title: Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.
abstract: OBJECTIVE
  We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia.
  
  
  METHODS
  In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper).
  
  
  RESULTS
  Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness).
  
  
  CONCLUSIONS
  Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
authors.affiliation: Judith Bradford and Sari L. Reisner are with The Fenway Institute, Fenway Health, Boston, MA. Judith Bradford is also with the Department of Community Health Sciences, Boston University School of Public Health, Boston. Sari L. Reisner is also with the Department of Society, Human Development and Health, Harvard School of Public Health, Boston. Julie A. Honnold is with the Wilder School, Virginia Commonwealth University, Richmond. Jessica Xavier is with the US Health Resources and Services Administration, Rockville, MD.
authors.forename: Judith
authors.initials: J
authors.lastname: Bradford
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.forename: Julie A
authors.initials: JA
authors.lastname: Honnold
authors.forename: Jessica
authors.initials: J
authors.lastname: Xavier
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016017:Odds Ratio; D063508:Social Discrimination / Q000706:statistics & numerical data; D063106:Transgender Persons; D014768:Virginia; D055815:Young Adult