Tamar Goldenberg1, Sari L Reisner2, Gary W Harper3, Kristi E Gamarel4, Rob Stephenson5. 1. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: tamargol@email.unc.edu. 2. Division of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Fenway Health, Boston, Massachusetts. 3. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan. 4. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan. 5. Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan; Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan.
Abstract
INTRODUCTION: The introduction and passing of restrictive and protective transgender-specific state policies have increased during the past decade. These policies are critical for the health of transgender and other gender diverse people; however, little is known about the relationship between these policies and healthcare use, and the role that race/ethnicity plays in this relationship. METHODS: Analysis was conducted in 2018-2019 using multilevel modeling and data from the 2015 U.S. Trans Survey (conducted by the National Center for Transgender Equality among nearly 28,000 transgender and other gender diverse people across the U.S.) to explore associations between transgender-specific state policies and healthcare avoidance because of fear of mistreatment. State policies included those related to experiences of discrimination, health insurance coverage, and changing legal documents. Restrictive and protective policies were measured individually and as a composite index. The relationship between race/ethnicity and healthcare use was also examined to determine whether there were differences in the association between race/ethnicity and healthcare avoidance by state. RESULTS: None of the individual policies were associated with healthcare use, but the composite index was significant, such that living in states with more protective policies was associated with reduced odds of avoiding health care because of fear of mistreatment. The relationship between race/ethnicity and health care also varied across states. CONCLUSIONS: Findings suggest the importance of advocating for more protective transgender-specific policies to improve healthcare access for transgender and other gender diverse people in the U.S., particularly for transgender and other gender diverse people of color.
INTRODUCTION: The introduction and passing of restrictive and protective transgender-specific state policies have increased during the past decade. These policies are critical for the health of transgender and other gender diverse people; however, little is known about the relationship between these policies and healthcare use, and the role that race/ethnicity plays in this relationship. METHODS: Analysis was conducted in 2018-2019 using multilevel modeling and data from the 2015 U.S. Trans Survey (conducted by the National Center for Transgender Equality among nearly 28,000 transgender and other gender diverse people across the U.S.) to explore associations between transgender-specific state policies and healthcare avoidance because of fear of mistreatment. State policies included those related to experiences of discrimination, health insurance coverage, and changing legal documents. Restrictive and protective policies were measured individually and as a composite index. The relationship between race/ethnicity and healthcare use was also examined to determine whether there were differences in the association between race/ethnicity and healthcare avoidance by state. RESULTS: None of the individual policies were associated with healthcare use, but the composite index was significant, such that living in states with more protective policies was associated with reduced odds of avoiding health care because of fear of mistreatment. The relationship between race/ethnicity and health care also varied across states. CONCLUSIONS: Findings suggest the importance of advocating for more protective transgender-specific policies to improve healthcare access for transgender and other gender diverse people in the U.S., particularly for transgender and other gender diverse people of color.
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