A Comparison of Mental Health, Substance Use, and Sexual Risk Behaviors Between Rural and Non-Rural Transgender Persons

Abstract

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.

Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting

“…Our findings conflict, in part, with Wienke and Hill, 16 who found no differences in health measures for lesbian and gay adults across different-sized cities and with Horvath et al, 18 who found worse health indicators for rural transgender men. It is worth noting that our categories of location (selfdescribed, dichotomous) differed from Wienke and Hill 16 (six population-based categories) but were similar to Horvath et al 18 (self-described, dichotomous).…”

“…It is worth noting that our categories of location (selfdescribed, dichotomous) differed from Wienke and Hill 16 (six population-based categories) but were similar to Horvath et al 18 (self-described, dichotomous). We found few health differences among suburban/urban and rural/small town lesbian, gay, and transgender veterans, with the exception that suburban/urban gay male veterans reported fewer depressive and anxiety symptoms, less tobacco use, and greater positive identity associated with community than rural/small town gay men.…”

“…41 Our rural/small town lesbian, gay, and transgender participants were also partnered at higher rates than the samples reported by Fisher et al, 13 Gonzales et al, 42 Horvath et al, 18 and Whitehead et al 24 Wienke and Hill 16 did not report on relationship status. Intimate partnerships are closely tied to economic status, which may have a stronger relationship to health.…”

“…An online survey of transgender adults living in the United States (n = 1229) found worse mental health indicators for rural than urban men but no differences for women across locations. 18 Even so, across locations, transgender women reported high levels of risky sexual behavior; and both transgender men and transgender women reported a high prevalence of past suicide attempts.…”

Adult development and quality of life of transgender and gender nonconforming people

“…Identity development and quality of life may be affected by sex, type of TGNC identity, sexual orientation, race/ethnicity, geographical location (52), and socioeconomic status (53). Study samples vary in representation of these characteristics.…”