RESEARCH PAPER
Comparing smoking behavior between female-to-male and male-to-female transgender adults
 
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1
Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, United States
2
Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, United States
3
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, United States
4
Equality Texas, Houston, United States
CORRESPONDING AUTHOR
Irene Tamí-Maury   

Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health,1200 Pressler St., Houston, TX 77030, United States
Publication date: 2020-01-14
Submission date: 2019-08-16
Final revision date: 2019-11-18
Acceptance date: 2019-11-22
 
Tob. Prev. Cessation 2020;6(January):2
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study aimed to assess the association between current smoking and gender identity among transgender individuals.

Methods:
Data were collected using a cross-sectional survey distributed among transgender individuals attending the Houston Pride Festival and those seeking care at a local transgender health clinic. Relevant variables were compared between female-to-male (FTM) and maleto- female (MTF) transgender individuals using χ2, Fisher’s exact, and two-sample t-tests, when appropriate. Gender identity was used to predict current smoking status using logistic regression, adjusting for other sociodemographic determinants.

Results:
The study sample (N=132) comprised 72 MTF (54.5%) and 60 FTM (45.5%) transgender individuals. Mean age of participants was 31.8 years. The sample was racially and ethnically diverse: 45.8% Caucasian, 25.2% Hispanic/Latino, 16.8% African American, and 12.2% other. Current smoking prevalence was 26.7% and 13.9% among FTM and MTF individuals, respectively. Transgender individuals were more likely to self-report current smoking if they were FTM (OR=3.76; 95% CI: 1.17–12.06; p=0.026) or were insured (OR=4.49; 95% CI: 1.53– 13.18; p=0.006).

Conclusions:
This study reports on important findings by examining intragroup differences in smoking behavior among the transgender population. However, further research is needed for tailoring smoking prevention and cessation interventions for transgender subgroups.

ACKNOWLEDGEMENTS
The authors thank transgender individuals seeking care at the clinic of Hunter A. Hammill, and those attending the 2015 Houston Pride Festival for their participation in this study. The authors are also grateful to Hiba Zwiya, for her assistance during the submission of this manuscript.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. J. Blalock reports grants from Cancer Prevention & Research Institute of Texas, University of Texas MD Anderson Cancer Center Lung Moon Shot and National Institutes of Health, and grants from Arnold Foundation, outside the submitted work.
FUNDING
This research was supported in part by: the National Institutes of Health through a Cancer Center Support Grant (P30CA16672) to The University of Texas MD Anderson Cancer Center; an MD Anderson Institutional Research Grant to principal investigator I. Tamí-Maury; and a Cancer Prevention Fellowship to A. Sharma (Cancer Prevention and Research Institute of Texas Grant Award RP170259, PI: S Chang).
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (29)
1.
Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390-400. doi:10.1016/s0140-6736(16)00683-8
 
2.
Buchting FO, Emory KT, Scout, et al. Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study. Am J Prev Med. 2017;53(1):e1-e7. doi:10.1016/j.amepre.2016.11.022
 
3.
Quinn GP, Sanchez JA, Sutton SK, et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin. 2015;65(5):384-400. doi:10.3322/caac.21288
 
4.
Conway L. How Many of Us Are There: An Investigative Report. Australia: The Gender Centre; 2012.
 
5.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report o the U.S. Trangender Survey, 2015. Washington, DC: National Center for Transgender Equality; 2016. https://transequality.org/site.... Accessed August 16, 2019.
 
6.
Hahn M, Sheran N, Weber S, Cohan D, Obedin-Maliver J. Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals: A Collaborative Multidisciplinary Team Approach. Obstet Gynecol. 2019;134(5):959-963. doi:10.1097/aog.0000000000003506
 
7.
Centers for Disease Control and Prevention. Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226-1228. doi:10.1001/jama.301.6.593
 
8.
Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M.Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. https://www.transequality.org/.... Accessed August 16, 2019.
 
9.
Alzahrani T, Nguyen T, Ryan A, et al. Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circ Cardiovasc Qual Outcomes. 2019;12(4):e005597. doi:10.1161/CIRCOUTCOMES.119.005597
 
10.
Ahmed J, Elyse P, Gentzke AS, Homa DM, Babb SD, King BA, Neff LJ. Current Cigarette Smoking Among Adults - United States, 2016. 2018;67(2):53-59. doi:10.15585/mmwr.mm6702a1
 
11.
Drope J, Liber AC, Cahn Z, et al. Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA Cancer J Clin. 2018;68(2):106-115. doi:10.3322/caac.21444
 
12.
Jannat-Khah DP, Dill LJ, Reynolds SA, Joseph MA. Stress, Socializing, and Other Motivations for Smoking Among the Lesbian, Gay, Bisexual, Transgender, and Queer Community in New York City. Am J Health Promot. 2018;32(5):1178-1186. doi:10.1177/0890117117694449
 
13.
Remafedi G. Lesbian, gay, bisexual, and transgender youths: who smokes, and why? Nicotine Tob Res. 2007;9(Suppl 1):S65-S71. doi:10.1080/14622200601083491
 
14.
Bottorff JL, Haines-Saah R, Oliffe JL, Sarbit G. Gender influences in tobacco use and cessation interventions. Nurs Clin North Am. 2012;47(1):55-70. doi:10.1016/j.cnur.2011.10.010
 
15.
Pachankis JE, Westmaas JL, Dougherty LR. The influence of sexual orientation and masculinity on young men's tobacco smoking. J Consult Clin Psychol. 2011;79(2):142-152. doi:10.1037/a0022917
 
16.
Kwon JY, Oliffe JL, Bottorff JL, Kelly MT. Heterosexual gender relations and masculinity in fathers who smoke. Res Nurs Health. 2014;37(5):391-398 doi:10.1002/nur.21614
 
17.
Bottorff JL, Oliffe JL, Sarbit G, et al. Assessing the feasibility, acceptability and potential effectiveness of an integrated approach to smoking cessation for new and expectant fathers: The Dads in Gear study protocol. Contemp Clin Trials. 2017;54:77-83. doi:10.1016/j.cct.2017.01.002
 
18.
Fleming PJ, Agnew-Brune C. Current Trends in the study of Gender Norms and Health Behaviors. Curr Opin Psychol. 2015;5:72-77. doi:10.1016/j.copsyc.2015.05.001
 
19.
Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men's health behaviors. Soc Sci Med. 2007;64(11):2201-2209. doi:10.1016/j.socscimed.2007.02.035
 
20.
Wheldon CW, Watson RJ, Fish JN, Gamarel K. Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity. LGBT Health. 2019;6(5):235-241. doi:10.1089/lgbt.2019.0005
 
21.
Hamilton CJ, Mahalik JR. Minority stress, masculinity, and social norms predicting gay men's health risk behaviors. Journal of Counseling Psychology. 2009;56(1):132-141. doi:10.1037/a0014440
 
22.
Jannat-Khah DP, Reynolds SA, Dill LJ, Joseph MA. A Comparison of Alternative Tobacco Product Usage, Knowledge and Beliefs Between the New York City Lesbian, Gay, Bisexual, and Transgendered Community and Heterosexuals. J Community Health. 2017;42(5):903-910. doi:10.1007/s10900-017-0332-9
 
23.
Shires DA, Jaffee KD. Structural discrimination is associated with smoking status among a national sample of transgender individuals. Nicotine Tob Res. 2015;18(6):1502-1508. doi:10.1093/ntr/ntv221
 
24.
Fluharty M, Taylor AE, Grabski M, Munafo MR. The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review. Nicotine Tob Res. 2017;19(1):3-13 doi:10.1093/ntr/ntw140
 
25.
Tibshirani R. Regression Shrinkage and Selection via the Lasso. Journal of the Royal Statistical Society: Series B (Methodological). 1996;58(1):267-288. doi:10.1111/j.2517-6161.1996.tb02080.x
 
26.
Kidd JD, Dolezal C, Bockting WO. The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health. LGBT Health. 2018;5(7):401-411. doi:10.1089/lgbt.2018.0103
 
27.
Bailey SR, Hoopes MJ, Marino M, et al. Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study. J Gen Intern Med. 2016;31(10):1198-1205. doi:10.1007/s11606-016-3781-4
 
28.
van Wijk EC, Landais LL, Harting J. Understanding the multitude of barriers that prevent smokers in lower socioeconomic groups from accessing smoking cessation support: A literature review. Prev Med. 2019;123:143-151. doi:10.1016/j.ypmed.2019.03.029
 
29.
Wheldon CW, Wiseman KP. Tobacco Use Among Transgender and Gender Non-conforming Adults in the United States. Tob Use Insights. 2019;12:1179173X19849419. doi:10.1177/1179173X19849419
 
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