Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island.
Center for Health Equity Research, Brown University, Providence, Rhode Island.
JAMA Netw Open. 2020 Mar 2;3(3):e201015. doi: 10.1001/jamanetworkopen.2020.1015.
Nonmedical prescription opioid use is a pressing public health issue in the United States. Transgender youth, including adolescent girls and young women who were assigned male at birth and currently identify as women, female, transgender women, or another diverse gender identity along the transfeminine gender spectrum, are more likely than their cisgender peers to report illicit substance use and meet diagnostic criteria for substance use disorders. However, relatively little is known about the experiences of these populations in the current era of opioid addiction and misuse.
To report the prevalence of and risk factors associated with lifetime nonmedical prescription opioid use in a high-risk community sample of transgender adolescent girls and young women who are sexually active.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2012 to 2015 baseline data from Project LifeSkills, a randomized clinical trial of a behavioral intervention to reduce the risk of HIV acquisition and transmission among a diverse sample of transgender adolescent girls and young women recruited from Boston, Massachusetts, and Chicago, Illinois. A total of 297 transgender girls and women aged 16 to 29 years who were sexually active were included in this analysis. Data were analyzed from June 2019 to August 2019.
Transgender woman identification.
Self-reported lifetime nonmedical prescription opioid use.
Among 297 transgender adolescent girls and young women (mean [SD] age, 23.4 [3.5] years), 145 (48.8%) identified as non-Hispanic/Latinx black, 76 (25.6%) identified as non-Hispanic/Latinx white, 37 (12.5%) identified as Hispanic/Latinx, 7 (2.4%) identified as non-Hispanic/Latinx Asian, and 32 (10.8%) identified as multiracial or other race/ethnicity. Thirty-five participants (11.8%) reported lifetime nonmedical prescription opioid use. Young transgender women who smoked cigarettes monthly or less (adjusted odds ratio, 3.92; 95% CI, 1.10-13.89) and who smoked daily (adjusted odds ratio, 5.69; 95% CI, 1.87-17.33) had greater odds of nonmedical prescription opioid use compared with those who did not smoke. Additionally, participants who identified as a sexual orientation other than heterosexual, gay, lesbian, or bisexual had significantly greater odds of lifetime nonmedical prescription opioid use compared with those who identified as heterosexual (adjusted odds ratio, 3.69; 95% CI, 1.07-12.72).
These findings suggest that transgender adolescent girls and young women have similar prevalence of lifetime nonmedical prescription opioid use compared with the US general population prevalence of 12.5%. These findings may serve as a call-to-action for public health surveillance studies and evidence-based interventions to be comprehensively tailored to examine and respond to specific trends of substance use, particularly opioid use disorder, among transgender populations.
在美国，非医疗处方类阿片类药物的使用是一个紧迫的公共卫生问题。跨性别青年，包括出生时被指定为男性且目前自我认同为女性、女同性恋者、跨性别女性或跨性别女性性别谱上的其他多样化性别认同者，比他们的顺性别同龄人更有可能报告非法物质使用和符合物质使用障碍的诊断标准。然而，对于这些人群在当前阿片类药物成瘾和滥用的时代的经历，我们知之甚少。
报告在一个高风险的跨性别青少年女性活跃性人群样本中，与终生非医疗处方类阿片类药物使用相关的流行率和风险因素。
设计、地点和参与者：这是一项横断面研究，使用了 2012 年至 2015 年 Project LifeSkills 的基线数据，这是一项针对行为干预的随机临床试验，旨在降低不同样本中跨性别青少年女性获得和传播 HIV 的风险，这些女性是从马萨诸塞州波士顿和伊利诺伊州芝加哥招募的。共有 297 名年龄在 16 岁至 29 岁之间、有性行为的跨性别女孩和女性纳入了这项分析。数据于 2019 年 6 月至 8 月进行了分析。
跨性别女性认同。
自我报告的终生非医疗处方类阿片类药物使用。
在 297 名跨性别青少年女性（平均[SD]年龄，23.4[3.5]岁）中，145 名（48.8%）是非西班牙裔/拉丁裔黑人，76 名（25.6%）是非西班牙裔/拉丁裔白人，37 名（12.5%）是西班牙裔/拉丁裔，7 名（2.4%）是非西班牙裔/拉丁裔亚洲人，32 名（10.8%）是多种族或其他种族/民族。35 名参与者（11.8%）报告了终生非医疗处方类阿片类药物使用。与不吸烟的人相比，每月或更少吸烟的年轻跨性别女性（调整后的优势比，3.92；95%CI，1.10-13.89）和每天吸烟的年轻跨性别女性（调整后的优势比，5.69；95%CI，1.87-17.33）更有可能使用非医疗处方类阿片类药物。此外，与异性恋、同性恋、双性恋或其他性取向的参与者相比，自我认同为非异性恋、同性恋、双性恋或其他性取向的参与者有更高的终生非医疗处方类阿片类药物使用的可能性（调整后的优势比，3.69；95%CI，1.07-12.72）。
这些发现表明，跨性别青少年女性与美国普通人群 12.5%的终生非医疗处方类阿片类药物使用流行率相似。这些发现可能呼吁开展公共卫生监测研究和循证干预措施，以全面针对跨性别群体的物质使用趋势，特别是阿片类药物使用障碍进行研究和应对。
