a difficult life stage in which to navigate a transgender identity, yet adolescence plays a key role in shaping educational trajectories. While transgender-related stigma and victimization within secondary school persists, the social climate in which transgender adolescents navigate their identity has changed over time. Analyzing data from the U.S. Transgender Survey, a national, non-probability sample of U.S. transgender adults, we propose to address the following research questions: 1) Is experiencing transgender identity milestones in adolescence associated with educational attainment?; 2) Does this association vary by birth cohort?

Report on Transgender Adults in Mississippi, Alabama and Arkansas

This report will focus on the experiences of USTS participants living in Mississippi, Alabama and Arkansas, comparing the experiences of participants in these three states to the national sample. Where there are substantial differences between the three states, data will be presented separately for each. In addition, where there are notable differences by participants’ race, age and gender identity, these findings will be presented separately. The report will cover outcomes in the areas of violence; police contact and incarceration; sex work; employment; and healthcare access. The report will be written for a non-scholarly audience and is intended to support programmatic and policy efforts in the states.

Report on Transgender Adults in the Workplace

This report will describe the workplace experiences of USTS participants nationwide. The report will describe participants’ career trajectories (educational attainment, rates of paid employment and self-employment, union membership, income, and source of health insurance coverage). It will then address rates of discrimination in the workplace, including access to gender-appropriate facilities, discrimination in hiring, promotion and job separation, and gender-based harassment. When appropriate, rates of these experiences will be presented separately by gender, race and age group. The report will be written for a non-scholarly audience and is intended to support efforts to improve transgender inclusion in the workplace.