title: Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults.
abstract: OBJECTIVE
  Enacted and anticipated stigma exist within healthcare settings for transgender people, but research has yet to examine the effects of these forms of stigma on the substance use behaviors of female-to-male (FTM) trans masculine people.
  
  
  METHODS
  Data were analyzed from the cross-sectional U.S. National Transgender Discrimination Survey, a convenience sample of transgender adults purposively sampled in 2008. Trans masculine respondents (n=2,578) were identified using a two-step method: Step 1, Assigned birth sex; Step 2, Current gender identity. A gender minority stress model of substance use was tested to examine the relation of enacted and anticipated stigma with substance use to cope with mistreatment.
  
  
  RESULTS
  Overall, 14.1% of the sample reported having been refused care by a provider (enacted stigma), 32.8% reported delaying needed medical care when sick/injured, and 39.1% delayed routine preventive care (anticipated stigma). Having been refused care was significantly associated with avoidance of healthcare, including delaying needed medical care when sick/injured and delaying routine preventive medical care. Substance use to cope with mistreatment was self-reported by 27.6% of the sample. Enacted stigma by providers was associated with self-reported substance use to cope. Delays in both needed and preventive care (anticipated stigma) were highly associated with substance use, and attenuated the effect of enacted stigma.
  
  
  CONCLUSIONS
  Gender minority-related stressors, particularly enacted and anticipated stigma in healthcare, should be integrated into substance use and abuse prevention and intervention efforts with this underserved population.
authors.affiliation: 1 Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts.|2 The Fenway Institute , Fenway Health, Boston, Massachusetts.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: 3 The Rockway Institute, Alliant International University , San Francisco, California.
authors.forename: Seth T
authors.initials: ST
authors.lastname: Pardo
authors.affiliation: 4 Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Gamarel
authors.affiliation: 2 The Fenway Institute , Fenway Health, Boston, Massachusetts.|5 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: White Hughto
authors.affiliation: 2 The Fenway Institute , Fenway Health, Boston, Massachusetts.
authors.forename: Dana J
authors.initials: DJ
authors.lastname: Pardee
authors.affiliation: 6 Michael E. DeBakey VA Medical Center and Menninger Department of Psychiatry, Baylor College of Medicine , Houston, Texas.|7 Department of Psychology, University of Houston, Houston, Texas.
authors.forename: Colton L
authors.initials: CL
authors.lastname: Keo-Meier
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057545:Social Stigma; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000523:psychology*; D063106:Transgender Persons / Q000523:psychology*; D014481:United States; D055815:Young Adult
keywords: healthcare; stigma; substance use; transgender.