Introduction
The introduction and passing of restrictive and protective transgender-specific state
policies have increased during the past decade. These policies are critical for the
health of transgender and other gender diverse people; however, little is known about
the relationship between these policies and healthcare use, and the role that race/ethnicity
plays in this relationship.
Methods
Analysis was conducted in 2018–2019 using multilevel modeling and data from the 2015
U.S. Trans Survey (conducted by the National Center for Transgender Equality among
nearly 28,000 transgender and other gender diverse people across the U.S.) to explore
associations between transgender-specific state policies and healthcare avoidance
because of fear of mistreatment. State policies included those related to experiences
of discrimination, health insurance coverage, and changing legal documents. Restrictive
and protective policies were measured individually and as a composite index. The relationship
between race/ethnicity and healthcare use was also examined to determine whether there
were differences in the association between race/ethnicity and healthcare avoidance
by state.
Results
None of the individual policies were associated with healthcare use, but the composite
index was significant, such that living in states with more protective policies was
associated with reduced odds of avoiding health care because of fear of mistreatment.
The relationship between race/ethnicity and health care also varied across states.
Conclusions
Findings suggest the importance of advocating for more protective transgender-specific
policies to improve healthcare access for transgender and other gender diverse people
in the U.S., particularly for transgender and other gender diverse people of color.
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REFERENCES
- Transgender History: The Roots of Today's Revolution.2nd ed. Seal Press, New York, NY2017
- Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions.Soc Sci Med. 2015; 147: 222-231
- Gendered restrooms and minority stress: the public regulation of gender and its impact on transgender people's lives.J Public Manag Soc Policy. 2013; 19: 65-80
- “I fear for my safety, but want to show bravery for others”: violence and discrimination concerns among transgender and gender-nonconforming individuals after the 2016 presidential election.Violence Gend. 2018; 5: 26-36
- State Anti-Transgender Bathroom Bills Threaten Transgender People's Health and Participation in Public Life.Center for American Progress, The Fenway Institute, Boston, MAPublished 2016https://fenwayhealth.org/wp-content/uploads/2015/12/COM-2485-Transgender-Bathroom-Bill-Brief_v8-pages.pdfDate accessed: August 27, 2018
- The Report of the 2015 U.S. Transgender Survey.National Center for Transgender Equity, Washington, DCPublished December 2016https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDFDate accessed: May 10, 2017
Human Rights Campaign Foundation. Equality from state to state & state equality index archives.www.hrc.org/resources/equality-from-state-to-state. Published 2019. Accessed April 2019.
- Transgender inclusion in state non-discrimination policies: the democratic deficit and political powerlessness.Res Polit. 2015; 22053168015612246
- State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations.Am J Public Health. 2009; 99: 2275-2281
- The state of transgender health care: policy, law, and medical frameworks.Am J Public Health. 2014; 104: e31-e38
- Psychosocial disparities among racial/ethnic minority transgender young adults and young men who have sex with men living in Detroit.Transgend Health. 2016; 1: 279-290
- Examining associations between state-level transgender policies and transgender health.Transgend Health. 2018; 3: 220-224
- Effects of state nondiscrimination laws on transgender and gender-nonconforming individuals’ perceived community stigma and mental health.J Gay Lesbian Ment Health. 2016; 20: 350-362
- Individual- and structural-level risk factors for suicide attempts among transgender adults.Behav Med. 2015; 41: 164-171
Human Rights Campaign Foundation. Violence against the transgender community in 2019. www.hrc.org/resources/violence-against-the-transgender-community-in-2019. Published 2019. Accessed June 28, 2019.
- Racial and ethnic differences in experiences of discrimination in accessing health services among transgender people in the United States.Int J Transgend. 2015; 16: 68‒79
- African American experiences in healthcare: “I always feel like I'm getting skipped over”.Health Psychol. 2016; 35: 987-995
- Smedley BD Stith AY Nelson AR Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The National Academies Press, Washington, DC2003
- Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present.Doubleday Books, New York, NY2006
- Racial Formation in the United States.3rd ed. Routledge, New York, NY2014
- Understanding Everyday Racism: An Interdisciplinary Theory.Sage, Newbury Park, CA1991
Movement Advancement Project. Equality maps snapshot: LGBTQ equality by state. www.lgbtmap.org/equality-maps. Published 2018 Accessed May 2, 2018.
Movement Advancement Project. LGBT policy spotlight: state and federal religious exemptions and the LGBT community. https://www.lgbtmap.org/policy-and-issue-analysis/policy-spotlight-rfra. Published September 2015. Accessed May 6, 2019.
Movement Advancement Project. LGBT policy spotlight: nondiscrimination protections for LGBT people.https://www.lgbtmap.org/policy-and-issue-analysis/policy-spotlight-nondiscrimination-laws. Published October 2015. Accessed May 6, 2019.
Movement Advancement Project. LGBT policy spotlight: identity documents laws and policies.https://www.lgbtmap.org/policy-and-issue-analysis/policy-spotlight-identity-documents. Published November 2015. Accessed May 6, 2019.
- Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization.Am J Public Health. 2012; 102: 1751-1757
- Barriers to quality health care for the transgender population.Clin Biochem. 2014; 47: 983-987
- Short screening scales to monitor population prevalences and trends in non-specific psychological distress.Psychol Med. 2002; 32: 959-976
U.S. Census Bureau. American Community Survey.https://www.census.gov/programs-surveys/acs/news/data-releases/2017/release.html. Published 2017. Accessed August 16, 2018.
U.S. Department of Agriculture. Rural-urban continuum codes.www.ers.usda.gov/data-products/rural-urban-continuum-codes/. Updated October 25, 2019. Accessed May 30, 2018.
- What do we do with missing data? Some options for analysis of incomplete data.Annu Rev Public Health. 2004; 25: 99-117
- Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences.3rd ed. Lawrence Erlbaurn Associates, Mahwah, NJ2003
- Stigma: Notes on the Management of Spoiled Identity.Simon and Schuster, New York, NY2009
- How does sexual minority stigma “get under the skin”? A psychological mediation framework.Psychol Bull. 2009; 135: 707-730
- A venue-based method for sampling hard-to-reach populations.Public Health Rep. 2001; 116: 216-222
- Race and Ethnicity of Adults Who Identify as Transgender in the United States.The Williams Institute, UCLA School of Law, Los Angeles, CAPublished October 2016
- Innovative recruitment using online networks: lessons learned from an online study of alcohol and other drug use utilizing a web-based, respondent-driven sampling (webRDS) strategy.J Stud Alcohol Drugs. 2012; 73: 834-838
- Bias in online recruitment and retention of racial and ethnic minority men who have sex with men.J Med Internet Res. 2011; 13: e38
- Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study.AIDS Behav. 2012; 16: 1430-1435
- The demise of queer space? Resurgent gentrification and the assimilation of LGBT neighborhoods.J Plan Educ Res. 2011; 31: 6-25
- Demographics of the gay and lesbian population in the United States: evidence from available systematic data sources.Demography. 2000; 37: 139-154
Article Info
Publication History
Published online: May 14, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
