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Transgender people experience interpersonal and structural barriers which prevent them from accessing culturally and medically competent health care. This rapid systematic review examined the prevalence of health care discrimination among transgender people in the U.S. and drew comparisons with sexual minority samples and the general U.S. population. Eight primary studies with 35 prevalence estimates were analyzed. The transgender population experience profound rates of discrimination within the U.S. health care system. Compared to sexual minorities, transgender participants appear to be more compromised in their access to health care. Service providers must change structural inequities which contribute to transgender people's invisibility.

Objective: To examine psychiatric comorbidities associated with alcohol use disorders (AUDs) and with tobacco use disorders (TUDs) among heterosexual, bisexual, and gay/lesbian men and women in the U.S. and whether stress-related factors were predictive of comorbidities. Methods:We used data from the National Epidemiologic Study on Alcohol and Related Conditions-III (2012-2013 to examine the co-occurrence of past-year AUD or pastyear TUD with past-year: (1) anxiety disorders, (2) mood disorders, and (3) post-traumatic stress disorder (PTSD) by sexual identity (heterosexual, bisexual, gay/lesbian) and sex. We also examined the association of stress-related factors and social support with presence of comorbidities.Results: Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay/lesbian (51%) individuals who met criteria for a past-year AUD had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year AUD did. Similardifferences were found among those who met criteria for a past-year TUD. Among sexual minorities, frequency of sexual orientation discrimination (significant aOR range=1.08-1.10), number of stressful life events (significant aOR range=1.25-1.43), and ACEs (significant aOR range=1.04-1.18) were associated with greater odds of comorbidities. Greater social support was inversely associated with TUD comorbidities (significant aOR range=0.96-0.97). Conclusions:This research suggests integrated substance use and mental health prevention and treatment programs are needed particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities.

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Background: Alcohol misuse remains a leading preventable risk factor for morbidity and mortality in the United States. Evidence suggests that alcohol misuse is more prevalent among *