Stressors Associated with Tobacco Use Among Trans Women

Rachel E Culbreth; Laura F Salazar; Claire A Spears; Richard Crosby; Matthew J Hayat; Dawn M Aycock

doi:10.1089/trgh.2020.0168

Stressors Associated with Tobacco Use Among Trans Women

Transgend Health. 2023 Jun 1;8(3):282-292. doi: 10.1089/trgh.2020.0168. eCollection 2023 Jun.

Authors

Rachel E Culbreth^{1

2}, Laura F Salazar^{2

3}, Claire A Spears³, Richard Crosby^{4

5}, Matthew J Hayat⁶, Dawn M Aycock⁷

Affiliations

¹ Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA.
² Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA.
³ Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
⁴ Department of Health Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
⁵ Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA.
⁶ Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
⁷ School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA.

PMID: 37342482
PMCID: PMC10277983 (available on 2024-06-01)
DOI: 10.1089/trgh.2020.0168

Abstract

Purpose: Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women.

Methods: This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance).

Results: The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use.

Conclusion: Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.

Keywords: discrimination; minority stress theory; stigma; tobacco use; transgender women; violence.