title: Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study.
abstract: OBJECTIVE
  We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women.
  
  
  METHODS
  We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links.
  
  
  RESULTS
  Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse.
  
  
  CONCLUSIONS
  Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population.
authors.affiliation: At the time of this research, Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute/Columbia University, New York, NY. Larry Nuttbrock, Andrew Rosenblum, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Sel Hwahng is with Columbia University.
authors.forename: Larry
authors.initials: L
authors.lastname: Nuttbrock
authors.forename: Walter
authors.initials: W
authors.lastname: Bockting
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenblum
authors.forename: Sel
authors.initials: S
authors.lastname: Hwahng
authors.forename: Mona
authors.initials: M
authors.lastname: Mason
authors.forename: Monica
authors.initials: M
authors.lastname: Macri
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Becker
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult; D008297:Male