Heterogeneity in Protective Factors as a Buffer for Unique Risk Factors and Daily Smoking among Transgender Adults.

Abstract

Introduction: Transgender individuals often face significant interpersonal and systemic gender identity-related stressors, which can confer risk of poor health behaviors, including cigarette use. Despite these adversities, social factors (e.g., family acceptance and work support) and gender identity milestones (e.g., affirming medical care) can buffer against stressors. Because transgender individuals live under different circumstances from one another, protective factors vary among individuals. We aimed to derive distinct classes of protective factors and explore whether the associations between gender identity-based stressors and combustible cigarette use varied across these classes.

Methods: We analyzed data from the National Transgender Discrimination Survey (N = 6,456; 76.0% white; 46.5% feminine/transfeminine).

Results: Using latent class analysis, we identified five classes of gender identity-related protective factors. Class membership moderated associations between stressors and smoking. Interpersonal gender identity-based stressors were associated with greater odds of daily smoking relative to never smoked status for all classes, except for a class characterized by not living congruently with gender identity but having family support and correct IDs. State inequality was associated with higher odds of daily cigarette smoking relative to never smoked for the class living congruently with their gender identity who had not undergone surgery.

Conclusions: These findings highlight the complexity of protective factor constellations and their differential protective impact on smoking risk. Prevention efforts should recognize that social factors and gender identity milestones are unevenly distributed and cultivate factors that are congruent with an individual's gender identity.

Implications: Transgender adults remain at higher risk for cigarette use than cisgender adults, a salient health disparity for this community. This study helps elucidate the complex interplay between protective factors and identity-based stressors in predicting cigarette smoking among transgender adults. Results demonstrated that interpersonal and systemic gender identity-based stressors were associated with more frequent cigarette smoking. Furthermore, there was substantial heterogeneity in protective factors transgender adults experience, underscoring the need for individualized, context-specific approaches to prevention and intervention efforts to address cigarette smoking within this community.