Social Work Faculty Publications

Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.

In March 2020, the World Health Organization declared a global pandemic due to the rapid spread of COVID-19. Two years into the pandemic, there have been over one million COVID-19 deaths in the United States alone. While the pandemic has impacted everyone, the most extreme impacts have been experienced by marginalized communities, including those who identify as LGBTQIA+. Although LGBTQIA+ people have faced the negative impacts of the pandemic, the LGBTQIA+ community may be well equipped to navigate the COVID-19 pandemic due to the historic and current societal oppression this community has endured. Using both a resilience and resistance framework, the present study explores the resilience and resistance strategies employed by LGBTQIA+ adults in the Southeast U.S. during the COVID-19 pandemic through the collection and analysis of monthly diary entries and video interviews. Findings show that resilience and resistance build on the knowledge base and histories of LGBTQIA+ people, and resilience and resistance have been re-imagined for this community during the COVID-19 pandemic. As a result of the pandemic, many LGBTQIA+ people are dreaming of and re-imagining a better future, a future that social work educators and practitioners can help co-create.

Using secondary data from the 2015 U.S. Transgender Survey, we explored transgender and gender-diverse Latinx individuals in the Southern U.S. experiences with transprejudice and antitrans violence at the individual, interpersonal, and structural levels. Findings include high rates of any form of antitrans violence in the past year and intimate partner violence in a lifetime. Most respondents accessed healthcare services in the past year. However, many reported transprejudice and antitrans violence accessing these services. Findings highlight the need for comprehensive changes at all levels to improve the well-being of transgender and gender-diverse Latinx Southerners experiencing gender-based violence.

Objective: This research evaluates the effectiveness of a pilot collaboration in Georgia (USA) designed to help homeless veterans, with open child support cases,locate employment, find permanent housing, resolve legal issues, and begin making child support payments. Method: The study employed a single group pretest posttest research design (n= 45). Quantitative and qualitative data were collected from all 45 participants enrolled in the study. Results: Between baseline and posttest,mean monthly child support payments increased 47% ($55 to $81). While child support payments improved, they remained well below the $396 mean monthly amount owed. Sixty-nine percent of the sample remained unemployed at posttest and presented with major barriers to employment. Half of focus group respondents reported improved housing conditions over the course of the study. While a few veterans reported progress on resolving legal issues, the majority had extant legal issues at the end of the study. Conclusions: While a majority of focus group participants felt their lives had improved, stronger interventions tailored to help participants overcome multiple, complex barriers to employment will be necessary to help homeless veterans secure living wage employment and make substantial child support payments.

Objective: To identify consequences of unmet housing needs in the period following cancer diagnosis.

Design: Qualitative descriptive design. Participants: New York City-based cancer patients and survivors (n=21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n=9) with relevant expertise (e.g. oncology social workers).

Methods: One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm.

Findings: Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living.

Conclusion: The simultaneous experience of cancer and unmet housing needs is broadly burdensome.

Implications for Psychosocial Providers: Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients.

As the U.S. continues to grapple with the need for a racial reckoning, and with a growth of progressive voices and movements-especially those lead by Black, Indigenous, and People of Color-now is an important time to re-examine social work's knowledge base. Students, researchers, and practitioners need the tools to challenge hegemony, inequity, injustice, and White supremacy from a structural position. Critical theory is an important tool for such work, yet it is not well integrated into social work textbooks, and many students still have limited exposure to it. In this paper, we explore critical theory's roots and evolution and discuss theories and approaches from this lens that have relevance to social work, including critical pedagogy, Foucauldian theory, queer theory, Critical Whiteness/Critical Race Theory, critical feminisms, and intersectionality. We discuss how these approaches can inform social work practice and education.

Using data from the 2015 United States Transgender Survey, this study investigates which patient sociodemographic characteristics and psychosocial risks are associated with likelihood of transgender mistreatment in healthcare and how patterns vary for patients of color. Numerous predictors, including alignment of identity documents, were associated with healthcare mistreatment. Among subgroups of transgender patients of color, psychosocial risks were more consistently significant than sociodemographic characteristics in predicting mistreatment. National and international health organizations are called to enact clear policies that affirm transgender patients and patients of color and establish a commitment to effectively serving these populations within their ethical codes.

The number of grandparents who have responsibility for raising grandchildren has increased dramatically over the past several decades. From an educational perspective, content on custodial grandparents can promote an increased interest in, and understanding of, the complexities of aging by stressing the intergenerational aspects of this family form. This paper describes the growing population of custodial grandparents, and the larger socio environmental contexts of these families. In addition, it highlights instructional approaches for including content on grandparent-headed families within didactic and experiential courses.

The enforcement of the gender binary is a root cause of gender-based violence for trans people. Disrupting gender-based violence requires we ensure “gender” is not presumed synonymous with white cisgender womanhood. Transfeminists suggest that attaining gender equity requires confronting all forms of oppression that police people and their bodies, including white supremacy, colonialism, and capitalism (Silva & Ornat, 2016; Simpkins, 2016). Part of this project, we argue, includes confronting the structures of gender-based violence embedded within digital technologies that are increasingly part of our everyday lives. Informed by transfeminist theory (Koyama, 2003; Simpkins, 2016; Stryker & Bettcher, 2016; Weerawardhana, 2018), we interrogate the ways in which digital technologies naturalize and reinforce gender-based violence against bodies marked as divergent. We examine the subtler ways that digital technology can fortify binary gender as a mechanism of power and control. We highlight how gendered forms of data violence cannot be disentangled from digital technologies that surveil, police, or punish on the basis of race, nationhood, and citizenship, particularly in relation to predictive policing practices. We conclude with recommendations to guide technological development to reduce the violence enacted upon trans people and those whose gender presentations transgress society’s normative criteria for what constitutes a compliant (read: appropriately gendered) citizen.

Transgender adults face a health care system rife with stigma, including a lack of culturally responsive providers and high likelihood of discrimination and mistreatment. However, there is a gap in knowledge about trans men—those assigned a female sex at birth who identify as men or as transmasculine—including subgroups, such as trans men of color. Using data from the U.S. Transgender Survey, the largest transgender survey conducted in the United States, this study analyzes whether trans men’s access to knowledgeable providers and their experiences of mistreatment in health care were related to demographic and mental health characteristics and degree of being “out” to providers. Among 7,950 trans men, respondent race and ethnicity, education level, disability status, psychological distress, suicidality, and being less “out” were associated with assessing one’s health care provider as not knowledgeable about trans-related care. Mistreatment in health care was more common among Alaska Native/American Indian trans men; those who lived in or near poverty; those who were queer, pansexual, bisexual, or an orientation not listed; those with a disability; those experiencing distress or suicidality; and those who were more “out.” This article discusses how findings can inform culturally responsive health care interventions with trans men.

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33 years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.

Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005-2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls’ likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys.

A wealth of information regarding how the immune system can influence the brain and result in changes in mood and behavior has accumulated. Inflammation is a causal factor in some cases of major depression and psychotic disorders, and predicts whether trauma will result in Post Traumatic Stress Disorder (PTSD). Fortunately, studies in the area of psychoneuroimmunology have also suggested ways to decrease inflammation. Knowledge of this information is vital for social workers so that the impact of their interventions can be maximized. Moreover, for macro-practice social workers the information underscores the importance of access to nutritional food, access to safe places for exercise, and the time for food preparation and exercise, which should be considered as social justice issues.

Lesbian, gay, and bisexual (LGB) older adults are more likely than their heterosexual peers to experience health disparities, discrimination from healthcare providers based on sexual orientation, and rejection from their family of origin, all of which can complicate medical care and decision making, as well as end-of-life arrangements. Yet, relatively few studies of LGB seniors have looked at motivations for advance care and end-of-life planning, which are strategies that can help ensure that healthcare treatment and end-of-life wishes are enacted as desired. The present qualitative study investigated this topic with a purposive sample of nine LGB and same-gender-loving adults in a metropolitan region of the Southeastern United States. The study involved in-depth face-to-face interviews, followed by a brief pen-and-paper survey. Participants’ ages ranged from 65 to 77; the sample included five men and four women. Six individuals were white/Caucasian, while three were African American/Black. We identified three themes related to motivations for advance care and end-of-life planning: wanting a sense of agency, learning from others, and reducing conflict and confusion for loved ones. We discuss the importance of these findings for social work practice with LGB older adults and for social work education, as well as implications for future research.

Background and Objectives: This study addresses a gap in the knowledge base regarding whether there are differences in mental, cognitive, and functional health between sexual minority women aged 65 and older and their heterosexual counterparts, as well as whether disparities are moderated by age, socioeconomic status, and race/ethnicity.

Research Design and Methods: This study analyzes 2015 Behavioral Risk Factor Surveillance System data from 21 states. Multivariate logistic regression is used to test the hypotheses.

Results: Compared to heterosexual women, lesbian/gay women aged 65 and older report worse functional health and bisexual women report worse cognitive health and more difficulties with instrumental activities of daily living. Disparities are particularly present for women in their late 60s and those in their 70s. While the likelihood of a depression diagnosis tends to be lower for heterosexual women with higher income, the inverse is true of sexual minority women. Additionally, sexual minority women with less education have lower odds of frequent mental distress and activity limitations than those with some college education. Sexual minority women of color have significantly lower odds of frequent mental distress, activity limitations, and use of special equipment compared to white sexual minority women.

Discussion and Implications: Findings indicate a need for gerontological services that provide support to older sexual minority women, particularly in relation to cognitive and functional health. Future research is needed to understand risk and protective factors contributing to these disparities, including forms of resilience that occur among older sexual minority women of color.

Based on data from the 2015 Behavioral Risk Factor Surveillance System, this study looks at whether transgender men have the same rates of health care access and engagement in preventive health behaviors as cisgender adults in the U.S. and whether race/ethnicity, socioeconomic status, and rural residence moderate these relationships. While there are some differences for transgender men, these differences no longer reach statistical significance after controlling for other sociodemographic factors. Rural residence and having less education are significant moderators for some models related to health care access and preventive health. We detail implications for social workers within health care settings,

The apparatus of social reproduction describes the process by which knowledge production contributes to oppressive conditions. This article explains and defines this process through the application of a critical theoretical lens informed the Foucauldian concept of apparatus or dispositif and social reproduction as developed by feminist activists and intellectuals. This process has a notable influence on the political economic conditions of transgender women, conditions that include disproportionate reliance on the use of criminalized economies such as sex work. Social workers inadvertently influence this process through an overreliance on broad categorizations for lesbian, gay, bisexual, transgender, and queer populations, which impede our ability to adequately assess such complex oppressive social relationships. Increasing the profession’s familiarity and competence with critical theory is necessary to reduce our participation in such processes and identify effective interventions for this population. Presenting a review of social work literature and a discussion of the proposed lens, the following seeks to illuminate the apparatus of social reproduction and explain how broad social categorization of transgender women is problematic. The authors recommend the adoption of the proposed lens as a tool social workers can use to better assess their research and practice and better understand the complexities of power and exploitation.

Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base.

Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health.

Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B = 0.26, p < 0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation ( p < 0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health.

Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare.