Social Determinants of Transgender Health
A dissertation by Scout. Columbia School of Public Health, 2005.
 | Why is it important? |
| Abstract |
| Table of Conten |
| What are "social determinants of health"? |
| Transgender 101 |
| Transgender health 101 |
| How was the study conducted? |
| Summary of findings -- coming soon |
| Preface Online -- includes acknowledgments, etc. |
| Introduction Chapter Online |
| Literature Review Chapter Online -- with list of all TG needs assessments. |
| Methods Chapter Online -- dry stuff here, whew. |
| Findings Chapter Online -- Most of the participant stories are here. |
| Conclusion Chapter Online -- including recommendations for action + cites. |
| Bibliography Online -- hey, do you need a cite library in Endnotes? email me. |
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Why is it important?
There's been a bunch of research demonstrating that transgender people have a host of high risk behaviors and health problems. Sex-work, addictions, high HIV rates, and mental health issues have all been strongly linked to these populations. This project is important because it looked back into a variety of transgender people's lives to find out why some of these later health problems exist. What did I find? The shortest answer is the pervasive stigma that transgender people endure from their first awareness of being different creates a path directly to all these health problems. The interviews basically showed how a lifetime of stress (especially violence-related stress for MTFs), social exclusion, and lack of social support mix together to leave transgender people very unstable and vulnerable to health problems. These same interviews also told of the incredible stories of daily willful survival transgender people achieve. Next, you can read roughly the same thing in academic language...
Dissertation Abstract
Social
Determinants of Transgender Health
Table of Contents
TABLE
OF CONTENTS
i
LIST
OF CHARTS, GRAPHS, AND ILLUSTRATIONS
iv
DEDICATION
vii
PREFACE:
A NOTE ON LANGUAGE viii
A
NOTE ON PRIVILEGE AND OWNERSHIP viii
An Introduction to “Transgender”
3
Statement of the Problem
8
Importance of the Study
11
Purpose of the Study 12
Research Questions
12
Delimitations and Limitations
13
Over view of the Dissertation
16
CHAPTER
TWO: REVIEW OF THE LITERATURE
19
Outline of Literature Review
19
Social Determinants of Health
20
The social gradient 24
Stress
25
Early life
26
Social exclusion
27
Work
28
Unemployment
28
Social support
29
Addiction
29
Food
30
Transport
30
Transgender Health 31
The Complicated Relationship with the
Medical Community
33
Health Outcomes
36
Sexually Transmitted Diseases
38
Silicone Use
40
Mental Health Issues 42
Additional Health Outcomes
44
Social Determinant Information
46
Social gradient
47
Stress
47
Early life
50
Social exclusion
52
Work and Unemployment 55
Social support
58
Addiction
60
Food & Transport
61
CHAPTER
THREE: RESEARCH METHODS
63
Introduction
63
The Research Plan: A Triangulation of
Qualitative Methods 63
Theoretical Foundation 66
Conceptual and empirical challenges in
studying the transgender population
69
The researcher’s role 72
Data Sources:
A Study in Finding Hard to Reach Populations 78
Low-Incidence and Low Profile
78
Findings Related to a Secondary Research
Question
80
The Sampling Plan
80
The Outreach Plan
83
Data Collection
97
Data Transcription, Cleaning, and
Verification 101
Data Analysis
102
Ethical Considerations 104
Plan for Study Results 105
Introduction: The effect of
discrimination
107
The Major Finding: Compromised Survival
109
Research Question:
How do social determinants affect transgender health?
110
Finding 1:
Transgender health is defined by extremely high levels of stress
Introduction to stress
111
The stress of pervasive violence
112
Place and Time 1: Amanda Milan on the
mind 112
The Level of Normalization of Violence
113
Trauma and early development: “A heart
of stone”
119
Violence and Social Role 124
Violence in perspective: exploring its
role across narratives
129
The Example of Three White Women:
visibility equals risk
130
FTMs: less exposure to violence but
still not safe
133
No Warning, Never Safe: the phenomena of
“hair-trigger violence”
136
One Survival Strategy: hiding
138
Violence in conclusion 140
Place and Time 2: Paola Matos on the
mind
141
The stress of internalized gender
oppression
141
Introduction: seeing the “the pattern
of craziness”
141
Traditional gender oppression and
transphobia: the story of Anna
143
Non-traditional gender paradigms still
oppress: the story of Carrington
146
Internalizing gender oppression in
perspective: its role across narratives
149
The stress of internalized gender
oppression: in conclusion 151
Finding 2: Transgender health is defined
by extremely high levels of social exclusion.
153
Extreme Social Exclusion: the story of
Darlene’s transition 153
Social exclusion from education
157
Education as Social Support: The story
of one unusual college in the south
159
Education as
Social exclusion from employment
166
Social Exclusion from Housing
174
Social Exclusion from Health Care
175
Interaction Between Social Exclusion and
Transitioning 180
Social Exclusion in Conclusion
183
Finding 3: Transgender health is
constrained by lack of social support.
185
Introduction
185
Social Support and Family of Origin
185
Widespread stories of early life
rejection and alienation
185
Occasional stories of support
188
Later life support from family of origin
190
Social Support & Personal
Relationships 191
Pre-transition friendships
191
The role of initial community contact
191
The key role of mentors 192
Post-transition friendships
194
Relationships
197
Social Support in Conclusion
201
CHAPTER
FIVE: SUMMARY AND CONCLUSIONS
203
Review and Discussion of Primary
Research Findings 203
Social determinants adversely affect
transgender health through the major paths of stress, social exclusion, and
inadequate social support 203
Transgender health is characterized by
compromised survival
208
Review and Discussion of Secondary
Research Findings
211
Social determinants is a valuable
framework for studying highly stigmatized populations
211
An outreach plan built on reciprocity of
value and existing social networks is successful in gaining access to this
hidden population
212
Recommendations for future research
212
Why so interested, why so angry?
The need for research on johns, violent offenders, and blatant
discriminators
212
Additional research on social determinants
Recommendations for action
Recommendations
for Action. 212
Prioritize
educational system interventions. 213
Prioritize
early life safety net interventions. 214
Pursue
multi-level policy changes. 215
Prioritize
mental health and trauma recovery services across the lifespan. 218
Prioritize
life-stabilizing interventions and services. 220
Prioritize
interventions tuned to population-specific challenges.
220
In Conclusion
221
APPENDIX: INSTITUTIONAL REVIEW BOARD PROPOSAL 237
More
dissertation info coming soon!!