An intersectional approach linking Minority Stressors Experienced by Transgender and Gender Diverse Adults to Alcohol and Drug Use and comorbid Mental and Physical Health Outcomes

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Abstract Transgender, and gender diverse adults (TGDAs) experience severe inequities rooted in and reflective of historical stigmatization due to their gender status and resulting in significant health disparities. In accordance with minority stress theory, systematic oppression, discrimination, and stigma are distal stressors that manifest through experiences of interpersonal violence and microaggressions. These experiences can lead to increased levels of stress and, in turn, alcohol abuse and drug use. Consequently, TGDAs experience high prevalence of adverse mental health and physical health outcomes in comparison to their cisgender counterparts. These risk factors and experiences of stress may increase the likelihood of TGDAs’ experiencing and/or perpetrating interpersonal violence. Unfortunately, few efficacious, comprehensive strategies for prevention and treatment of alcohol abuse, drug use, interpersonal violence, mental health and physical health have been specifically designed for TGDAs. The primary goal of this proposal is to use minority stress model and intersectionality to examine a host of stressors that contribute to inequities in alcohol abuse and drug use, cross-reciprocal interpersonal violence, and subsequent physical and mental health outcomes among TGDAs. The goal will be achieved by conducting a 12-month prospective cohort study with a racially and gender diverse sample of 400 TGDAs, ages 18-55. The following aims will be fulfilled: Aim 1:Identify the structural/community factors and proximal/distal minority stressors most strongly predictive of alcohol abuse and drug use as intermediary outcomes to mental health outcomes (i.e., depression, PTSD, etc.) and physical health outcomes (i.e., cardiovascular disease, sleep, etc.) for TGDAs; Aim 2: Evaluate if differences in Aim 1 direct and indirect effects are evident by TGD subgroup (i.e., gender diverse, transfeminine, transmasculine) and across intersecting identities of race/ethnicity; Aim 3: Examine whether Aim 1 associations are moderated by resilience factors (i.e., healthcare utilization, social support), and Aim 4: Explore the mechanistic roles of acute and chronic daily stresses (assessed by biomarkers), controlling for sex hormones, in associations examined for Aim 1. Another subaim will be to examine the intraindividual variability in the momentary cross-reciprocal relationship between interpersonal violence and alcohol abuse. Multiple forms of data will be collected to assess these goals: 1) self- reported survey data collected at baseline, 6- and 12-months, 2) ecological momentary assessments administered, and 3) saliva, hair clippings, and cheek swabs, in addition to BMI, blood pressure, and waist-to-hip ratio. Our expected outcomes are to provide evidence regarding modifiable factors associated with alcohol use and drug use as well as the pathways by which interpersonal violence and physical and mental health outcomes occur,and to identify priorities in treatment and prevention designed for TGDAs.