Gioi Tran

Topic

Substance use among transgender and non-binary people in Canada

Social Dimensions of Health

Date & location

• Tuesday, August 20, 2024
• 8:00 A.M.
• Virtual Defence

Examining Committee

Supervisory Committee

• Dr. Nathan Lachowsky, School of Public Health and Social Policy, University of Victoria (Supervisor)
• Dr. Karen Urbanoski, School of Public Health and Social Policy, UVic (Co-Supervisor)
• Dr. Ayden Scheim, Department of Epidemiology and Biostatistics, Drexel University (Outside Member)

External Examiner

• Dr. Gail Gilchrist, Department of Addictions, King's College London

Chair of Oral Examination

• Dr. Kara Shaw, School of Environmental Studies, UVic

Abstract

Background: Substance use is a public health concern. There is a paucity of population research comparing substance use between transgender and non-binary (TGNB) people and the general population and examining substance use correlates among TGNB sex/gender groups. My dissertation aims to 1) estimate and compare substance use prevalence among TGNB people and the general population in Canada; 2) examine correlates of hazardous alcohol drinking among TGNB people in Canada; and 3) examine how cigarette and e-cigarette use changed between pre-COVID-19 and after the first six months of the COVID-19 pandemic, and examine the effects COVID-19 impacts on changes in cigarette and e-cigarette use.

Methods: To meet the first aim (manuscript 1), I estimated and compared substance use (using standardized prevalence differences) among 2,294 TGNB people (from Trans PULSE Canada survey - TPC) and the general population in Canada from two national population-based surveys, the 2017 Canadian Tobacco, Alcohol, and Drugs Survey (CTADS) and the 2017-2018 Canadian Community Health Survey (CCHS).

For my second aim (manuscript 2), I employed minority stress theory to examine potential predictors of hazardous alcohol drinking (HAD) among 2,324 TGNB individuals from the TPC. Logistic regression models were fit to examine the effects of 1) minority stressors and discrimination and 2) stress-buffering factors on the likelihood of HAD, stratified by gender.

For my third aim (manuscript 3), within-person changes in cigarette and e-cigarette use between the two time points among 767 TGNB individuals who participated in the TPC (baseline) and the Trans PULSE Canada Cohort COVID survey (follow-up) were calculated. Multinomial logistic regression models were fit to examine mental health, social support, and pandemic-related predictors of changes (compared with no change) in cigarette and e-cigarette use.

Results: I found that TGNB people used fewer cigarettes and alcohol, but more e-cigarettes, cannabis, and unregulated drugs than the general population in Canada.

Enacted discrimination predicted higher odds of HAD in all four TGNB sex/gender groups. Social support was associated with lower odds of HAD in trans men, NB-AFAB, and NB-AMAB groups, but with higher odds of HAD in trans women. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across sex/gender groups.

More participants reduced (6.1%) than increased (3.3%) their cigarette use. Approximately equal numbers of participants increased (4.8%) and decreased (4.1%) their e-cigarette use. Increased e-cigarette use (compared with no change) was associated with working more during COVID-19 and a negative impact of COVID-19 on one’s financial security. Greater depression at baseline was associated with higher odds of reduced cigarette use. Higher social support was associated with lower odds of increased cigarette use.

Conclusions: My dissertation provides an understanding of different aspects of substance use among TGNB people in Canada, including robust population-level evidence on substance use disparities between TGNB groups and general population, understanding about predictors of past-year HAD within and across the TGNB population, and change in cigarette/e-cigarette use and predictors of such change following onset of the COVID-19 pandemic. Substance use patterns also differed by TGNB sex/gender groups, calling for tailored public health strategies to substance by TGNB groups. My dissertation findings also suggest that harms of substance use could be mitigated through public health policy and interventions that consider reducing structural discrimination, strengthening social support, ensuring financial security, and addressing mental health problems, tailored for distinct TGNB sex/gender groups.