Structural and Interpersonal Discrimination and Smoking Status Among a National Sample of Transgender Individuals
Limited evidence suggests that transgender individuals smoke at significantly higher rates than the general population. Discrimination, violence, and a lack of social support (i.e., minority stress) contribute to poor physical and health outcomes among minority groups, including the transgender population. This study examined smoking in a national sample of transgender individuals. We aim to determine whether structural or interpersonal discrimination experiences predict smoking behavior when socio-demographics and gender identity are controlled.
Methods
A secondary analysis of the National Transgender Discrimination Survey (N=4,781) was conducted. Current smokers were those who had smoked at least 100 cigarettes and were currently smoking. Socio-demographic predictors included race/ethnicity, age, sexual orientation, education level, annual household income, health insurance status, employment status, HIV status, the use of alcohol or drugs to cope with mistreatment, and gender identity (female-to-male vs. male-to-female, and a measure of gender transition status). The measure of structural discrimination included those who reported housing, education, and work discrimination due to their transgender status. A measure of interpersonal discrimination included reported experiences of verbal abuse, denial of services, and physical violence due to transgender status. Descriptive analyses and chi square statistics were used to test bivariate associations. Logistic regression models were used to determine factors associated with smoking (model 1 = socio-demographic variables only, model 2 = socio-demographic plus gender identity variables, model 3 = socio-demographic and gender identity variables plus structural and interpersonal discrimination).
Results
The participants were mostly white (74.8%) and 51.7% were 25-44 years old. Almost one-third (27.1%) were current smokers. Most participants reported experiences of both structural (78.9%) and interpersonal (64.3%) discrimination. Factors associated with being a current smoker included race/ethnicity, age, sexual orientation, education, annual income, health insurance, employment status, HIV status, alcohol/drug use, gender transition status, and both structural and interpersonal discrimination experiences. Although model 1 (socio-demographics only) significantly predicted discrimination (p<.001), the addition of gender identity variables in model 2 was non-significant. The third model was significant, p<.001, R2 = .145. Participants who reported some college (OR=0.77), a college degree (OR=0.42), a graduate degree (OR= 0.30), and were full transitioned (OR = 0.81) were less likely to smoke compared to those with a high school degree or less. Uninsured participants were more likely to report smoking compared to those with private insurance (OR= 1.54), as were those who used alcohol or drugs for coping (OR=2.35). Participants who reported structural discrimination were more likely to report smoking (OR=1.65).
Implications
Transgender participants smoked at a higher rate than the general population (27% vs. 18%). While gender identity (MTF or FTM) was not associated with smoking status, once socio-demographic characteristics were controlled, structural discrimination due to transgender status was associated with a greater likelihood of smoking. Social workers should be aware of the connection between discrimination and smoking among the transgender community and advocate for non-discrimination policies to protect this vulnerable population.