title: Substance use and treatment of substance use disorders in a community sample of transgender adults.
abstract: BACKGROUND
  Transgender people have elevated substance use prevalence compared with the U.S. general population, however no studies have comprehensively examined the relationship of psychosocial risk factors to substance use and substance use disorder (SUD) treatment among both male-to-female (MTF) and female-to-male (FTM) transgender adults.
  
  
  METHODS
  Secondary data analysis of a 2013 community-based survey of transgender adults in Massachusetts (N=452) was conducted. Adjusted multivariable logistic regression models were fit to examine the relationship of four risk factor domains with SUD treatment history and recent substance use: (1) demographics; (2) gender-related characteristics; (3) mental health; (4) socio-structural factors. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (95% CI) were estimated.
  
  
  RESULTS
  Ten percent of the sample reported lifetime SUD treatment. Factors associated with significant increase in odds of lifetime SUD treatment alongside recent substance use (all p<0.05) were: (1) older age (aOR=1.02; 95% CI=1.01-1.04), higher educational attainment (aOR=3.59; 95% CI=2.35-5.50), low income (aOR=0.58; 95% CI=0.39-0.86); (2) MTF identity (aOR=3.03; 95% CI=1.95-4.67), gender-affirming medical care (aOR=1.99; 95% CI=1.32-3.00); (3) intimate partner violence (aOR=1.68; 95% CI=1.13-2.49), posttraumatic stress disorder (aOR=2.56; 95% CI=1.69-3.88), depression (aOR=2.30; 95% CI=1.58-3.35), mental health treatment (aOR=1.65; 95% CI=1.11-2.45); (4) discrimination (aOR=1.90; 95% CI=1.22-2.95), unstable housing (aOR=1.80; 95% CI=1.21-2.67), and sex work (aOR=2.48; 95% CI=1.24-4.95).
  
  
  CONCLUSIONS
  Substance use and SUD treatment among transgender adults are associated with demographic, gender-related, mental health, and socio-structural risk factors. Studies are warranted that identify SUD treatment barriers, and integrate SUD treatment with psychosocial and structural interventions for a diverse spectrum of transgender adults.
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Alex S
authors.initials: AS
authors.lastname: Keuroghlian
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Electronic address: sreisner@fenwayhealth.org.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; Chronic Disease Epidemiology, Yale School of Public Health, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: White
authors.affiliation: Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005783:Gender Identity; D006304:Health Status; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D008960:Models, Psychological; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D063106:Transgender Persons / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Alcohol; Drugs; Posttraumatic stress disorder; Substance use; Transgender; Unstable housing