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Approved Requests for USTS Data

Please review this list of abstracts of approved projects before applying for access to this study. These abstracts describe work currently in progress that uses this data, and we provide them to help reduce the risk of duplication of research efforts.

Last updated: 18 June 2021

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Approved User/Project PIResearch Project TitleAbstractApproving organization
Not providedExploring the interplay between housing status and health outcomes among transgender populationsHomelessness rates among transgender populations remain disproportionately high. Homelessness has been well-established as a catalyst for substance use and sexual risk behaviors. Significantly higher rates of health and psychosocial challenges among transgender populations magnify these risks. In addition, health and psychosocial challenges may be further exacerbated by housing status. Historically, research has focused primarily on already homeless versus at risk of losing housing. Thus, current research has failed to acknowledge the association between housing instability or insecurity, as a precedent, and mental health outcomes. Determining the effects of housing status on mental health outcomes among transgender populations presents significant public health and clinical practice implications. The proposed study seeks to address this gap in the literature by examining how housing status influence mental health outcomes.NCTE
Not providedGetting care: factors affecting negative experience in care amongst transgender and gender non-binary individuals.

Finding and accessing an affirming healthcare provider is a major determinant of access to care among gender minorities. Barriers to care are found on the systemic, provider, and individual patient level, as well as at the points of interactions between these levels. Importantly, prior negative experiences in healthcare, including lack of provider knowledge, decrease patient engagement in care. Better understanding of factors associated with such negative experiences is crucial in development and implementation of programs to address gaps in provider knowledge and cultural competency, and to increase patient engagement in care. Hence, we propose to investigate the characteristics of healthcare providers for gender minority patients, and their relation to patient experience and participation.

We specifically aim to investigate associations between negative experiences with healthcare providers, and prescribers of hormonal care. This would include whether the prescriber is also the provider of preventive care for the individual; the distance travelled to the provider; and patient characteristics including area of residence (rural vs. urban), and transition related care needs and history. At the level of interaction between patients and the system, we will investigate association of negative experiences with insurance availability and type.

Not providedHealth Disparities Across Segmented Transgender PopulationsTransgender communities in the United States are highly marginalized and have been systematically and infrastructurally erased due to the widespread fundamental belief that gender exists as a binary. The dichotomous theoretical framework of sex and gender prevented public recognition of the community as a population of interest for public health research and targeted intervention. Sexual and gender minority (SGM) populations have fought for basic human rights, including access to affordable healthcare. The National Center for Transgender Equality (NCTE) is an organization founded in 2003 to “advance transgender equality”. In 2015, the NCTE conducted the United States Transgender Survey (USTS) to collect data on people who identify among the transgender spectrum (n=27,715). For this research, the author will utilize the results of the USTS for the purpose of elucidating health disparities in the transgender community to advocate for policy changes and public health health interventions. The author will segment the respondents into three subpopulations for comparison: trans-femme/trans-feminine (TF), trans-masc/trans-masculine (TM), gender non-conforming/gender non-binary (GNC). The authors will compare access to healthcare, health behaviors, and health outcomes among individuals across each group. Additionally, the authors will employ the concept of intersectionality to analyze the layered effects of race, ethnicity, sexual orientation, ability etc. on healthcare access, behaviors, and outcomes. The purpose of this statistical analysis is to identify health disparities within the transgender community itself to determine the most effective population segments to target for intervention.NCTE
Not providedExperiences of Health Care Discrimination Among Transgender People of Color in the USTSAlthough 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.NCTE
Not providedThe Effect of Discriminatory Health Care Encounters, Forgone Care, and Informal Care Networks on Mental Health Outcomes among U.S. Transgender Care-SeekersTransgender 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.


Not providedThe Healthcare Experiences of Transmasculine Adults: Differences by Sociodemographic Characteristics and the Importance of Access to a Transgender-Competent Healthcare ProviderThis 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.NCTE
Not providedWhen Health Care Isn't Actually Care: An Intersectional Look at Discrimination and Barriers to Trans Affirming Health CareTransgender 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.NCTE
Not providedBarriers 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.NCTE
Not providedHealth Care Access Among Transgender Older AdultsBackground: Current research indicates that aging gender minority people suffer health disparities that can be linked to exposure to social stigma, discrimination, and health care inequity (dickey, Budge, Katz-Wise, & Garza, 2016; Institute of Medicine, 2011; Stanton, Ali, & Chaudhuri, 2017; Zelle & Arms, 2015). Access to health insurance and interactions with health care providers and insurers have been found to involve instances of discrimination or inspire fear of discrimination are attributed with impacting treatment choices (Gonzales & Henning-Smith, 2017; Kattari & Hasche, 2016; Padula & Baker, 2017; Seelman, Colón-Diaz, LeCroix, Xavier-Brier, & Kattari, 2017). 
Objective: Identify the relationship between health care quality (provider knowledge and treatment of the individual), barriers to insurance access and utilization (distance to reach a health care provider, lack of insurance, and insurance rejection and communication), outness to providers, and physical and mental health in gender minority people over age 65. Poor health care quality and greater barriers to insurance access and utilization are expected to be associated with poorer mental and physical health in gender minority people over 65. 
Method: Through a secondary data analysis of the 2015 U.S. Transgender Survey, 803 respondents over the age of 65 will be evaluated for responses regarding insurance coverage, experience with insurers, experience with health care providers, provider knowledge, and outness to providers. These will be analyzed through ordinal & linear regression for their relationship with respondent overall health and psychological stress responses while controlling for income and housing status. 
Implications: Greater knowledge of the health outcomes in relationship to institutionalized and stigma relate barriers among aging gender minority people can help inform improved education for health providers and illuminate gaps in quality of care delivery. The establishment of a relationship between health status and utilization can also inform policy decisions to improve financial access to care.
Not providedExamining the Impact of Rurality on Healthcare Resource Access, Healthcare Utilization, Mental Health and Global Well-Being in Transgender Adults: A Comparison StudyThe purpose of this study is to examine the ways in which residing in a rural location impacts the mental health and global well-being of individuals identifying as transgender. Residing in a rural location, for anyone, often presents a set of unique factors with which to navigate, due to lack of resources, limited access to healthcare and counseling services, and inexperienced healthcare provider competency. While there is insufficient research examining the specific experiences of transgender people living in rural areas, research that does exist suggests that they face unique barriers not shared by non-transgender people in rural areas or by many transgender people living in urban areas. The goal of this research study is to explore the impact rurality has on the mental health of transgender individuals when compared to those residing in large, metropolitan cities. In particular, the study seeks to explore the experiences of this population in accessing healthcare resources and the subsequent outcomes of these interactions for transgender people living in rural locations within the United States. The results of this research will work to inform healthcare providers and practitioners in rural communities on the best practices and approaches in working with this distinct population.NCTE
Not providedInsurance Coverage and Access to Care: A Comparison of Trans and Cisgender PeopleThe 2008 National Transgender Discrimination Study results were compared to the National Health Interview Survey (NHIS) in an article published in 2016. The article, published in Psychology of Sexual Orientation and Gender Diversity (dickey, Budge, Katz-Wise, & Garcia, 2016), reported the results of a study that explored the differences in trans and cis people with regard to access to health care and insurance coverage. Clear health disparities were seen in the results. Trans people were less likely to be insured, less likely to have a primary care physician, and were more likely to use the emergency department (ED) for care than were cisgender people. In this study we plan to follow-up on the original study to determine how and if the atmosphere in health care has changed. We will compare the USTS data to the NHIS data to determine if there are any changes in the health arena. It is notable that the USTS data was collected after the Affordable Care Act (ACA) was implemented. We would expect to see less difference in the numbers of trans people who have insurance coverage. This may not change whether a person has a primary care provider as there continues to be a shortage of providers in the United States. The results of this study can be used to inform policy about the need to ensure that people have access to affordable insurance, that there are sufficient primary care providers who can work with trans patients (e.g., providers need to have cultural and clinical competence), and the need for training of ED staff to ensure culturally competent care.NCTE
Not providedTransgender memes for discursive teens: A look at digital bottom-up health epistemology in transgender communitiesThis thesis analyzes the content of memes from transgender Facebook meme pages in order to record and characterize the health and wellness of transgender meme makers and sharers. Understanding memes as discrete units of speech, memes can enlighten researchers as to topics important to transgender digital natives. With trans people self-selecting topics of memes, researchers have a window into what topics are important in the lived experience of being transgender, as opposed to topics chosen for discussion by researchers. While these memes discuss an array of topics, memes that discuss health and well being are of particular interest to this thesis for what information they can provide to care providers and advocates.NCTE
Not providedTrans-cending categories and interrogating the method: Trans/GNC people’s experiences with quantitative categoriesThis study has three broad research questions: 1. How do current “best practices” on survey construction capture participants’ gender? 2. How do participants resist and conform to quantifiable categories on gender in surveys? 3. How do trans and gender non-conforming people experience surveys on their identity? To answer these questions using the U.S. Trans Survey, the researcher will compare interactions across different educational attainment levels (question 2.22) and geographic locations (2.26). This study will look at how trans/GNC identified people interact with a survey publicized through the National Center for Transgender Equality focused on benefiting rather than pathologizing the trans community. How are we quantifying trans/GNC people and how are they critiquing and interrogating quantitative methods with their stories (section 32) and what does this mean for researchers, practitioners, and policy-makers? Open-ended responses and open fields will be assessed specifically around gender and sex/gender identification (Section 1; Section 2.1-2.8).NCTE
Not providedThe Lives of Trans MillennialsThis 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.NCTE
Not providedThe Role of Identity, Discrimination, and Safety in the Political Attitudes and Behavior of the Transgender PopulationIn 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.NCTE
Not providedPerformative Partisanship: Investigating the Partisan Gender Gap in the Transgender CommunityOne 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.NCTE
Not providedGender Identity Documents and Voting: The Relationship among Identification Cards, State Policies and Transgender Voting HabitsIt 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).NCTE
Not providedTogether We Rise: The Role of Community Socialization in Transgender Citizens’ Levels of Civic EngagementIn 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.NCTE
Not providedHow transition status and type of transition change self- reported levels of workplace discrimination and workplace stressThe research paper at focus pertains to the effect transition status and type of transition has on self-reported level of workplace discrimination and workplace stress among trans. What we don’t know is how the experiences of discrimination and stress might be unique for the trans population. Trans may be at risk to have acute and chronic stressors that may be associated with discrimination. Understanding how the stressors are associated with discrimination can provide some insight to how discrimination and stress may correspond with one another (Dewaele, Houtte, & Vincke, 2014). Previous research specifies that professed discrimination is a unique psychosocial stressor with significant implications for physical and mental health inequalities (Hedwig, & Turney, 2012). However, Intersectionality theory identifies different social groups and their experiences which indicates that understanding and focusing on the different components of a person and how the different components intertwine and identifies the person is how variance is described. Therefore, it is important to further understand the variances that might exist in regarding workplace stress and perceived discrimination. However, perceived discrimination and discrimination is a contributing factor to psychosocial stressors (Schwartz & Meyer, 2010). Nonetheless, the purpose of this study will be to learn the different perceptions trans have on discrimination in the workplace and how they are affected by it. Also, it would be valuable to understand what predicts higher versus lower scores on workplace stress as it relates to perceived workplace discrimination. Understanding the problem can contribute to the solution through providing data that increase knowledge as it relates to trans and discrimination and decrease assumptions which can assist professionals in providing empowering care.NCTE
Not providedThe Labour Market Outcomes of Transgender, Gender Non-Conforming and Genderqueer IndividualsTo 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.
Not providedRisk and Resilience Profiles Among Transgender Sex WorkersPrevious scholarship on transgender individuals’ experiences with engagement in the sex economy has heavily focused on individual and public health risk, consistently finding evidence that engagement in sex work confers a greater risk of contracting HIV and other sexually transmitted infections (Nemoto, Sausa, Operario, & Keatley, 2006; Sausa, Keatley, & Osperario, 2007), and experiencing violence and victimization (Farley & Barkan, 1998; Stotzer, 2009) and police harassment (USTS 2015). The multilevel risks associated with engagement in sex work vary based on a number of demographic, sociocultural, and contextual factors. For example, Nemoto and colleagues (2016) reported that different commercial venues (i.e. soliciting customers via the street or through a bar or club) demanded that workers negotiate varying physical locations, rules, expectations, and social hierarchies.  While the risks of engagement in the sex work economy are well documented, limited research has examined the conditions under which transgender sex workers yield resilient outcomes, or the specific conditions under which sex work confers greater and lesser risk.  Although research is scant, scholars have argued that involvement in the sex work economy is a complex site where participants can draw on, resist, and reimagine dominant and subjugated discourses about sex work (Smith 2017) and where transgender individuals negotiate boundaries between economic independence, self- empowerment, and relational resources  (Nemoto et al. 2016; Sevelius, 2013).
From a pleasure-based positive sexuality perspective, we aim to examine risk and resilience profiles among transgender individuals engaged in the sex work economy. Based on previous literature, we hypothesize heterogeneity in the experiences of transgender sex workers as a function of demographic covariates and and sociocultural contextual factors. Different transgender sex work profiles will likely indicate varying degrees of risk and resilience which can inform harm-reduction interventions and depathologize the elements of sex-work that confer resources to transgender individuals.
Not providedTransgender Men and Women in 2015: Employed, Unemployed or Not in the Labor ForceThis 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.NCTE
Not providedThe Impact of Party Affiliation of US Governors and State Legislature on Labor Market Outcomes of Transgender Individuals This study will investigate whether there is a causal impact of party affiliation of U.S. state governors and state legislature on the labor market outcomes of transgender individuals. The common perception is that Republicans favor pro-labor policies and are more likely to believe a person's gender is determined by their sex assigned at birth than Democrats. Such beliefs can influence voting, policies, and practices. We use survey data on economic outcomes and other individual-level characteristics from the U.S. Transgender Survey as well as state-level data on governance in 50 states. We exploit variations in the party affiliation of governors and variation in the number of state representatives and senators associated with each political party between various states of the country. In addition to Ordinary Least Squares (OLS) estimation, we employ Propensity Score Matching (PSM) techniques to provide additional support to the main findings. The outcomes of interest include employment status, hours worked, earnings, as well as the extent of underground labor market activities. We will also investigate the heterogeneous effect by gender identity, race and ethnicity.NCTE
Not providedIntersections of Oppression: Intersectionality and Occupational Discrimination of Transgender and Gender Non-Binary AdultsThis study will explore the impact of occupational discrimination on the psychological distress of transgender and gender non-binary/gender-queer (TGNB) individuals. The aim of this study is to explore the effects of occupational discrimination on mental health. Special attention will be paid to intersecting identities including people of color and those with disabilities that have been shown in the preliminary USTS report to compound various health disparities. The data explored in this study will be taken from the U.S. Transgender Survey (2015). Implications for these findings will provide suggestions for a framework to assess and reduce stigma-based discrimination in occupational settings inclusive of the external (distal) stressors and internalized (proximal) stressors unique to multiple intersecting identities. Findings will provide formative data to develop interventions to address stigma-based workplace discrimination and identify the individuals who may be at increased risk for psychological distress.NCTE
Not providedTrans Men in the Sex Work IndustryDespite the increase of research including trans identities over the past 10 years, little is known about this specific population. Regarding the field of sex work, literature and data collection neglects the specific circumstances of trans men in the industry. A lack of knowledge and the invisibility of male identified trans sex workers increases the obstacles and risks faced by this group. The chapter “Trans Men in Sex Work” will first give a general introduction about trans masculine identities. I will show the overall risk factors faced by this community, with an emphasis on socioeconomic circumstances, mental and physical health aspects. The introduction is followed by a description of the current situation reported by trans men in the sex work industry. Research shows that trans masculine sex workers mostly work independently and name on the one hand several specific concerns about their health and safety, but also report on the other hand about empowering elements of engaging in sex work. This given picture is based on the outcomes of an online survey amongst trans male sex workers, which has been conducted in 2017/18, specifically for this book chapter. Data from the 2015 USTS about the experiences of trans men who have participated in sex work will be explored in this chapter.NCTE
Not providedReport on Transgender Adults in the WorkplaceThis 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.NCTE
Not providedExploring the Role of Spirituality/Religion in the Lives of Trans-Spectrum PeopleOver 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.NCTE
Not providedFaith Community Rejection and Transgender Well-beingResearch 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.NCTE
Not providedExploring the Relationship of Religion and Spirituality in Trans/GNC Students' Likelihood to Enroll and Persist in Postsecondary EducationA 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).NCTE
Not providedUnderstanding the Relationships between Stigma, Resilience, and Engagement in HIV Care Among Transgender Women Living with HIVUnderstanding the Relationships between Stigma, Resilience, and Engagement in HIV Care Among Transgender Women Living with HIV: This project is part of a doctoral dissertation examining stigma, resilience, and health among transgender and gender diverse communities in the United States. This study will apply latent class analysis to better understand how domains of stigma and resilience are associated with engagement in HIV care among transgender women living with HIV. Resilience refers to a process of overcoming the potential negative effects of being exposed to a risk. Resilience can be understood through environments and resources that promote coping strategies (e.g., institutions and interpersonal relationships that provide social support, community connectedness, and gender affirmation). In moving beyond an examination of the negative factors contributing to HIV disparities for transgender women, and instead focusing on how environments in which transgender women live contribute to opportunities for resilience and improved engagement in HIV care, we can gain insight into how to develop interventions that can improve transgender women’s engagement in HIV care. Since resilience is understood as occurring in response to being exposed to risk, we will include measures for both stigma (risk) and resilience in this study. Stigma will be measured through experiences of discrimination and victimization across multiple environments (e.g., employment, housing, education, health care) and experiences of systematic vulnerability (e.g., unemployment, homelessness, incarceration). Resilience will be understood through resources that promote resilience, such as social support (e.g., from a partner/spouse, children, immediate family, co-workers, classmates), community connectedness (measured through experiences with other transgender and gender diverse people), support from institutions (e.g., religious institutions), and access to gender affirming legal document changes. The primary outcome of engagement in HIV care will be examined across the continuum of HIV care and will include linkage to care (i.e., ever seeing an HIV provider), initiation of ART (i.e., prescription of ART), and adherence to ART (i.e., current use of ART as it was prescribed).NCTE
Not providedIntersection of Gender, Ethnoracial, and Class Stigma and HIV Testing Patterns among Transgender Women of ColorThe 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.NCTE
Not providedAdherence to HIV Care and Medication among trans men, women and nonbinary individuals: Findings from the US Trans SurveyAdherence 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.NCTE
Not providedTrans identity development among millennialsIn 2005-06, Sue Rankin and I conducted a study of transgender identity development that involved 3,500 individuals completing a survey and 400 subsequent interviews. The work became our 2011 book The Lives of Transgender People, and outside of the surveys done by NCTE, it is the largest study of transgender people in the U.S. Sue and I would like to use the USTS data (specifically the responses to the questions in sections 3 and 4 and to the qualitative question in section 32) to examine differences in transgender identity development between our 2006 data collection project and the 2015 USTS data. Given the greater visibility of transgender people over the past decade and the greater use of social media, we expect to find that transgender individuals today generally recognize themselves and come out earlier, are more socially engaged, and are more out to family, friends, and others around them. Because similar questions regarding transgender identity development were used in both surveys, we will be able to compare participant responses.NCTE
Not providedImpact of time between personal realization and stages of transition on well-being on transgender individualsTransgender 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.
Not providedTransgender Identity Development Across the Lifespan: Findings from the 2015 U.S. Transgender SurveyRecent 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.NCTE
Not providedEducational 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?NCTE
Not providedThe Relationship Between Age of First Awareness and Later Identity, Social Transition, and Medical Intervention in Transgender and Gender Non-Conforming AdultsEven though approximately 1/3 of adults in the 2015 U.S. Transgender Survey (USTS) self-identified as something other than binary transgender, there has been very little research specifically looking at the developmental aspects of nonbinary identities (Harrison, Grant & Herman, 2012).  In addition, a binary transnormative narrative (Johnson, 2016) continues to exist which asserts/assumes that all transgender and gender non-conforming (TGNC) individuals: a) become aware of the incongruence between their assigned sex and affirmed gender at a very young age; b) will benefit from early (prepubertal) social transition; and c) desire “complete” medical transition, referring to hormones and various gender confirmation surgeries.  The extent to which a TGNC person is influenced by this narrative often impacts the way one thinks about one’s gender identity and the various decisions that are made about both social and medical transition.  Given this, it is important to ascertain the extent to which this assumed narrative actually fits the population.  In this study, the relationship between the age that TGNC adults first became aware of their TGNC identity and the decisions they made about a) their identity/identity labels, b) the extent of and age of social transition, and c) the extent of and age of sought medical interventions will be examined.  Due to the cultural shifts that have occurred overtime, the proposed study will also examine these relationships from a developmental perspective. For example, people who are now in their 70’s compared will be compared to those who are in their 20’s, 30’s, 40’s, etc. to look for any generational differences in the way these variables relate to one another.NCTE
Not providedGender Identity Profiles and Trans-Related Health Care SeekingGender 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.NCTE
Not providedLegal gender recognition, psychological distress, and suicide risk among transgender adults in the United StatesLegal (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?
Not providedPublic policy and the public experience: A case for comprehensive transgender-affirming identity document policyThe study gender and sexual minorities continues to garner the interest of scholars and maintain the status of a methodologically rich, but understudied, field. Fortunately, the United States Transgender Survey (USTS) provides significant opportunity for rigorous scholarship. James (2017) most notably crafted a paradigmatic dissertation about the political behavior and characteristics of transgender people using USTS. The proposed research will employ a public policy and politics framework to assess the statistical significance of identity document incongruences with the negative experiences of transgender people in public spaces, while controlling for other factors. It will explore how the presentation of incongruent name and gender markers on four identity document types leads to transgender people's greater likelihood of being denied services, harassed, or even physically assaulted.NCTE
Not providedConnecting the invisible dots: A look into the intersectionality of transgender undocumented personsBeing 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.NCTE
Not providedSuicidal Behaviors Among Transgender and Gender Diverse People with Military ExperienceResearch in the U.S. shows that transgender and gender diverse (TGGD) people, compared to cisgender people, are more likely to report suicidal behavior. However, little is known about the risk and protective factors for suicidal behavior among TGGD people, or how these factors may vary across subgroups of this population. The proposed research will compare civilian and military TGGD people in terms of their suicidal behavior, including suicide attempts, suicidal ideation, and self-harm behaviors. In addition, we intend to examine differences between civilian respondents and those with military history (i.e., veterans and active duty) in specific vulnerability and protective factors that may help to explain disparities in suicidal behaviors. Previous research on service members has illuminated some military-specific stressors (e.g., frequent deployments, combat exposure), but also some potential benefits of military service relative to civilian life (full-time employment, universal healthcare) that may be related to mental health or self-harm and suicidal behaviors. In addition, there may be differences in the prevalence and impact of both general risk factors (e.g., discrimination, stigma) and protective factors (e.g., social support, community connectedness) that affect TGGD people regardless of whether or not they have military history. Comparisons of suicidal behavior among military and civilian TGGD people (controlling for possible demographic confounds) will be conducted using the 2015 U.S. Transgender Survey (USTS).NCTE
Not providedTransgender Military Inclusion: Transgender Service Members’ Health and Well-being at the Brink of Open ServiceIn 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.NCTE
Not providedGender Affirmation Interventions, Social Transition, and Suicide Risk in Transgender Adults With and Without History of Military ServiceData 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.NCTE
Not providedIntersection of Gender Identity, Discrimination, Violence, and Access to Healthcare on Suicidal Ideation and Attempts in Transgender People of ColorSuicide ideation and attempts are a health crisis that significantly burdens transgender populations and warrants additional research for effective intervention and prevention (National Institute on Minority Health and Health Disparities, 2016; Wolford-Clevenger, Frantell, Smith, Flores, & Stuart, 2018). Unfortunately, transgender people of color (POC) are at an even higher risk for structural and institutional transphobia, interpersonal violence, and minority stress, known correlates for suicide ideation and attempts (James et al., 2016; Meyer, 2003; Perez-Brumer, Hatzenbuehler, Oldenburg, & Bockting, 2015; Testa et al., 2017). Thus, these experiences with internal and external minority stress culminate and contribute to greater feelings of rejection, judgment, and othering, particularly for transgender POC (Meyer, 2003). Despite the known risk factors for suicide ideation and attempts among transgender people, there is a scarcity of research and a lack of clear findings on various intersecting identities and their association with suicidal ideation in transgender populations (Wolford-Clevenger, Frantell, Smith, Flores, & Stuart, 2018). While there has been an overall lack of intersectional perspectives on suicide ideation and suicide attempts among transgender populations, research has also yet to examine within group differences on suicidal risk among transgender POC. In light of these gaps in the literature, this analysis seeks to answer the question, “How do the associations between discrimination, violence, access to transgender-related healthcare, and social support on suicidal ideation and suicide attempts differ for Black, Latino, and Asian transgender and gender non-conforming people?” Structural equation modeling will be used to examine within group differences in how various social identities and experiences of transgender POC compounds or protects against the risk of suicidal ideation.NCTE
Not providedNetwork Analysis of Multiple Identities, Transition Related Medical Intervention, Social Support and Discrimination in High and Low Suicidality Transgender AdultsIndividuals who identify as transgender and gender non-conforming (TGNC) are not a monolith, and their lived experiences can vary widely. While transgender people as a population are at higher risk for suicidal behaviors and thinking, some individual experiences or identities may promote resiliency, and others which increase risk. However, exploring how each of these identities and experiences promote resiliency or risk alone neglects the relations with other aspects of lived experience. Something might be a resiliency factor in one context, but when combined with other experiences, become a risk factor. This study proposes exploring the dynamic relations between multiple identities, access to transition related medical intervention (TRMI), social support, and discrimination. By exploring the differences in these networks in individuals who have endorsed different experiences of suicidality, the ways factors reinforce or mitigate each other to increase resilience will be clarified. Data from USTS is requested to perform a network analysis on these identities and experiences in TGNC individuals with recent suicidal ideation, with a history of suicide attempt(s), and those with no history of ideation or attempt. The goal of this project is a deeper understanding of the ways in which the aspects of a person’s lived experience interact, and how these interactions are different in TGNC individuals with different experiences of suicidality. While other approved projects overlap in some of the variables they address, our proposal is unique in that it employs a sophisticated statistical analysis to specifically explore TGNC identities and how those relations may change according to context. This proposal also incorporates the ideation to action framework of suicide (Klonsky & May, 2015) to help frame these relationships in a way that may be meaningful in the progression from suicidal thoughts to behaviors.NCTE
Not providedRisk of Psychological Disorders and Attempted Suicide among Transsexuals: Importance of Transsexual Identity Characteristics and Experiences of DiscriminationThis study will examine predictors of mental health among a large sample of transsexuals living in the United States using the USTS.  Mental health outcomes will include currently living with a serious psychological disorder and lifetime suicide attempts (among other possible health outcomes, including physical health).  Predictors of mental health included standard sociodemographic characteristics (e.g., age, race/ethnicity), transsexual identity characteristics (e.g., visibility of transsexual identity), and the experience of discrimination due to being transsexual (e.g., verbal harassment, physical assault).  Transsexual participants may show relatively high rates of living with a serious psychological disorder and lifetime suicide attempts compared with the general US adult population.  Several characteristics of participants’ transsexual identities and experiences of discrimination may predict mental health outcomes.  Analyses will focus on experience of discrimination and whether such experiences tend to mediate the relationships between transsexual identity characteristics and both living with a serious psychological disorder and lifetime suicide attempts.NCTE
Not providedSuicidal ideation risk after gender affirmation surgery: An analysis of the 2015 U.S. Transgender Survey.Suicide rates in transgender individuals are higher than in the general population, with certain studies reporting rates greater than 40%. Various of psychosocial risk factors contribute to this increased anxiety and stress, thereby leading to depressive symptoms and subsequent suicidal ideation1. Although there is clinical consensus on the benefits of gender affirmation procedures, especially on quality of life outcomes, there is paucity of well-designed studies. Literature provides mixed results; a large cohort study from Sweden that evaluated outcomes after gender affirmation procedures noted that risk for suicidal ideation and subsequent mortality increased as compared to the general population. However, this study was limited in its ability to quantify the change in suicidal risk within the studied population. Surgical intervention provides visual congruency which may decrease the inherent risk of suicide. Our study will quantify the independent effect of surgical transitioning on suicidal ideation risk. Moreover, we will evaluate which interventions are associated with the greatest decrease in suicide risk. We will utilize logistic regression and multilevel survival analysis techniques incorporating Cox proportional hazards models with mixed effects, and then subsequently incorporate cluster‐specific random effects to modify the baseline hazard function to get adjusted estimates of effect of surgical transition on suicide rates. The results of this study would have an important impact for public health policy and future cost compensation of transition-related care.NCTE
Not providedPatterns of Suicide Risk in Transgender Adults: a Latent Class AnalysisPrevious 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.NCTE
Not providedSuicide Thoughts and Attempts among Transgender AdultsThis 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. NCTE
Not providedThe Influence of Psychological Distress and Substance Use on Suicide Ideation Among Transgender People Over Four Age CohortsGuided 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.NCTE
Not providedAssociations of Prejudice and Health Among Gender Minority Youth with Binary and Non-Binary Gender IdentitiesCompared 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.NCTE
Not providedSuicide Prediction in Transgender Adults: A Machine Learning ApproachSuicide 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.NCTE
Not providedSyndemic Dynamics: Modeling Mental Health and Substance Use Risks and Resiliencies in a Large U.S. National Non-Probability Sample of Gender Minority AdultsIn 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.NCTE
Not providedAffirmation, Mental Health, and Physical Health Among Non-Binary and Genderqueer Individuals: Findings from the 2015 USTS SurveyNon-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.NCTE
Not providedThe Asian American experience as transgender in the U.S.: A Mixed Method AnalysisDespite 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?
Not providedRelationship Experiences, Minority Stress, and Health Outcomes among Transgender and Gender Non-conforming AdultsThough health disparities facing the transgender and gender non-conforming (TGNC) community have been increasingly recognized and studied, little knowledge exists about the impact of relational experiences on the health outcomes of TGNC individuals. Though romantic relationships can increase well-being and serve a protective function in health, they may be less supportive for TGNC individuals depending upon levels of rejection and/or transphobia exhibited by one’s partner(s). Existing research is minimal, though some suggests that romantic partners of TGNC adults can contribute in significant ways to experiences of hostility, prejudice, and discrimination. For example, the USTS dataset contains important information related to relational minority stressors (e.g., whether romantic partners have been physically, emotionally, verbally, and/or sexually violent; whether romantic partners have interfered with gender transition-related care). Analysis of this large and robust secondary dataset will provide important new information about the role of romantic relationships in the health and well-being of TGNC adults. This study aims to examine the frequency and impact of minority stress experiences within romantic/sexual relationships of TGNC adults, as well as the role that relationship status plays in health outcomes for this community. The overall objective of this study is to identify how, within romantic relationships, gender-based support and/or minority stressors influence the health of TGNC adults. Identifying the role that romantic relationships may play in minority stress experiences of TGNC adults is critical to the development of future health prevention and intervention strategies.NCTE
Not providedMental health, HIV, and exposure to violence among trans and non-binary people who have participated in sex work or exchange sexResearch suggests that transgender and non-binary people (TNBP) participate in sex work at higher rates than the general population. Those who participate in sex work are at elevated risk for poor mental health, HIV, and exposure to violence. Race, ethnicity, and poverty often further compound these risks. We approach this work via the framework of syndemics - the concentration of two or more co-existing conditions that interact to exacerbate the outcome of each condition. Existing research on trans sex work is limited by examining mental health, HIV, or exposure to violence bilaterally, primarily among transgender women, and not distinguishing paid sex work from exchange sex. Existing syndemic research often does not test for the critical disease interaction component because of small sample sizes. The USTS offers a large sample size of TNBP who have participated in sex work to examine interactions between these factors within one sample. We hypothesize that the co-existence of poor mental health, HIV, and violence interact in a way that exacerbates the severity of the outcomes for the other factors among TNBP who have participated in sex work and/or exchange sex compared to those who have not. We will first explore the rates of these health outcomes across TNBP who participate in sex work or exchange sex to discern differential risk factors. Then, we will examine the interactions between these factors among people who have engaged in sex work and/or exchange sex. This research will identify health risks and relationships in order to tailor interventions for TNBP who have, or currently are, engaging in sex work. If syndemic interactions between conditions exist, this work could advocate for a holistic approach to care and treatment for TNBP among health and social service providers.NCTE
Not providedDiscrimination and Suicide Risk among Transgender Adults: Testing Minority-Stress and Social-Ecological Models of SuicideTransgender adults demonstrate consistent patterns of elevated risk for experiences of discrimination and suicide. Data is requested to examine the link between discrimination experiences (e.g., in counseling and conversion therapy; unequal treatment, harassment, and physical assault) and suicide-related behavior in a nationally representative sample of Transgender and Gender Non-Conforming adults. Consistent with a Minority Stress (Herek, 2016, Meyer, 2013) perspective, we will test the moderating effects of coping (e.g., family and peer support; substance use) on the discrimination-suicide link. From a Social-Ecological (Cramer & Kapusta, 2017) view, we will examine additional multi-level influences such as interpersonal (e.g., experiences in the workplace), community (e.g., military status) and societal (e.g., geographic region) factors. Analyses will result in scholarly publications, and inform further primary data collection and grant development efforts. Consistent with Minority Stress Theory, we specifically treat social support and coping as moderators of the discrimination-suicide/mental health link. In contrast, other approved proposals examine social support from clustering approaches in relation to other outcomes (e.g., trauma) or among specific subgroups (e.g., military) unrelated to suicide.NCTE
Not providedInteractions between blending and identity concealment: Effects on Non-Binary people’s distress, suicidality, and experiences of victimizationIdentity concealment (whether or not a person is open with others about their transgender status) and passing/blending (how much a transgender person can, or chooses to, blend into the binary social environment) have been shown to impact transgender people’s experiences in various ways, but few studies examine these constructs in the lives of Non-Binary transgender individuals. Living in a binary-gendered world may impact people with a Non-Binary gender identity in unique ways, creating unique stressors for this population. Also, little research to date examines Non-Binary transgender people’s mental health and victimization experiences, which could be related to blending and identity concealment. This study will use the Non-Binary subset of the sample from the United States Transgender Survey data to examine the interactive effects of blending/passing and identity concealment on distress, suicidality, and victimization. Blending will be operationalized as how others perceive Non-Binary participants in public (“for people in your life who don’t know that you’re non-binary/genderqueer, what gender do they usually think you are?”). Identity concealment will refer to how often the respondents correct binary gender assumptions placed on them (“when people in our life assume you are something other than non-binary/genderqueer, how do you respond?”).NCTE
Not providedThe Health and Well-being of Trans, Nonbinary, and Gender Nonconforming Adults in the Upper MidwestThe objective of this project is to assess health status, access to care, and experiences of violence among TGNC people in the Midwestern United States, with particular attention to Wisconsin and the Upper Midwest (IA, IL, MI, MN, ND, SD, WI). According to the Transgender Law Center, 9 out of 12 states in the Midwest and 7 out of 8 states in the Upper Midwest are rated as “low” or “negative” policy environments in terms of TGNC-affirmative health laws and policies. The overall policy environment in the Midwest is uneven, with only two states (Illinois and Minnesota) scoring “high” in terms of laws and policies that support TGNC residents. In a series of comparative analyses, our research will evaluate health access and outcome measures within Wisconsin by respondent gender identity, sex assigned at birth, age, race/ethnicity, socioeconomic status, and so on, as well as between states in the region and the Midwest in relation to the U.S. overall. Particular measures of interest include: health insurance coverage, access to transition-related, general, and mental health care, quality of care, health status indicators, and experiences of interpersonal and structural violence. Methods will include descriptive and inferential statistical analyses, as well as (if relevant) textual analysis of open-ended responses. Outputs from this project will include infographics and factsheets for community members and policy makers, as well as scholarly articles in social and health science journals.NCTE
Not providedReport on Transgender Adults in Mississippi, Alabama and ArkansasThis 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.NCTE
Not providedSmall Area Estimation of the Transgender and Gender Nonconforming Population in Seattle-King County: Demographics and HIV Related Health OutcomesIn contrast to other urban settings, Public Health Seattle-King County (PHSKC) estimates low HIV prevalence among transgender and gender nonconforming (TGNC) individuals living in Seattle, with just 55 prevalent HIV infections among transgender women, and 3 among transgender men ever reported as of 2016. This discrepancy likely results from the misclassification of TGNC individuals in HIV surveillance data due to historically inaccurate methods of capturing gender identity. The proposed research aims to address the current gaps in HIV surveillance data and knowledge of the sexual health of TGNC people living in Seattle. We will characterize the demographics of the TGNC population in Seattle-King County, and estimate prevalence of key health outcomes using the USTS 2015 dataset. Specifically, we will apply small area estimation statistical methods to estimate the prevalence of HIV testing, self-reported HIV infection, and antiretroviral therapy coverage, and related outcomes, as well as HIV risk factors among TGNC people living in Seattle. Ultimately, these estimates will be used to parametrize a deterministic compartmental mathematical model of the HIV epidemic among sexual and gender minorities in Seattle. We will model how the scale-up of biomedical interventions among TGNC people, including PrEP and ART, would reduce 10-year HIV incidence. Epidemic models that include all gender minorities (i.e. transgender men and non-binary individuals, in addition to transgender women) are needed as a critical tool to inform HIV prevention outreach to TGNC people. Further, development of these estimation methods will support other public health departments in understanding local HIV and STI epidemics among TGNC populations and inform local public health strategies.NCTE
Not providedRadical Reproductive Justice Accompliceship: Following the Lead of Trans BIPoCReproductive 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.NCTE
Not providedState-Level Discrimination Laws, Violence Victimization, and Self-Harm among Transgender and Gender-Nonconforming PeopleLittle 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.NCTE
Not providedImpact of Pro-LGBT Legislation on the Social and Health Disparities Experienced by Transgender PeopleStudies 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?NCTE
Not providedExamining Race Differences in the Relationship Between State-Level Stigma-Related Policies and Transgender HealthState-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).NCTE
Not providedPredictors of Non-Medical Prescription Drug Use Among Transgender and Gender Nonconforming Adults: Findings from the 2015 U.S. Transgender SurveyIn 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.NCTE
Not providedTobacco Use Associations Among Transgender People Living in the U.S.Tobacco use is the leading cause of preventable death in the US. Little research to date has investigated the risk factors of tobacco use among transgender communities. This study seeks to increase understanding of tobacco use among transgender persons through analyses to identify key characteristics associated with tobacco use in the 2015 USTS sample and to examine how tobacco use varies among different groups of transgender people, based on demographics and gender transition. Data from the 2015 US Transgender Survey (USTS) indicate that tobacco use differs by age, race, and income generating activities (e.g., underground economy). Transgender persons who are interested in hormone treatment and/or gender transition surgery are generally advised to stop tobacco use. One study of 156 transgender patients reported transgender women who receive hormone therapy are more likely to quit smoking. Guided by Minority Stress Theory and Intersectionality Theory, this study aims to 1) examine how risk factors for tobacco identified among the general and LGB population correlate with tobacco use among USTS respondents, 2) assess risk factors that uniquely impact transgender communities (e.g., discrimination, lack of adequate care), and 3) examine the association between gender transition and tobacco use.NCTE
Not providedFactors associated with de-transitioning: an analysis of the 2015 U.S. Transgender SurveyAlthough the majority of transgender individuals have no regrets with their transition, a small minority choose to de-transition to their sex assigned at birth1. A multitude of psychosocial factors have been attributed to this decision, but the few studies to date that have queried this topic have had small samples sizes and poor methodological rigor, thereby limiting their generalizability2–4. Medical and surgical reversal can be challenging to both patients and providers. In addition to the complexity of such surgical procedures, the increased morbidity associated with additional surgery may preclude providers from offering such therapeutic solutions. Moreover, the increased financial burden may prohibit patients from actively seeking out such care1. In this study we will evaluate the independent effect of various demographic, economic, clinical, psychosocial and psychosexual factors that affect an individual’s decision to de-transition. We will employ a mixed effects model to address geographical confounding and use a multitude of epidemiological techniques to model risk and protective factors, including cluster analysis and structural equation models to address confounders and effect modifiers. The results of this study will provide important insights to clinical providers, identifying individual-level risk factors that are associated with de-transitioning. NCTE
Not providedCorrelates, Consequences, and Reasons for DetransitionWhile many advancements have been made in the field of Transgender/Gender Non-Conforming (TGNC) health, minimal research has been done in the United States (US) on individuals who have chosen to detransition. Most recent data on rates of medical detransition are based on a 2014 Swedish study with estimates around 2.2%. These data came from individuals who had received a new legal gender, via unspecified medical procedures, and then applied for reversal to their natal sex. Further the aforementioned study is limited to a relatively small sample size of 767 Swedish individuals. There are currently no published studies on why TGNC individuals choose to detransition, including socially, hormonally, and medically. Further, few studies look at correlates of detransition. Data provided from the US Trans Survey would can fill in these research gaps by providing a large sample size, spanning a broad definition of detransition, and providing much needed data on correlates of detransition. Specifically, this study has two aims: 1) Identifying most common reasons for detransitioning, and 2) examining correlates of detransition, including potential risk factors (i.e., intrapersonal factors and social determinates of health) and potential mental health outcomes (i.e., substance abuse and psychological distress). This will be the first large US based study to investigate why individuals detransition and provide a wealth of specific data on both risk factors and correlates of this understudied phenomenon. Information on why detransition is chosen and predictors/correlates of detransition can equip healthcare providers with important knowledge regarding culturally sound transition-related care.NCTE
Not providedThe Effect of Gender Transition-Related Health Care Utilization on Suicidal Thoughts and Behaviors: Findings from the 2015 U.S. Transgender SurveyPrior 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.NCTE
Not providedChildhood & Adolescent Experiences with Gender-related Medical Care and Depressive Symptomatology in AdulthoodThe 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.NCTE
Not providedContrasting preferences for gender transition procedures between transgender and gender non-binary individuals: An analysis of the 2015 USTS databaseProcedures 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.NCTE
 Predictors and Effects of Specific Transition-Related Surgical Procedures on Transgender PatientsThere is an expanding body of clinical research within surgical literature describing the psychosocial benefits of transition-related procedures on transgender individuals. While the results are consistently positive, the data comprises primarily case reports and case series of single surgeon, single institution experiences. The purpose of this study is to evaluate both the predictors and outcomes of specific gender transition related surgical procedures through two separate projects. The first project will examine the correlation between specific surgical procedures and depressive symptomatology, suicidal thoughts and behaviors, adherence to HIV medication regimens, and substance abuse. The second project will evaluate the predictors of undergoing specific surgical procedures, including insurance status, socioeconomic status, income, education, access to providers, family support, prior experience of violence, and discriminatory health care encounters. Through an analysis of a large nationally-represented dataset, we hope to provide surgeons with information on both access to the impact of transition-related procedures on transgender patients.NCTE
Not providedOlder Transgender Medicare Recipients and Access To Gender-Affirming CareAARP seeks to investigate the relationship between older transgender recipient of Medicare benefits and access to gender-affirming care, as well as other healthcare access. According to the USTS, transgender people who have Medicare are denied coverage for cross-sex hormone treatment and gender-affirming surgeries less often than those without Medicare. As of 2014, Medicare covers hormone treatments and reassignment surgeries that are deemed medically necessary, which might explain this phenomenon. Research highlights the fact that transgender individuals experience discrimination when trying to access both gender-affirming care and routine medical care, and as a result, may not utilize access to medical care even when they have insurance. AARP will explore the data to understand the barriers to care that transgender Medicare recipients encounter and how this affects their health. AARP will examine subgroups differences among age cohorts, those with disabilities and multicultural populations. Findings will be highlighted in research reports, professional conferences and publications.NCTE
Not providedClinical and socio-economic determinants of surgical transition: an analysis of the 2015 U.S. Transgender SurveyEven minor surgical procedures can profoundly improve a transgender (TG) individuals’ self-esteem and functioning. However, despite receiving medical and hormonal therapy, certain individuals choose not to obtain gender affirming surgery. Several social factors such as race, sexual orientation, socio-economic status (including income, education), family/social support and mental health are postulated to negatively and positively affect rates of transitioning. Most literature has evaluated these factors singularly; there have not been studies that have evaluated the interaction of the factors and the resultant effects on surgical transitioning. Our study proposes to elucidate the impact of various socio-economic factors using a mixed effects model. We will utilize geographical and time-sensitive intercepts to account for the clustering of data. Additionally, we will utilize cluster analysis and structural equation models to identify confounding factors. The results of this study will be important from a surgical and public health perspective; identifying modifiable social and economic factors will enable policy makers to intervene, channeling resources to bring about effective change. From a surgical standpoint, identifying patient cohorts that are most and least likely to desire surgery, stratified by the type of surgery will help improve the clinical care that is offered.NCTE
Not providedFamily Matters: Trauma and Resilience in Trans CommunitiesThe 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.NCTE
Not providedExamining Risk Factors and Health Consequences of Intimate Partner Violence among Transgender People: Findings from the 2015 U.S. Transgender SurveyStudies 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.NCTE
Not providedTransgender Intimate Partner Violence in a National U.S. SampleIntimate 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.NCTE
Not providedIntimate Partner Violence in Transgender Population; Identity, Risk, and Health ImpactEmerging 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.NCTE
Not providedRates of Polyvictimization Among Non-Binary Individuals: A Comparison of Individuals Assigned Male and Assigned Female at BirthDespite 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.NCTE
Not providedUnderstanding factors of post-traumatic growth (PTG) in transgender adults: an analysis of risk and protective influencesThis research team seeks to understand and identify factors of post-traumatic growth by conducting secondary analysis from the USTS. Our research identifies the following hypotheses:
1) The following factors will play a role in the presence of higher levels of resilience, improved behavioral and physical health outcomes and more markers of post-traumatic growth: a. the farther along the identified stage of social or medical transition; b. the more supportive/inclusive faith communities; c. involvement of trans-affirmative medical providers.
2) The following factors will contribute to higher risk factors and the less significant presence of factors of PTG: a. Less involved family of origin/lack of family of choice; b. Less identified social support; c. High frequency of more marginalized/less visible sexual identities including bisexuality, asexuality and polyamory.
3) Trans-oppressive/non-affirming medical providers can perpetuate and facilitate traumatic events contributing to the presence or absence of PTG, which can lead to negative physical and behavioral health outcomes.
The research team has extensive work in quantitative secondary data analysis from the AddHealth study, mixed methods research and qualitative analysis, particularly in 20th century feminist theory, queer theory and thematic narrative analysis.
We hope to publish two papers – the first focusing on mitigating risk factors in order to facilitate post-traumatic growth within the trans community directed at medical and nursing professional, particularly for those who provide post-surgical support during medical affirmation surgery. We seek to publish this paper in medical/nursing journals The second paper will be dedicated to behavioral health professionals to build trans affirmative treatment practices to facilitate the five pillars of post-traumatic growth: spiritual changes, new possibilities, appreciation of life, relating to others and personal strength. This second publication is aimed at behavioral health and queer journals.
Not providedTrauma and Mental Health Among Disabled Trans and Gender Nonconforming Emerging Adults in the U.S.Existing research on the impact of violent and traumatic experiences (i.e. bias incidents, hate violence, sexual assault, employment discrimination, etc.) on disabled transgender and gender nonconforming (TGNC) emerging adults is nearly non-existent. However, some existing research indicates that disabled and neurodivergent individuals, trans individuals, and emerging adults are all, separately, more likely to experience most forms of violence and also more likely to report decreased wellbeing and overall mental health. This project will complete a series of chi-square analyses and advanced binomial regression tests to assess not only the baseline disparities in mental health outcomes for disabled TGNC emerging adults, but also some of the factors that impact those outcomes--including but not limited to experiences of violence and trauma; other demographic variables such as race ethnicity, sexuality, educational attainment, employment status, etc.; and access to and utilization of comprehensive and competent mental health care services. Findings will be published in 2-3 peer reviewed LGBTQIA+ and/or health journals.NCTE
Not providedVictimization and Health Outcomes for TGNC Individuals in Women’s PrisonsThis study examines the prevalence of victimization and quality of transitional health care provided to transgender and gender non-conforming (TGNC) individuals formerly incarcerated in women's prisons. Current research indicates significant disparities in terms of health outcomes and experiences of violence for transgender individuals broadly, and transfeminine individuals while incarcerated more specifically; yet, it is still largely unknown to what extent these experiences compare amongst incarcerated transmasculine and non-binary individuals. This study seeks to address this glaring gap in the literature through a quantitative analysis of experiences and outcomes for transgender and other gender non-conforming formerly incarcerated individuals. Specifically, this study seeks to address the following aims: 1) to explore the prevalence of experiences of violence for TGNC individuals previously incarcerated in women’s prisons (for the purposes of this study, “violence” refers to physical and sexual assault, by both other inmates and correctional staff); 2) to examine the relationship between transgender identity and the nature of treatment by law enforcement and prison staff; and 3) to explore the quality and extent of healthcare for TGNC individuals in women’s prisons, specifically with regard to the availability of hormone replacement therapy and other forms of care related to gender transition. This study uses USTS data regarding the experiences of transmasculine and non-binary individuals (assigned female at birth) who were previously incarcerated, held in immigration-related detention, or have had encounters with law enforcement to explore the extent to which these individuals experience violence and health disparities in relation to their interactions with the criminal justice system, and to theorize what factors affect these complex health experiences and outcomes.NCTE

Katherine Sobering

(A)gender in OppositionThe proposed research is one of two portions of a mixed methods study examining agender identities. In an effort to understand the ways in which agender individuals develop and understand their identities, and how those identities are employed to navigate systems of gender, this study seeks to answer the following questions: 1. How do agender individuals define their gender identity (or lack there-of)? 2. How do agender individuals navigate gendered spaces? 3. How can agender identities be theorized? The first portion of this study is a series of interviews with individuals who identity as agender. These interviews seek to explore personal understandings of agender identities and experiences related to those identities.The second portion of this study is a data analysis of the 2015 U.S. Transgender Survey. This analysis would focus on data from individuals who indicated identifying as agender in order to better understand the experiences of those individuals and trends within that community. The restricted data are required for this research as reports and other documentation of this data have not addressed agender identities specifically. While some reports have included basic demographic information of the respondents, including information about the percentage of respondents that identify as agender, none have specifically analyzed this subpopulation of respondents. Analyzing these data would allow for a richer investigation into these identities.ICPSR
S. Marie HarveyTRANSGENDER ADULTS LIVING WITH DISABILITIES: FACTORS ASSOCIATED WITH HEALTH CARE UTILIZATIONThe overall goal of the proposed study is to examine the relationship between disability status and utilization of health care for transgender adults. Importantly, gender identity and disability status are considered demographic variables, not outcomes, in this project. I hope to use data from the 2015 United States Transgender Survey (USTS) for this project. The USTS is largest sample of transgender adults captured to date (James, Herman, Rankin, Keisling, Mottet, & Anafi, 2016) and the only dataset available to address the following aims: Aim 1: Compare health care utilization by transgender adults living with and without disabilities. Transgender adults living with disabilities have a myriad of reasons to utilize and avoid health care. Comparing transgender adults living with and without disabilities allows for a better understanding the influence of disability status has on health care utilization behavior for transgender adults. Aim 2: Examine what predisposing and enabling factors are associated with health care utilization for transgender adults living with disabilities. Many factors likely influence health care utilization for transgender adults living with a disability. USTS data will be used to assess predisposing and enabling factors that may impact health care utilization in transgender adults living with disabilities, such as visual conformity, age, race/ethnicity, psychiatric distress, location, education level, income, health insurance status, and distance to provider. Aim 3: Compare predisposing and enabling factors associated with health care utilization for transgender adults living with and without disabilities. Although many factors may impact health care utilization, these factors may differ (or differ in strength) based on disability status within the transgender population. Comparing transgender adults living with and without disabilities allows for a better understanding of the unique factors associated with health care utilization for transgender adults living with disabilities and if these factors differ from transgender adults without disabilities.ICPSR
Margaret AndoverThe Influence of Transition, Discrimination, and Family Support on Suicidal Thoughts and Behaviors Among Transgender and Gender Diverse AdultsBackground: Using the life course health development framework, we can conceptualize coming out and gender transition as a turning point in life that involves identity exploration, the interaction of macro-contexts and environments (e.g., family support, health care system, inequality), and changing ones role in social relationships and society (Halfon & Hochstein, 2002). Qualitative research suggests that gender transition is a life-changing process for TGD people, one that impacts many facets of life (Levitt & Ippolito, 2014). This raises the possibility that the impact of gender transition supersedes other transitional periods for TGD people, such as emerging adulthood. A large percentage of TGD emerging adults must simultaneously navigate these two transitional periods of gender transition and emerging adulthood. Yet it remains unknown whether emerging adulthood or gender transition are more strongly related to STBs among TGD people. Ultimately, the present research aims to fill gaps in previous research on STBs among TGD adults, including investigating how gender transition compares to emerging adulthood in conferring risk for STBs. Research Question: How does transition compare to chronological age as a predictor of suicidal thoughts and behaviors (STBs)? Hypotheses: H1: Not completing transition will be a significantly stronger predictor of increased STBs compared to chronological age. H2: Older age of completing transition will be a significantly stronger predictor of increased STBs compared to chronological age. H3: Fewer years since transitioning will be a significantly stronger predictor of increased STBs compared to age. Necessity of Dataset: The USTS is the best dataset for this study not only because of the large sample size and diversity of respondents, but also because it provides a detailed account of the experiences of TGD people across a number of categories, including health, family life, and mistreatment and discrimination (James et al., 2016). Research Questions: How do discrimination and family support impact the relationship between transition and STBs? Does discrimination moderate the relationship between transition and STBs at different levels of family support? Hypotheses: H1: Discrimination will moderate the relationship between transition (completing transition, age of transition, years since transition) and STBs, with lower levels of discrimination strengthening the association between transition and reduced STBs. H2: Family support will moderate the relationship between transition (completing transition, age of transition, years since transition) and STBs, with high levels of family support strengthening the association between transition and reduced STBs. H3: As discrimination decreases, the relationship between transition and reduced STBs will be strengthened, but only at medium and high levels of family support. Necessity of Dataset: The USTS is the best dataset for this study not only because of the large sample size and diversity of respondents, but also because it provides a detailed account of the experiences of TGD people across a number of categories, including health, family life, and mistreatment and discrimination (James et al., 2016).ICPSR
Nelson Eugene WallsExplorations of Religious Experiences Among Transgender/Nonbinary IndividualsThe research aims to understand religious affiliation (both lifetime and current), changes in religious affiliation, experiences with religion-based conversion therapy and non-supportive clergy, and differences in these experiences based on demographics (e.g., disability, sexual orientation, race, income, urbanicity) among transgender/nonbinary individuals in the United States. The full dataset is requested to enable examination of differences in religious experiences by demographics.ICPSR
Stephanie CookDiscrimination and Health Among Transgender Individuals in the U.S.The purpose of our research will be to examine health patterns and outcomes among transgender individuals in the U.S. in relation to stress experienced by these individuals. Example analyses will include perceived discrimination and mental health outcomes (e.g., suicidality) among transgender individuals. Access to the 2015 USTS Public Use Dataset will allow us to carry out our research aims utilizing a large U.S.-based sample of transgender individuals.ICPSR
Katie AcostaTrans Women & Sexual Violence Using USTS 2015 Data (Working Title)Since the election of Donald Trump to the U.S. presidency, twelve state legislatures, including states from Alabama and Texas to New York and Washington, have considered “bathroom bill” legislation that would effectively “limit transgender people to facilities consistent with their” sex assigned at birth (Richardson 2017). In February, 2017, only weeks after the inauguration, Trump “rescinded protections for transgender students that had allowed them to use bathrooms corresponding with their gender identity” (Peters, Becker, and Davis 2017). The Texas state legislature attempted to pass a “bathroom bill” during their general session that would force trans/nonbinary students to use the bathroom of their assigned sex, but the bill failed (Balingit 2017). However, Governor Abbott later called legislators back for a special session in which they then passed legislation restricting “municipalities from passing anti-discrimination ordinances designed to protect transgender people” (Fernandez and Montgomery, 2017; Balingit 2017). In July 2017, Trump tweeted a decision to ban trans/nonbinary people from serving in the military (Davis and Cooper 2017). Under Trump’s administration, the Department of Health & Human Services has worked to define sex and gender as what one was assigned at birth, removing previous Title IX protections that were extended to trans/nonbinary people under the Obama administraton (Levenson 2018). Further, the Trump administration has moved to rollback health care protections provided to transgender people under the Affordable Health Care Act by removing regulations requiring insurance companies to cover gender affirming care (Dickson 2019). These changes have not yet taken place and none have gone without challenge. However, each of these attempts under the Trump administration highlight the increasing lack of safety for trans/nonbinary people in the U.S. Within this precarious political climate, trans Black, Indigenous, and People of color (BIPOC) find themselves with heightened social sanctions and consequences regarding their actions, behavior, and opportunities. Objectives In this study we are guided by Black cis and trans women committed to reproductive justice to utilize our respective positions within the academy to argue for the critical need to center trans BIPOC within reproductive justice work. Critical feminist work inherently requires centering those who are most vulnerable (Crenshaw 1991; hooks 1984). While previous studies have utilized the USTS dataset to analyze experiences of IPV for trans women, there have yet to be studies analyzing whether there exist statistically significant differences in experiences of sexual assault for trans women by race and income. In our analyses, we ask how frequencies of sexual assault are moderated by race for trans women and nonbinary people assigned male at birth? Second, we ask how frequencies of sexual assault are moderated by race and income? We hypothesize that: 1. Black, Latina, and Indigenous trans women have significantly higher rates of sexual assault than white and Asian trans women. 2. Black and Indigenous trans women have significantly higher rates of sexual assault than Latina trans women. 3. As income increases, Black, Indigenous, and Latina trans women experience lower rates of sexual assault. Study Methods Upon receiving IRB approval, we will submit a data request through ICPSR for access to the USTS 2015 data. Upon access, we will clean data, running descriptive analyses on gender, race/ethnicity, level of “outness,” age, and income demographics that have already been recoded and weighted by the data authors. We will then potentially collapse codes and continue to clean data before running preliminary analyses to assess correlation effects and normalcy. Then, we will run ordinary logistic regressions on frequency of sexual assault for trans women moderated by race. Finally, we will run ordinary logistic regression on frequency of sexual assault for trans women moderated by race with interaction effects for race and income. We will then assess statistical significance, decide upon necessary analytical next-steps, and interpret the data before writing and publishing.ICPSR
Rainier MasaMicroeconomic Correlates of HIV Risk in Transgender People in the United StatesThe topic is microeconomic factors affecting HIV risk in transgender men and women in the United States. I am particularly interested in examining the prevalence of poverty and the association of poverty and its measures/indicators (e.g., employment status, receipt of social assistance, and income) with HIV risk factors, including sex work, sexual activity for food, a place to sleep, or drugs, and unwanted sexual contact. In addition, the proposed research will examine whether there are non-economic moderators (e.g., race, immigration status, HIV status, transition status) that affect the relationship between microeconomic factors and HIV risk. Another topic to explore is whether microeconomic factors are associated with HIV treatment cascade and care continuum (e.g., HIV testing, linkage to HIV care, and adherence to antiretroviral therapy), among transgender men and women who are living with HIV. The restricted data are required to examine the research questions that I stated above.ICPSR
Oralia LozaImpact of Name Change and Gender Marker Correction among Transgender Women in the U.S.The purpose of this study is to assess the association between Name Change and/or Gender Marker Correction and structural factors such housing, employment, and harassment among transgender women in the U.S. The goals of this study among transgender women in The U.S. are to: (1) Assess the association between Name Change and/or Gender Marker Correction and structural factors: Housing (e.g., eviction and discrimination). Employment (e.g., engaging in sex work, fired or Forced to Quit for being transgender) Harassment (e.g., experienced harassment by TSA or Police) (2) Determine ethnic differences in the attempting and successfully achieving Name Change and/or Gender Marker Correction process. (3) Determine if there are state level differences in barriers to attempting and successfully achieving Name Change and/or Gender Marker Correction process (Texas and rest of U.S.). (4) Determine if there are regional level differences in barriers to attempting and successfully achieving Name Change and/or Gender Marker Correction process (Border Region and rest of Texas). These findings may be used to justify changes in policy to reduce barriers to the Name Change and/or Gender Marker Correction process and hosting Name Change and/or Gender Marker Correction clinics in our state or region.ICPSR
Maggi PriceGender Minorities' Healthcare Experiences and Treatment Utilization PatternsThe proposed study is an archival data analysis of existing survey data from the most recent US Trans Survey to better understand the relations between gender minorities' experiences in healthcare and associations with treatment utilization. This study is the first step in a longer-term project aimed at enhancing mental health treatment engagement for gender minorities through the development of a provider-focused training to enhance competency in gender-affirming care. More specifically, data from the US Trans Survey will be used to identify potential mechanisms to be targeted in the future intervention. A more detailed description is below. To inform intervention development, data from the largest-known survey of gender minorities will be analyzed to explore the nuances and associations of two hypothesized mechanisms: knowledge and self-efficacy. While previous research suggests that knowledge and self-efficacy can be modified in brief provider trainings, it is unclear which facets of knowledge and behavior-related self-efficacy are most important for gender minorities’ treatment utilization. For instance, it is possible that GM individuals are more likely to engage in treatment if providers use affirming language, and it may be relatively less important that providers are well-educated in transgender health. Determining which provider characteristics are most critical for GM individuals’ treatment utilization is central to intervention development, as it will inform the prioritization of training methods and content (e.g., time spent on hormone treatment didactics versus time spent role-playing gender-affirming communication). Data. Data on GM adults’ perceptions of provider knowledge and behaviors from the U.S. Trans Survey (USTS; N = 27,715 GM adults) will be analyzed. The USTS was administered online in 2015 by the National Center for Transgender Equality. The survey was completed by a large non-probability sample of GM adults (ages 18-87 years), 42% of whom were young adults (ages 18-24 years; n = 11, 640). Few population-based surveys of GM individuals exist, and none to our knowledge collect data on consumer experiences in treatment. To facilitate comparisons with national data sources, survey weighting was used in the USTS report analyses. These weights are provided in the dataset and will be used in the proposed study. The USTS includes questions drawn from federally administered national population-based surveys and collects data on individuals’ experiences in a variety of settings, including healthcare. Data are available by request from the University of Michigan Inter-university Consortium for Political and Social Research (ICPSR). Respondents provided information about their providers’ knowledge in “trans-related healthcare” with 4 options ranging from “I am not sure” to “They know almost everything about trans healthcare. Participants also reported whether or not they needed to teach their provider “about trans people” in order to get appropriate care and, if applicable, endorsed whether they experienced 12 providers’ behaviors in treatment (e.g., “My doctor knew I was trans and treated me with respect,” “…used harsh or abusive language when treating me”). Six treatment utilization items inquired about whether or not the respondent had used a particular health service, including both general and gender-specific services (e.g., gender-related counseling/therapy) as well as whether the participant needed to see a doctor in the past year but refrained from doing so because “you thought you would be disrespected as a trans person.” Descriptive analyses outlined in the USTS report69 suggest variability in the above domains. For example, 23% of respondents avoided treatment due to fear of being mistreated, 33% reported one or more negative provider behaviors in the past year, 15% did not have a routine provider, and 58% reported a history of therapy or counseling. Analysis and reporting of results. To determine the relative associations between provider experiences and treatment utilization, survey weights will be incorporated into random forest models to determine the relative importance of each treatment experience in predicting treatment utilization. More specifically, these models will use recursive partitioning to produce realistic and accurate estimates of 12 provider behaviors and 5 domains of knowledge, in predicting 6 treatment utilization outcomes. This analytic method overcomes many limitations of standard parametric models and is recommended for psychological research involving several categorical predictors and outcomes. Analyses will stratify participants by age group (e.g., young adults ages 18-25, adults ages 26 and above) to explore patterns specific to young adults, the subsample most relevant to the target population of the proposed intervention, and to examine potential differences across developmental stages. Study results will be summarized in a manuscript and submitted for publication.ICPSR
Jodi FordTransgender Adolescent and Young Adult Suicide: A Bioecological ApproachThe purpose of the proposed study is to examine risk factors across multiple contexts (family, school, work, church) on suicidal thoughts and behaviors among transgender youth. Data from the 2015 Transgender Youth Survey are being requested, and the data are classified as restricted.ICPSR
Enbal ShachamAssociations of state policy environments and state advocacy organizations on pathways to transgender health outcomesTransgender individuals in the United States experience significant health disparities such as elevated rates of psychological distress, chronic illnesses, substance use, sexually transmitted infections and suicidality. These health disparities are often the result of minority stress processes, by which internal and external stigma and discrimination results in a lack of resources, knowledge and power. Structural stigma, a primary driver of minority stress, is often a function of state policy environments, which either protect transgender individuals from discrimination or allow for discrimination and reinforce cultural stigma. However, resiliency in the form of activism, social support and community connectedness has been shown to moderate these relationships. While this has been viewed through community and interpersonal lenses, state level transgender advocacy organizations may also moderate this relationship at a structural level. Objective: To understand the associations of: 1) state policy environments on transgender health outcomes, including the moderating effect of state transgender advocacy organizations; 2) state transgender advocacy organizations on transgender health outcomes; and 3) state transgender advocacy organizations on state policy environments. Methods: Data on state policy environments will be sourced from legislative tracking groups, the Movement Advancement Project and Human Rights Campaign. Data on transgender health outcomes will be sourced from the 2008 and 2015 United States Transgender Surveys and 2014-2018 data from the Sexual Orientation/Gender Identity (SOGI) module of the Behavioral Risk Factor Surveillance System (BRFSS). Finally, data will be sourced from the Equality Federation, a national transgender advocacy organization with state member organizations in 39 states. Comparative analyses will be conducted between states with positive/negative transgender equality ratings, along with the presence of an Equality Federation organization. In addition, difference-in-difference analyses will be used to assess changes in outcomes over time resulting from implementation of specific transgender laws or an Equality Federation organization. Implications: Results from these data will help inform what impact transgender policies have on the health of transgender individuals, and whether interventions such as state advocacy organizations are effective in moderating the impact or passage of transgender policies, or promoting resiliency within transgender populations. These data can then be used to better inform policymakers and other stakeholders on how to reduce transgender health disparities.ICPSR
Gabriel MillerExamining Health, Trauma, and Social Integration in the U.S. Transgender Survey (2015)Project 1: How do state-level political and policy factors impact the health of Transgender individuals? Politics and policy play a key role in determining health outcomes and often create or reproduce health disparities. Government type, party ideology, and public policy implementation impact public health outcomes (Navarro et al. 2003; Navarro and Shi 2001; Rodriguez, Bound and Geronimus 2013). Political actors, institutions, and bureaucracies have control in implementing health and social policy agendas. For example, suicide rates are higher in Europe under more conservative administrations (Gilligan 2011; Page, Morrell, and Taylor 2002; Shaw, Dorling, and Smith 2002), infant mortality rates are lower during Democratic compared to Republican presidential administrations in the United States (Rodriguez et al. 2013), teen birth rates are generally lower in liberal states than in conservative states (Zhu and Walker 2013), and state expenditures on healthcare and other social services similarly have a direct impact on health outcomes (Bhattacharya, Goldman, and Sood 2003; Goldman et al. 2014; Sood et al. 2014; Diffenbach and Fauci 2011; Talbert-Slagle et al. 2015; Talbert-Slagle et al. 2016). Additionally, LGBTprotective policy are associated with lower decreased odds of mood disorders and self-direct violence (Blosnich et al 2016), lower risk for suicide attempts (Gleason et al 2016), and lower HIV/ AIDS incidence and mortality (Miller 2020). We plan to merge the U.S. Transgender Survey data with the PI’s proprietary politics and policy dataset which includes state-level political and policy measures. The dataset includes measures on 1) state-centered political measures; 2) society-centered political measures; 3) LGBT-protective policies; 4)Transgender-specific-protective policies; 5) state social services and state health spending; 6) state public health infrastructure; 7) state comorbidity and health behaviors; and 8) state demographics. Merging this data will allow us to explore the political and policy determinants of the following outcomes for transgender individuals: • Psychological Distress (Kessler 6) • Self-rated health • HIV/AIDS • Suicide ideation • Disability/ mobility • Alcohol, tobacco, and illicit drug use • Health behaviors and Health access We plan to explore the impact state-level political and policy factors have on these outcomes based on where transgender individuals currently live as well as the state they were born in order to consider the life course impact of politics and policy on health. 
Project 2: How do state-level political and policy factors impact other outcomes for Transgender individuals? Research on lesbian, gay, bisexual, transgender, and queer individuals in the United States demonstrates the importance of examining how individuals’ experiences vary based on location (regional, state, and local environments). LGBT youth living in rural communities within the United States, specifically those in the South and Midwest, more likely to report victimization in school based on sexual orientation and gender expression (Kosciw, Greytak, and Diaz 2009). Studies have shown disparities in access to LGBT specific health services and discrimination experiences in interactions with health care providers based on region (Martos, Wilson, and Meyer 2017; Kattari et al. 2015). Furthermore, lesbian, gay, and bisexual individuals living in rural communities may experience greater stigma and discrimination than those living in urban areas (Swank, Fahs, and Frost 2013). We plan to expand on previous research by exploring variation in transgender individuals’ experiences of private and public life based on geographic location (Question 1.4). Similar to the focus of project 1, we will also explore the impact regional political and policy factors have on other outcomes including: • Level of outness or fear of living out (Section 2) • Levels of support among family, coworkers, classmates, religious institutions (Sections 4 & 5) • Utilization of assistance programs (SNAP or WIC; Cash Assistance programs; Unemployment benefits) (Section 7) • Experiences with discrimination and major negative events (Sections 26, • Access to public goods/services (Sections 20, 22, 23, 24, 25) • Political engagement (Sections 29 & 30) • Perceptions on important issues (Section 31).
Project 3: How does political engagement impact the health of Transgender individuals? The connection of politics to the policy adoption process is widely debated. The analysis of social and public policy results in a debate between state-centered perspectives and society-centered perspectives. State-centered theory holds that states are autonomous from the external environment, are power holders in their own right, and that state elites exercise a degree of power over the policy adoption process (Block 1977; Evans et al. 1985; Orloff and Skocpol 1984; Skocpol 1985; Skocpol and Amenta 1986; Skocpol and Kinegold 1982; Weir et al. 1988). In contrast, societycentered theorists argue that groups, classes, and the public are important power holders whose power originates outside of the state influencing the policy adoption process (Ackard 1992; Dahl 1958; Dahl 1998; Lindbloom 1982; Lipset 1994; Manley 1983; Polsby 1960; Quadagno 1984; Quadagno 1992; Therborn 1970). Research on the politics of LGBT rights has mostly found support for societycentered perspectives on the policy adoption process. For example, Haider-Markel and Meier (1996) find that in passing policy protections for LGBT populations, interest groups interact with sympathetic political elites to pass protections, supporting a society-centered perspective of the policy process. In contrast, support for state-centered perspectives would require that interest groups would not have a significant role in the policy process, and political elites would pass or reject protections on their own. Rodriguez et al. (2013) research on infant mortality and the President’s party supports this state-centered perspective. Research on the politics of health disparities finds support for both state-centered perspectives and society-centered perspectives. Utilizing individual political engagement measures from the U.S. Transgender Survey (sections 29-30), we plan to explore the impact these individual-level society-centered political measures have the health outcomes outlined in project 1.
Seth MeyerAdministrative homophobia and transphobiaThe purpose of this research is to explore the experiences of LGBTQ people and their experiences interacting with government and nonprofit organizations. This data will be used to specifically show how transgender individuals interact with government and nonprofit organizations and the ways in which transphobia impacts those who need services.ICPSR
Katie Heiden-RootesHistory of conversion therapy and psychological well-beingThe topic of research is the effect of exposure to "conversion therapy" (e.g., efforts to change sexual or gender identity) on overall health within a sample of individuals with a marginalized gender identity (i.e., transgender, gender non-binary, etc.). Our analysis plan is to compare those exposed to “conversion therapy” and those not exposed on measures of physical and mental health, with a particular focus on, suicidality, smoking, and substance abuse. Previous research demonstrates the negative effects of "conversion therapy", though most of those studies included only those with a marginalized sexual orientation while neglecting those with transgender identities. In addition, "conversion therapy" often occurs within religious frameworks and with clinicians or clergy who bring religious beliefs or practices to the approach. Therefore, our study will include the variables associated with exposure to "conversion therapy", religiosity, health outcomes, substance use, and suicidality. These variables are within the restricted data, which we are requesting access to in this application. The topic of research is the effect of experiences in health care settings and treatment by healthcare professionals on mental health outcomes and substance use among individuals who identify as transgender and gender non-binary. Our analysis plan is to look at correlations between discrimination in healthcare, healthcare provider knowledge of trans health, refusal of care, suicidality and psychological distress, smoking, and substance abuse. Previous use of this data set correlates the effects of negative experiences in health care settings and mental health outcomes but neglect to include substance use variables, though the relationship between mental health outcomes and substance use is documented. Therefore, our study will include the variables associated with healthcare settings and healthcare providers, mental health outcomes, substance use including cigarette use, alcohol use, and prescription drug use, and suicidality. These variables are within the restricted data, which we are requesting access to in this application.ICPSR
Kevin Robertson, M.D.Hormone Therapy for Transgender Individuals and Risk of Suicidal IdeationBackground and Preliminary Data: Gender-affirming hormone therapy (GAHT) is commonly the first, and sometimes only, medical gender affirmation intervention prescribed to transgender individuals. Previous research has demonstrated that administration of GAHT seems to have overwhelmingly positive psychological effects in both male-to-female and female-to-male transgender individuals. Clinically, GAHT has shown to help with various aspects of gender dysphoria-related mental distress including reducing symptoms of anxiety and depression as well as improving quality of life and self-esteem in both adolescent and adult transgender individuals. Other studies have shown that these internalizing psychopathologies which often accompany gender dysphoria appear to worsen with age. The objective of this study is to examine associations between the length of time before transgender individuals access GAHT and their long-term mental health outcomes. Hypothesis: Transgender individuals who have a shorter period of time between recognizing their gender identity and accessing genderaffirming hormone therapy have a decreased risk of suicidal ideation and overall better mental health outcomes as adults. Specific Aims: Using multivariable logistic regression to control for potential confounding variables, we will examine any associations between the period of time before accessing GAHT and risk of suicidal ideation as well as multiple other measures of adult mental health outcomes. Comparisons of these associations between female-to-male and male-to-female transgender may also be considered. If determined to be relevant, barriers that prevent transgender patients from access gender-affirming hormone therapy may also be analyzed. Methods Proposed: We will use the self-reported histories of 20,619 transgender adults aged 18 to 36 years old from a dataset obtained by the National Center for Transgender Equality in the 2015 US Transgender Survey. The 2015 US Transgender Survey is the largest dataset of transgender adults and includes data regarding demographics, family support, mental health outcomes and past gender-affirming medical treatment. Expected Outcomes (Experimental and Work Products): The dataset used for this analysis has only been available for little over a year and a half so all research arising from this work will be novel in the field of transgender care. The statistical work done as a part of this project will directly answer the proposed hypothesis using the largest and thus far most comprehensive source of data on issues of transgender health and access to care. Our proposed research has the potential to result in multiple eventual work products including but not limited to presentation at national medical conferences and publication in a variety journals relevant to the care of transgender patients.ICPSR
Yana RodgersConversion therapy and health outcomes among transgender adults in the U.S.The goal of this study is to use data from the 2015 Transgender Survey to examine the effect of conversion therapy on the mental and physical health of transgender and gender diverse adults in the U.S. Since unobservable characteristics such as socioeconomic status and upbringing may affect both exposure to conversion therapy and health outcomes, simple correlations that do not account for reverse causality or omitted variable bias may be misleading. To identify the causal impact of conversion therapy on health outcomes, we utilize a difference-in-difference (DD) design in the context of differences in age and exposure to conversion therapy. We also utilize an instrumental variables approach in which we instrument exposure to conversion therapy with a dummy variable for being born in a state that bans conversion therapy and in a young enough cohort to be affected, arguing that state- and timing-of-birth is randomly assigned. This approach allows us to estimate a substantive treatment effect for gender diverse individuals by leveraging differences in the probability of having exposure to conversation therapy by age and state. We hypothesize that exposure to conversion therapy has a negative causal effect on health outcomes among trans and gender diverse individuals. This study proposes to use data from the 2015 Transgender Survey, a dataset collected by the National Center for Transgender Equality (NCTE), to examine the experiences of transgender adults in the United States. Very little is known about the causal impact of conversion therapy on health outcomes among trans and gender diverse individuals. Our goal is to fill this gap.ICPSR
Brian DodgeExperiences of Violence and Mental Health among Racial/ethnic minorities in the U.S. SouthIn this study we aim to address how various experiences of abuse may impact mental health outcomes among racial/ethnic minority transgender individuals in the U.S. south.This study evaluates transgender health in domains and a geographical region that have previously been under examined in the literature. I am seeking to use data that will not place any participants at risk or use data beyond the state level.ICPSR
Natalie SchwehrMACPAC Analysis – Heath Care Access for Sexual MinoritiesMedicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). One major area of study for MACPAC is health care access and the exploration of access for key subgroups, such as sexual minorities. On behalf of MACPAC, researchers at the State Health Access Data Assistance Center at the University of Minnesota School of Public Health would like to analyze public use data from the U.S. Transgender Survey (USTS) to explore issue related to health care access for sexual minorities. This analysis will explore issues such as behavioral health, insurance coverage, health care access and use, use of social services (e.g. WIC) and quality of care. To the extent possible (as supported by the data), the analysis will explore these issues by insurance status and for specific subgroups of interest (e.g. sexual orientation, education, income). We are requesting these data, because this is the largest survey of its kind that focuses on individuals who identify as transgender, trans, genderqueer, non-binary, and other identities on the transgender identity spectrum. MACPAC will use information gained from this analysis to inform Medicaid policy. This analysis will include basic descriptive statistics, including cross tabulations by demographic information. Statistical difference between subgroups will be explored by running t-tests and researchers will use Stata 17 to accommodate the survey’s complex sample design. Published results will be limited to those meeting SHADAC’s disclosure standards, which includes suppression of estimates with small sample and/or high Relative Standard Errors. Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). One major area of study for MACPAC is health care access and the exploration of access for key subgroups, such as sexual minorities. On behalf of MACPAC, researchers at the State Health Access Data Assistance Center at the University of Minnesota School of Public Health would like to analyze public use data from the U.S. Transgender Survey (USTS) to explore issue related to health care access for sexual minorities. This analysis will explore issues such as behavioral health, insurance coverage, health care access and use, use of social services (e.g. WIC) and quality of care. To the extent possible (as supported by the data), the analysis will explore these issues by insurance status and for specific subgroups of interest (e.g. sexual orientation, education, income). We are requesting these data, because this is the largest survey of its kind that focuses on individuals who identify as transgender, trans, genderqueer, non-binary, and other identities on the transgender identity spectrum. MACPAC will use information gained from this analysis to inform Medicaid policy. This analysis will include basic descriptive statistics, including cross tabulations by demographic information. Statistical difference between subgroups will be explored by running t-tests and researchers will use Stata 17 to accommodate the survey’s complex sample design. Published results will be limited to those meeting SHADAC’s disclosure standards, which includes suppression of estimates with small sample and/or high Relative Standard Errors.ICPSR
Tusty ten BenselA Mixed-Methods Approach to Understanding Transgender Homelessness in the United StatesThe purpose of this research project is to better understand the issue of transgender homelessness through this national dataset. Specifically, this line of research aims to understand the factors associated with transgender individuals entering homelessness, experiences with conducting sex work while homeless, interactions with law enforcement officers, and experiences with agencies and shelters. The primary research questions for this line of research are: What risk factors are associated with transgender folks becoming homeless in the United States? What are the experiences of homeless transgender folks in the United States? This research project will utilize both quantitative and qualitative data from the 2015 U.S. Transgender Survey to answer these research questions. The restricted data is requested to understand the qualitative nature of their lived experiences.ICPSR
Lisa DiamondWell-Being Across the Spectrum of Gender DiversityExtensive previous research has documented health disparities among gender-diverse individuals, but the majority of this research has focused on gender-diverse individuals who identify as transgender. A growing number of gender-diverse youth and adults identify as non-binary -- some of these individuals also identify as transgender, and some do not. Little is known about the similarities and differences between nonbinary individuals and transgender individuals, but a small (and growing) body of studies suggest that nonbinary individuals often have poorer mental and physical health outcomes than transgender individuals, owing to the fact that they often experience invalidation of their identities by the LGBTQIA communities. The 2015 Transgender Survey is one of the only large-scale surveys that accurately captures the full spectrum of gender diversity (owing to the uniquely sensitive and comprehensive way in which questions about identity were asked). In addition to allowing individuals to identify as nonbinary, it allowed for a range of other identities that are often underrepresented in studies of health disparities in transgender populations, such as "gender fluid." The other strength of this survey is that it has detailed measures pertaining to individuals' exposure to stigma, invalidation, harassment, and victimization, and their mental and (self-reported) physical health. No previous research has systematically compared the day-today experiences of stigma and marginalization of nonbinary/genderfluid individuals and transgender individuals, and whether these differential experiences are linked to mental and physical health outcomes. This gap in current research is entirely attributable to the lack of solid data on a large enough sample of transgender and nonbinary/genderfluid individuals of different ages, ethnicity, and socioeconomic positions. Hence, the data in the 2015 Transgender survey is uniquely suited to answering critical questions about differences between the experiences of nonbinary/genderfluid and other transgender individuals; no previous publications using this dataset have directly investigated these questions. We believe that our research will make critical contributions to future research on the mental and physical health needs of individuals across the entire spectrum of gender diversity, and to understanding the factors (such as social support or access to affirming communities) which can moderate the consequences of stigma exposure.ICPSR
Lydia RossEducational Experiences of Transgender and Non- Binary StudentsThis project aims to study the educational experiences of transgender or gender non-conforming students as it relates to disciplinary practices, labor market outcomes, and degree completion. This project will examine data collected by the National Center for Transgender Equality (NCTE) from the United States Transgender Survey (USTS). The USTS is the largest survey of trans people in the country with over 28,000 respondents. Many quantitative studies have documented the experiences of racial and ethnic minorities, language minorities, socio-economic minorities and more, however, quantitative analyses around gender minorities often focus more on women than on other gender minorities outside of the traditional western gender binary. With the development of the USTS, now there is data available to researchers to begin to address the existence and experiences of different gender minorities. This study will be looking at data that’s already been collected to identify at trends and patterns.ICPSR
Aliya SapersteinTransphobia at Work: An Intersectional Investigation of the Consequences and Responses to Gender-Based Discrimination and Bias in the Workplace Amongst Transgender and Gender Non-Conforming AdultsMy project investigates how the intersection of transgender and gender non-conforming (TGNC) status, gender identity, visual conformity, and race and ethnicity impact the economic and health consequences of transphobia in the workplace. Specifically, I ask: How does TGNC status, gender identity, visual conformity, and race and ethnicity impact income and self-reported health amongst those who experience transphobia bias and discrimination in the workplace? How do TGNC adults attempt to mitigate the risk of discrimination and bias in the workplace and how do their intersecting identities shape the types of actions available and their economic and health costs? To develop an intersectional understanding of the economic and health costs of experiencing and mitigating workplace transphobia amongst TGNC adults, I will conduct multiple ordered/cumulative logistic regression models using the 2008 and 2015 survey waves of the NTDS. I am requesting access to the 2015 NTDS because it is the largest, and only, dataset that captures discrimination against TGNC adults across the U.S. Being able to access the qualitative information included in the restricted dataset will allow me to more thoroughly understand the consequences of transphobia at work and how TGNC adults exercise agency to respond to transphobia by allowing me to create my own codes and categories for analysis. I will combine the 2008 and 2015 survey waves of the NTDS to mitigate the NTDS's limitation of being a convenience sample.ICPSR
Christina DeJongFactors Related to Police Harassment of Transgender PeopleAn Intersectional Analysis of Police Harassment of Trans People Police harassment of the LGBTQIA + community has deep, historic roots. Perhaps the most notable occurrence of this harassment came to the notice of the public after the Stonewall riot, in which LGBTQIA+ people fought back against police harassment (Nappo, 2010). Since then, however, there is substantial evidence that police have continued to harass LGBTQIA+ people, particularly those who are transgender (Carson, 2008; Nemoto et al., 2011; Tillery et al., 2018; Woods et al., 2013). There are many reasons why trans people experience police harassment. First, LGBTQIA+ people are at higher risk of homelessness due to family rejection, which, combined with laws criminalizing homelessness, increases the likelihood trans folks will encounter the police (Minter & Daley, 2003; Marksamer, 2008). Family rejection can also lead to multiple negative mental outcomes for trans people, including depression, as well as a general inability to access health care (Paulino et al., 2021). This in turn can also increase the likelihood of experiencing a police encounter, as individuals with mental illness are more likely to be targeted for arrest than the general public (Livingston, 2016). Racial and ethnic identities are an integral part of the experiences of trans people and their interaction with the criminal legal system (Irvine, 2015; Serpe & Nadal, 2017; Woods et al., 2013). Trans women of color are more likely to be approached and harassed by police than other groups (Grant et al., 2011; Irvine, 2015; Lanham et al., 2019; Logie et al., 2017). Trans women of color are more likely to be arrested when calling the police for help, and some Black trans women report that police frequently assume they are sex workers, placing them at higher risk of arrest (Irvine, 2015). Trans people are also more likely than cis people to be propositioned for sexual favors by police (Irvine, 2015). Beyond harassment, the transgender folx are also more likely to be physically and sexually assaulted by police (Lanham et al., 2019; Logie et al., 2017). Some claim that one role of the police is to enforce traditional gender norms; for example, as recently as 2011, the New York City Police Department could still charge someone with “impersonating a female” (INCITE! Women of Color against Violence, 2018; PBS News Hour, 2015). It is for these reasons that trans people may have a negative view of the police and expect they will not be treated fairly by them (Miles-Johnson, 2015; Serpe & Nadal, 2017). There are many negative outcomes of police harassment for trans people. Increased police contact can lead to increased likelihood of arrest, conviction, and incarceration--this increases the likelihood of victimization while under control of the criminal legal system (i.e., while in jail or prison). Police harassment of trans people can result in loss of access to health care and other relevant social services (Aristegui et al., 2019). Research questions: # How does race, gender, and sexuality interact to explain police harassment of trans people in the United States? # Are trans people who experienced family rejection more likely to experience harassment by the police? # Is police harassment correlated with lack of care (social services, health, etc.)? Why are these restricted data necessary to test the hypotheses? While a significant number of agencies have published reports on harassment of transgender people by police, they are often limited geographically to a small area. In addition, the selection of variables to include is driven by issues of interest to the agency and local needs and may not contain a wide array of variables. The U.S. Transgender Survey improves upon local reports by including a nationally representative sample of trans people and a large number of variables driven by scholarship on these issues.

Variables of Interest: Demographics: Q1_9: Gallup LGBT Question Q2_1: Sex at Birth Q2_2: Self-Identity Q2_3: Current Gender Q2_6: Gender live in on day-to-day basis Q2_7: People can tell I'm trans even if I don't tell them Q2_8: Sexual Orientation Q2_9: Racial/ethnic identity Q2_12: RELIGIOUS recode into binary (not religious/spiritual; religious/spiritual) Q2_13: Age Q2_15: Relationship status Q2_16: Marital status Q2_18: Citizenship Q2_20_7: Person with disabilities Q2_21: main language spoken at home Q2_22: highest level of school Q2_23: Current living arrangements Q7_7: EMPSTATUS: recode employment status Q7_10_1 through Q7_10_3: Currently receive SNAP/WIC? Q7_11 (ALL): current sources of income Q7_12: Total combined individual income 2014 Q7_13: Total combined family income 2014 Q7_14: Total combined household income 2014 HHINCOME: Recoded household income in 2014 HHINCOME6: Recoded 6-level household income in 2014 Police: Q6_5_1 through Q6_5_3: Interact with police while doing sex work Q6_6_1: Officers used wrong pronouns Q6_6_2: Officers asked about my transition Q6_6_3: Officers verbally harassed me Q6_6_4: Officers physically attacked me Q6_6_5: Officers forced sexual activity Q6_6_6: Unwanted sexual contact from officer Q6_6_7: Arrested for drugs in my possession Q6_7_1 through Q6_7_3: Arrested while doing sex work Q6_8: how many times arrested for sex work Q6_9_1 through Q6_9_5: Police considered items evidence Q6_10_1: Charges were dropped Q6_10_2: Pled guilty Q6_10_3: Trial, found not guilty Q6_10_4: Trial, found guilty Q6_10_5: Something not listed above Q6_11_1 through Q6_11_10?: Paid for selling drugs/other illegal work Q6_11ANY: Recode of illegal work Q28_1: comfortable asking police for help Q28_2: interacted with police, last year Q28_3: police knew trans Q28_4: police treated you with respect Q28_5_1 through Q28_5_7: misgendered, questions, assumed, harassed, attacked by police Q28_6: arrested, past year for anything Q28_7: arrested, past year for being trans Q28_8: incarcerated Q28_9_1 through Q28_9_7: type of incarceration Q28_10 through Q28_20: victimized in prison, and type Airport Security: Q27_1: Past year went through airport security Healthcare Access: Q11_4 to Q11_8 accessibility to trans care Q12_1: Overall health Q12_2_1 through Q12_2_6: Kessler emotional health items KESSLER6: Recode of Q12_2 Q12_3: Did emotional health interfere with life? Q12_4: Past year did not see a doctor due to cost Q12_5: Past year did not see a doctor due to mistreatment Q12_6: Past year have seen doctor Q12_7_1 through Q12_7_10: Interactions with doctors/healthcare Q12_8_1 through Q12_8_4: Ever wanted therapy, counseling, medication for transition Q12_9_1 through Q12_9_4: Ever had therapy, counseling, medication for transition Q12_10: Age began hormone treatment Q12_11: Age began puberty blockers Q12_12: Currently taking hormones Q12_13: Where get hormones Q12_15_1 through Q15_5: Had/want surgery? Q12_16: Age first surgery (AFAB only) Q12_17: Pap smear (AFAB only) Q12_18_1 through Q12_18_10: Procedures completed Q12_19: Age first surgery (AMAB only) Q14_1: Ever tested for HIV Q14_2: HIV test result Family Rejection: Q4_6 Immediate family supportive? Q4_7_1: Immediate family stop speaking to you or ended relationship Q4_7_2: Immediate family were violent towards you Q4_7_3: Immediate family kicked you out of the house Q4_7_4: Immediate family didn’t allow clothes that matched gender Q4_7_5: Immediate family sent you to therapist, counselor, religious advisor FAMREJECT: Recode of Q4_6 and Q4_7 Other Rejection Variables: Q4_9: Ever run away from home Q5_2: Left spiritual community afraid rejection Q5_3: Left spiritual community because rejected Q5_7_4: Past year told being trans was a sin Q5_7_5: Asked you to meet with religious leader to stop being trans Q5_7_6: Asked you to get help to stop being trans Q5_7_7: Asked you to stop coming to services Control Variables (factors that can place people at risk of police contact): Q6_1: Ever engage in sex work for money Q6_3_1: Street-based sex work Q6_3_14: Forced to engaged in sex work (underage) Q6_5_1: Interact with police while engaged in sex work (no) Q6_5_2: Interact with police while engaged in sex work (yes) Q6_5_3: Interact with police when they assumed sex work Q15_1_1 through Q15_1_6: drug and alcohol use Q23_1: Ever experienced homelessness Q23_2: Past year denied home/apartment Q25_1: Past year visited domestic violence shelter (service access)

Dalton ConleyMeasuring gender and labor market heterogeneity1. Abstract: This project aims to explore labor market inequalities within the transgender community using cluster analysis to consider multiple dimensions of gender and transness. Gender is theorized as a complex concept that is constructed relationally, but due to data limitations, quantitative research is typically limited to considering the gender binary. Thus, this research project will leverage variables about different aspects of gender for transgender individuals to explore how gender can be measured and conceptualized multi-dimensionally in quantitative research. Using the 2015 United States Transgender Survey (USTS), this project will conduct an inductive cluster analysis to explore groupings within the USTS that are salient for examining heterogeneous experiences of transgender people, taking into account multiple dimensions of gender—including gender identity, degree of outness to family and bosses, and visual conformity —as well as demographics. The groupings from the cluster analysis will then be used to consider labor market experiences in order to examine how using a different gender categorization changes how we understand economic outcomes and experiences of discrimination within this transgender population. Overall, this analysis will reveal how different ways of measuring gender impacts our understanding of the labor market experiences of transgender individuals. 2. Justification for why the requested restricted data are required: As all of the 2015 United States Transgender Survey data is restricted, I am requesting these data in order examine different dimensions of gender in the transgender population in this survey. It is not possible to explore these research questions with other datasets because most surveys are of presumed cisgender individuals.ICPSR
Meredith WorthenUntitledI have a few research questions I am interested in but none that I will know for sure until I am able to see the data. Some broad questions include, why are trans and non-binary people categorized under one umbrella term?; how is the art of drag used as a form of family? I am specifically interested in queer studies, especially in regards to trans women of color, so I am just trying to obtain a reliable dataset that I can analyze. I would love this dataset because the sample size is huge and it is encompassing of many queer (especially trans) issues. My ultimate purpose for this dataset is to contribute to both public and academic scholarship to further progress thought and social activism around queer studies.ICPSR