Jaclyn White Hughto

• PhD, MPH
• Associate Professor at Brown University

Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources...

Objectives: To review evidence from prospective cohort studies of the relationship between hormone therapy and changes in psychological functioning and quality of life in transgender individuals accessing hormone therapy over time. Data sources: MEDLINE, PsycINFO, and PubMed were searched for relevant studies from inception to November 2014. Ref...

Rationale: Correctional healthcare providers' limited cultural and clinical competence to care for transgender patients represents a barrier to care for incarcerated transgender individuals. Objective: The present study aimed to adapt, deliver, and evaluate a transgender cultural and clinical competence intervention for correctional healthcare prov...

Background: Fatal overdoses involving cocaine (powdered or crack) and fentanyl have increased nationally and in Massachusetts. It is unclear how overdose risk and preparedness to respond to an overdose differs by patterns of cocaine and opioid use. Methods: From 2017 to 2019, we conducted a nine-community mixed-methods study of Massachusetts resid...

Background Medications for opioid use disorder (MOUD; methadone, buprenorphine, naltrexone) are the most effective treatments for OUD, and MOUD is protective against fatal overdoses. However, continued illegal drug use can increase the risk of treatment discontinuation. Given the widespread presence of fentanyl in the drug supply, research is neede...

Importance In the US, transgender, nonbinary, and gender diverse (TGD) adults have high rates of depression. Gender-affirming hormone therapy (GAHT) is associated with improved mental health outcomes, yet existing US studies have short follow ups and lack sample diversity. Objective To evaluate the use of GAHT delivered in primary care as an inter...

Transgender and nonbinary young adults in the United States (U.S.) experience disproportionately high rates of HIV and face unique barriers to accessing HIV testing, a key component of HIV prevention. Gender-affirming practices in healthcare settings may improve care access and reduce care avoidance among transgender and nonbinary people. To our kn...

Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008-2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender...

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk envi...

Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and pr...

Background In recent years, overdoses involving illicit cocaine, methamphetamine, and other stimulants have increased in the U.S. The unintentional consumption of stimulants containing illicit fentanyl is a major risk factor for overdoses, particularly in Massachusetts and Rhode Island. Understanding the drug use patterns and strategies used by peo...

Transgender and gender diverse (TGD) adults experience increased discrimination and victimization relative to cisgender adults, thus elevating their risk for suicidal ideation (SI). Social support and connection to the broader TGD community may mitigate the relationship between gender identity-based stressors (i.e., interpersonal minority stressors...

Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults’ percept...

BACKGROUND Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the US is not well known. OBJECTIVE To evaluate the relationship between initiating GAHT via a telehealth clinic and...

Background Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known. Objective This study evaluated the relationship between initiating GAHT via a te...

This cross-sectional study uses a national dataset to examine the prevalence of gender-affirming surgical procedures among minors and adults in the US.

Motivations for substance use and the substance use treatment experiences of transgender and gender diverse (TGD) people who use drugs (PWUD) are not well understood. From July to August 2022, 12 TGD PWUD in Rhode Island completed an in-depth interview regarding substance use treatment experiences. Integrated thematic analysis using a socio-ecologi...

Background We introduce the concept of harm reduction capital (HRCap) as the combination of knowledge, resources, and skills related to substance use risk reduction, which we hypothesize to predict MOUD use and opioid overdose. In this study, we explored the interrelationships between ethnicity, HRCap, nonfatal overdose, and MOUD use among PWUD. M...

Men who have sex with men (MSM) with a history of childhood sexual abuse (CSA) are more likely to report crystal methamphetamine use and condomless anal intercourse (CAI) than MSM without CSA. MSM with CSA may benefit less in HIV prevention interventions due to long-term psychological effects. Data are from a pilot randomized, controlled trial test...

Background In the US, transgender and gender-diverse (TGD) individuals, particularly trans feminine individuals, experience a disproportionately high burden of HIV relative to their cisgender counterparts. While engagement in the HIV Care Continuum (e.g., HIV care visits, antiretroviral (ART) prescribed, ART adherence) is essential to reduce viral...

Background: In recent years, overdoses involving illicit cocaine, methamphetamine, and other stimulants have increased in the U.S. The unintentional consumption of stimulants containing illicit fentanyl is a major risk factor for overdoses, particularly in Massachusetts and Rhode Island. Understanding the drug use patterns and strategies used by pe...

This cross-sectional study compares emergency department use among transgender and gender-diverse as well as cisgender Medicare beneficiaries.

Across the globe, sexual and gender minority populations experience stressors (e.g., stigma, discrimination, violence) at the individual, interpersonal, and environmental levels that may increase their risk of substance use and substance use disorders compared to their heterosexual and cisgender peers. This chapter describes the scope of disparitie...

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

While transgender and gender diverse (TGD) people may never seek treatment related to their gender identity, many require access to gender-affirming treatments, including surgery. Starting in 2014, Medicare began covering gender-affirming surgery (GAS) on a case-by-case basis. In this study, we use national Medicare data to compare receipt of GAS b...

Numerous studies have linked minority stress to substance use among transgender and genderdiverse (TGD) individuals. Yet, there has been limited research on how TGD patients experience alcohol, tobacco, and other substance use communication with their providers. Therefore, we used qualitative interviews to explore the substance use communication ex...

As health systems move to make electronic health records (EHRs) accessible to patients, there is a need to examine if, and the extent to which, bias toward patients may be evident in these records. This scoping review aimed to summarize the scientific literature on methods used to detect biased language about patients in the EHR and the nature and...

Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, including in anogenital sexually transmitted infections (STI). Gender-affirming hormone therapy (GAHT) is known to be medically necessary and improve health. Few studies have assessed the effect of GAHT on STI diagnoses. To evaluate the effect of GAHT delivered i...

Background Incarcerated trans women experience significant victimization, mistreatment, barriers to gender-affirming care, and human rights violations, conferring high risk for trauma, psychological distress, self-harm, and suicide. Across the globe, most carceral settings are segregated by sex assigned at birth and governed by housing policies tha...

Background Providing sterile drug smoking materials to people who use drugs can prevent the acquisition of infectious diseases and reduce overdose risk. However, there is a lack of understanding of how these practices are being implemented and received by people who use drugs globally. Methods A systematic review of safer smoking practices was con...

Purpose Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults’ odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult’s...

Background: Trans people are incarcerated at disproportionately high rates relative to cisgender people and are at increased risk of negative experiences while incarcerated, including poor mental health, violence, sexual abuse, dismissal of self-identity, including poor access to healthcare. Aims: This scoping review sought to identify what is know...

Transgender and gender-diverse communities are disproportionately incarcerated in the USA. Incarcerated gender minority populations are detained within carceral systems constructed around a cisgender (gender identity matches sex assigned at birth) binary (only male and female identities recognized) understanding of gender. This leads to marginalizi...

Around the world, incarcerated trans women experience substantial victimisation and mistreatment equating to increased risk of suffering and self-harm compared to the general incarcerated population. This case study shares the story of Natasha Keating, a trans woman incarcerated in two male settings in Australia between 2000 and 2007. We examine 12...

Background Injection drug use poses significant risk for skin and soft tissue infections, such as abscesses. In places with endemic fentanyl and an increasingly contaminated drug supply, injecting and injection-related harms may be increasing, yet are understudied. We aimed to explore abscess prevalence, experiences, and themes among people who inj...

The ‘makeshift medicine’ framework describes how individuals address healthcare needs when they are unable to access the US healthcare system. The framework is applied to gender-affirming care, the health of people who inject drugs and abortion access. Recommendations for future research, advocacy and policy are made.

Introduction The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk f...

Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a samp...

Introduction: Hepatitis C virus (HCV) prevalence among transgender and gender-diverse individuals ranges from 1.8% to 15.7% versus 1% in the general population. Previous HCV studies inclusive of transgender and gender-diverse individuals primarily rely on convenience-based sampling methods or are geographically restricted. The purpose of this stud...

Purpose: Unsatisfactory collection of cells during Papanicolaou (Pap) tests prevents the detection of cervical cancer and dysplasia. Prior research found that trans masculine (TM) individuals are significantly more likely than cisgender women to have an unsatisfactory Pap test. The purpose of this study was to identify factors that place some TM in...

Trans women are disproportionately incarcerated in the United States and Australia relative to the general population. Stark racial and ethnic disparities in incarceration rates mean that Black American and First Nations Australian trans women are overrepresented in incarceration relative to White and non-Indigenous cisgender and trans people. Info...

Background: Transgender and gender diverse (TGD) adults experience high levels of stigma which contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV, TGD individuals may be less likely to engage in healthcare to avoid further discrimination. Setting: This analysis included 529 TGD ad...

Purpose: Health disparities in transgender and gender diverse (TGD) veterans compared with cisgender veterans have been documented. However, there is a paucity of literature focused on older TGD veterans. We assessed health conditions and social stressors in older TGD veterans compared with matched cisgender veterans. Methods: Using gender identity...

OBJECTIVES This study examined differences by sexual and gender minority (SGM) and incarceration statuses in mental health indicators among youth. METHODS Population-based, cross-sectional data are from the 2019 Minnesota Student Survey (N = 72 324) and includes public school students (Mage = 15.49) and youth incarcerated in juvenile correctional...

Transgender and gender-diverse (TGD) people are disproportionately impacted by incarceration, interpersonal violence, HIV and other sexually transmitted infections, substance use disorders, and suicidality. Little is known about successful approaches to improve health outcomes for TGD individuals impacted by incarceration. We review the barriers to...

Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multiva...

The sexual partnerships of transmasculine (TM) adults—those assigned female at birth who identify as transgender men or a masculine spectrum gender identity—and characteristics associated with STI/HIV risk behavior remains understudied. Participants in the current study were TM adults (n = 141) receiving care at a community health center in Boston,...

Objectives. To compare survival by gender and race among transgender and cisgender people enrolled in private insurance in the United States between 2011 and 2019. Methods. We examined Optum’s Clinformatics Data Mart Database. We identified transgender enrollees using claims related to gender-affirming care. Our analytic sample included those we id...

BACKGROUND The sexual health of transmasculine (TM) people—those who identify as male, men, or nonbinary and were assigned a female sex at birth—is understudied. One barrier to conducting HIV- and sexually transmitted infection (STI)–related research with this population is how to best capture sexual risk data in an acceptable, gender-affirming, an...

This case study provides a critical discourse analysis of 121 letters of complaint and self‐advocacy authored by Natasha Keating, a trans woman incarcerated in two Australian male correctional facilities from 2000 to 2007. During her incarceration, Natasha experienced victimization, misgendering, microaggression, and institutional discrimination. D...

Trans women incarcerated throughout the world have been described as “vulnerable populations” due to significant victimization, mistreatment, lack of gender-affirming care, and human rights violations, which confers greater risk of trauma, self-harm, and suicide compared with the general incarcerated population. Most incarceration settings around t...

Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% rand...

Purpose: Transgender (TG) individuals are a historically understudied and underserved patient population. Although clinical guidelines for the care of TG patients exist, quality measures (QMs) specific to this population are lacking. The goal of this study was to obtain expert input on aspects of care for which quality measurement may be appropriat...

Purpose: Prior algorithms enabled the identification and gender categorization of transgender people in insurance claims databases in which sex and gender are not simultaneously captured. However, these methods have been unable to categorize the gender of a large proportion of their samples. We improve upon these methods to identify the gender of a...

Most incarceration settings around the world are governed by strong cisnormative policies, architectures, and social expectations that segregate according to a person's legal gender (i.e. male or female). This paper draws on the lived experiences of 24 formerly incarcerated trans women in Australia and the U.S. to elucidate the way in which the pri...

When taken as prescribed, buprenorphine is effective in reducing opioid withdrawal, cravings, and use and preventing fatal overdose among people living with opioid use disorder (OUD). Despite the well-documented potential of buprenorphine provision to curb the opioid and overdose crises, this medication is severely underutilized in the treatment of...

Background: Transgender and gender diverse (TGD) people are disproportionately incarcerated in the United States relative to the general population. A dearth of quantitative research has explored victimization as a risk factor for incarceration as well as the victimization experiences of formerly incarcerated TGD populations. Methods: In 2019, 574...

Purpose: To facilitate identification of the impact of incarceration on the health of sexual and gender minority (SGM) populations, we sought to identify publicly accessible, representative health datasets that assessed SGM status and incarceration history from 2010 to 2020 and to examine SGM disparities in lifetime incarceration experiences. Metho...

Combination therapy with estrogen and spironolactone may help some transgender women achieve desired results. We used two databases, OptumLabs® Data Warehouse (OLDW) and Veterans Health Administration (VHA), to examine trends in feminizing therapy. We included 3368 transgender patients from OLDW and 3527 from VHA, all of whom received estrogen, spi...

Study/research objective To develop and validate a brief intimate partner violence (IPV) scale that screens for controlling behaviors and psychological abuse tactics directed toward transgender individuals. Rationale Transgender individuals are at elevated risk of physical and sexual IPV compared to cisgender individuals. IPV often takes on unique...

The burden of morbidity among privately insured transgender people is largely unknown. We identified transgender people enrolled in private insurance (using claims from 2001-19) and compared their rates of selected chronic conditions, using the Elixhauser Comorbidity Index, with claims for a matched cisgender cohort. We documented disparities betwe...

Background People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-...

IntroductionRecent policies have restricted the rights of the US transgender people; there is a need to explore transgender people’s knowledge and attitudes regarding such policies and related mental health.Methods In 2019, 580 transgender adults living in the Northeastern US completed a survey assessing demographics, knowledge/attitudes toward tra...

Background: Substantial research gaps exist regarding the relationship between transgender-related discrimination and substance use outcomes for transgender adults, with few studies accounting for other experiences of victimization. Methods: Transgender adults (N = 600) from Massachusetts and Rhode Island completed a survey online or in-person....

Overdose deaths across the country have spiked since the onset of the COVID-19 pandemic. It is crucial now, more than ever, to address the continuing and worsening, complex and dynamic opioid and overdose epidemics. In 2018, The Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, based at Rhode Island Hospital, launched with t...

See also Wesson et al., p. 446. I n the United States, transgender women who were assigned a male sex at birth and identify along the feminine gender spectrum experience extensive discrimination, violence, and other forms of stigma. 1 Transgender stigma operates at the structural (e.g., discriminatory laws and policies), inter-personal (e.g., enact...

Background Limited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults. Methods In 2019, TGD adults (n = 562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial...

Background Valid and reliable quality measures can help catalyze improvements in health care. The care of transgender patients is ripe for quality measurement, as there is increasing awareness of the increasing prevalence of this population and the urgency of improving the health care they receive. While best practices may not exist for some aspect...

Importance Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. Objectives To investigate the prevalence of SUDDs among transgender and cisgender adu...

Purpose: The purpose of this study was to examine the extent to which transgender people have observed negative transgender-related messages in the media and the relationship between negative media message exposure and the mental health of transgender people. Methods: In 2019, 545 transgender adults completed an online survey assessing demographic...

Background: Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may...

Historically, federal and state policies have narrowly defined treatment models that have resulted in limited access to and engagement in counseling for individuals receiving medications for opioid use disorder (MOUD; e.g., methadone and buprenorphine). In response to the coronavirus pandemic, outpatient MOUD treatment providers rapidly transitione...

A dearth of research has explored concurrently the associations between multiple forms of gender affirmation (or transitioning) and the mental health of transgender adults. In 2015, 288 U.S. transgender adults completed a cross-sectional, online survey assessing demographics, gender affirmation experiences, and mental health. Adjusting for age and...

Background: Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. Objective: The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. Resear...

BACKGROUND Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, especially in HIV infection. Medical gender affirmation such as hormone replacement therapy and gender-affirming surgeries is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the...

Background Transgender and gender diverse (TGD) adults in the United States experience health disparities, especially in HIV infection. Medical gender affirmation (eg, hormone therapy and gender-affirming surgeries) is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the effe...

There remains a limited understanding of current levels of transgender-related knowledge and acceptance among members of the general public. This study sought to develop and psychometrically evaluate a transgender knowledge, attitudes, and beliefs (T-KAB) scale in the general US population. We developed and evaluated the reliability and validity of...

Background In recent years, Massachusetts (MA) and Rhode Island (RI) joined a growing list of states allowing residents to easily change the gender marker and name on government-identification (ID) documents. This was an important change for transgender and gender diverse (trans) residents, who face frequent mistreatment and thus for whom legal gen...

The sexual partnerships of transmasculine adults-who were assigned female at birth and identify on the masculine gender continuum-remain understudied. This includes characteristics of transmasculine adults' sexual partnerships associated with engaging in HIV/sexually transmitted infection (STI) sexual risk behavior. This study examined individual-...

An estimated 1.2 million people in the United States are living with HIV. Of those living with HIV, only 40% are engaged in HIV care, 37% are prescribed antiretroviral therapy (ART), and 30% are virally suppressed. Individual-, interpersonal-, and structural-level factors that represent barriers to engagement along the HIV care continuum are import...

Rationale: A growing body of transgender (trans) health research has explored the relationship between stigma and health; yet, studies have conceptualized and operationalized anti-trans stigma in multiple ways. Objective: This scoping review aims to critically analyze quantitative measures of anti-trans stigma in the U.S. using a socioecological...

Gay and bisexual men might face unique, status-based competitive pressures given that their social and sexual relationships often occur with other men, who are known to compete for social and sexual gain. In a multistage study, we delineated intraminority gay community stress theory-that status-focused elements of the gay community challenge the me...

Background: In the U.S., transgender and gender diverse (TGD) populations face structural, interpersonal, and individual barriers to healthcare. Less is known, however, about the HIV prevention and treatment experiences of TGD youth in the U.S. The current study was developed to fill this research gap. Methods: This article describes the researc...