Walter Bockting's research while affiliated with Columbia University and other places

Publications (147)

Article
Objective Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. I...
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Purpose Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. Methods Between 2016 and 2...
Article
Transgender and nonbinary people’s life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences...
Article
Objectives: Investigate the associations of gender minority stressors (including stigma consciousness [SC] and gender-related discrimination [GRD]) with sleep health in gender minority individuals. Design: Cohort. Participants: 279 gender minority individuals. Measurements: SC and GRD were measured using the Stigma Consciousness and Everyday...
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Long-acting injectable cabotegravir (CAB-LA) is in advanced stages of clinical trials. Under the standard protocol, CAB-LA is injected into the gluteal muscle by a healthcare provider every eight weeks. To explore transgender women’s barriers and facilitators to tailored delivery strategies—including self-injection and injection in “drop-in” center...
Article
Behavioral and neurobiological effects of GnRH agonist treatment in mice—potential implications for puberty suppression in transgender individuals Christoph Anacker1,2,3,4, Ezra Sydnor5,9, Briana K. Chen 6 , Christina C. LaGamma1,10, Josephine C. McGowan6 , Alessia Mastrodonato1,2, Holly C. Hunsberger1,2, Ryan Shores1 , Rushell S. Dixon6 , Bruce...
Article
Introduction Existing data on cardiovascular disease among transgender people are inconsistent and are derived from nonrepresentative samples or population-based data sets that do not include transgender-specific risk factors such as gender-affirming hormone use and gender minority stressors. A nationally representative sample of cisgender and tran...
Article
Objective Research examining the prevalence and severity of eating-related psychopathology in transgender and gender nonbinary individuals is limited. This study examined how identity development and minority stress relate to the presence of disordered eating behaviors and cognitions in transgender and gender nonbinary individuals, and improvement...
Article
While the COVID-19 pandemic in the United States disproportionately impacts marginalized communities, no empiric US-based research has focused specifically on transgender and gender nonbinary (TGNB) people. We examined the pandemic’s impact on an established longitudinal cohort of TGNB individuals (N = 208) by administering an online survey between...
Article
Background Prescription drug (PD) misuse, particularly opioid misuse, is a major US public health concern. While transgender and gender nonbinary (TGNB) individuals experience numerous health disparities, including substance use disparities, little research has focused on PD misuse in this population. Methods Data for this secondary analysis come...
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Transgender and gender nonbinary (TGNB) individuals were recently designated a health disparity population by the U.S. National Institutes of Health. We examined the effect of gender-related discrimination and resilience factors on the mental health of a community sample diverse in gender identity, age, and race/ethnicity. We report on the baseline...
Article
In the United States, ~1.4 million individuals identify as transgender. Many transgender adolescents experience gender dysphoria related to incongruence between their gender identity and sex assigned at birth. This dysphoria may worsen as puberty progresses. Puberty suppression by gonadotropin-releasing hormone agonists (GnRHa), such as leuprolide,...
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There are several long-acting biomedical HIV prevention products in the development pipeline, including injections and implanted medication delivery devices (IMDDs). It is critical to understand concerns and preferences on the use of these products in populations that shoulder a disproportionate burden of the HIV epidemic, such as transgender women...
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The purpose of this study was to assess gender identity differences in CVD risk and CVD conditions among adults in the U.S. Using data from the 2014–2017 BRFSS we compared CVD risk and CVD conditions in gender minorities (transgender men, transgender women and gender nonconforming persons) to both cisgender men and women. The sample consisted of 66...
Article
Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analy...
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Background: Transgender and gender nonconforming (TGNC) people have gained visibility in public discourse leading to greater awareness, understanding, and social change. However, progress made in policies to combat stigma and improve public accommodation and healthcare for this minority population have been targeted for reversal, particularly sinc...
Article
Purpose: We describe the development of a measure of internalized transphobia, defined as discomfort with one's transgender identity as a result of internalizing society's normative gender expectations. Methods: An item pool was created based on responses from a small clinical sample (N = 12) to an open-ended questionnaire. Expert judges reviewed...
Article
Transgender women are less likely to engage in HIV care and adhere to antiretroviral medications than other at-risk populations. Health care and social service providers, in addition to consumers, have experiences that can elucidate barriers and facilitators to care and inform interventions. Guided by the social/ecological model, we conducted inter...
Article
Purpose: The purpose of this study was to explore home health care nurses' attitudes, perceptions, and experiences related to routine collection and documentation of sexual orientation and gender identity data. Methods: This was a qualitative descriptive study. Twenty-four nurses from a large home health care agency in the New York metropolitan ar...
Article
Background: Transgender women (TW) in Puerto Rico (PR) face social stigmatization. Physicians' transgender stigma can have detrimental consequences for TW's health. Purpose: The objective of this study was to document physicians' knowledge, competencies, and attitudes towards TW in PR and study their associations with stigma towards TW. Methods...
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Background. Transgender women (TW) in Puerto Rico (PR) face social stigmatization. Physicians’ transgender stigma can have detrimental consequences for TW’s health. Purpose. The objective of this study was to document physicians’ knowledge, competencies, and attitudes towards TW in PR and study their associations with stigma towards TW. Methods. We...
Article
We examined differences in suicidality based on gender identity while adjusting for known suicide risk factors in a sample of United States adolescents. Using data from the 2017 Youth Risk Behavior Survey we used logistic regression models to examine three suicide-related outcomes. Youth were categorized as transgender (1.3%), gender-questioning (1...
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This paper grows our understanding about PrEP knowledge in transgender women (TW) to improve PrEP-focused education/outreach. Research took place in New York City. We conducted four focus groups in English or Spanish (N = 18). Discussions focused on participants’ perceptions and knowledge of oral PrEP. Most participants knew that PrEP is efficaciou...
Article
Objective While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals. Methods Data come from a multi-site, longi...
Article
Mental health disparities among transgender adolescents are well documented and have generally been attributed to minority stress. However, significantly less is known about the minority stress experiences of non-binary adolescents or those who do not identify as exclusively male or female. This study qualitatively explored the unique ways that non...
Article
To address a shortage in research on Pre-Exposure Prophylaxis (PrEP) amongst women at high risk of HIV acquisition, this study explored the attitudes and preferences of female sex workers (FSW) (n = 15) and women who inject drugs (WWID) (n = 16) to existing (e.g., pill) and new (e.g., injection, implant) PrEP modalities, in Baltimore, Maryland, U.S...
Article
Health disparities have been documented in the lesbian, gay, bisexual, and transgender population, but more research is needed to better understand how to address them. To that end, this observational study examined what is documented about sexual orientation and gender identity in narrative home care nurses' notes in an electronic health record. L...
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Transgender women may face a disparate risk for HIV/AIDS compared to other groups. In 2012, Truvada was approved for daily use as HIV pre-exposure prophylaxis (PrEP). However, there is a dearth of research about barriers and facilitators to PrEP in transgender women. This paper will shed light on transgender women living in New York City’s perceive...
Article
Purpose: Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and me...
Article
Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock’s model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgen...
Article
We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD = 13.78, range =...
Article
The current study uses an ecological model of biopsychosocial vulnerability to guide the description of risk and protective factors for the mental health of gender minority (i.e., transgender and gender non-conforming) adolescents at the individual, family, community, and societal levels. Minority stress is the vulnerability of youth who are lesbia...
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Purpose: Research on healthcare among gender-diverse populations has largely focused on people who describe their gender in binary terms, either as trans men or trans women. This qualitative study examined the healthcare experiences of young adults who identify as genderqueer or nonbinary (GQ/NB). Methods: Participants (N = 10) were interviewed...
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The assessment of biomarkers related to HIV and chronic stress increases opportunities for the design of more comprehensive research and intervention efforts on the health of transwomen within the context of Health Psychology. In this paper, we present data from a study implemented in Puerto Rico that aimed to: document the feasibility/acceptabilit...
Article
Purpose: This study examined internalized transnegativity and psychological distress in two age groups of transgender individuals who identified their gender identity on the feminine spectrum (rather than congruent with their male sex assigned at birth). Due to greater visibility and acceptance of gender diversity in the United States, we hypothes...
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The current study examined demographics, sexual orientation, gender characteristics, and gender minority stress and their association to excessive alcohol, cannabis, and illicit (noncannabis) drug use among 1210 transgender adults living in the United States. The authors conducted a secondary analysis of data that included 680 transgender women (Ma...
Chapter
This chapter reviews existing knowledge in the area of sex therapy with transgender clients. As well as reviewing and synthesizing current scholarly work, the chapter offers insights and knowledge based on the authors' extensive clinical experience working with trans people, their partners, and their families. It provides an overview of issues to c...
Article
Objectives: To describe the health status of the transgender population in the United States. Methods: We used 2014 Behavioral Risk Factor Surveillance System data that comprised a probability sample from 19 US states and Guam (n = 151 456). Results: Bivariate analyses showed that, in comparison with cisgender individuals, transgender individu...
Article
Aims and objectives: To examine patients' perceptions of being asked about their sexual orientation and gender identity in the healthcare setting. Background: Health disparities exist in the lesbian, gay, bisexual and transgender population, but further research is needed to better understand these disparities. To address this issue, experts rec...
Article
Widespread availability of electronic health records coupled with sophisticated statistical methods offer great potential for a variety of applications for health and disease surveillance, developing predictive models and advancing decision support for clinicians. However, use of “big data” mining and discovery techniques has also raised ethical is...
Article
Aims and objectives: To conduct an integrative review of nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self-injury; and to examine the risk factors associated with nonsuicidal se...
Article
Psychological research with transgender and gender nonconforming (TGNC) people is a relatively new field with great promise to advance our understanding of this population’s needs and develop, implement, and evaluate corresponding interventions to reduce their health disparities and promote psychosocial adjustment, mental health, and well-being. Af...
Article
Objective Transgender people face unique challenges when accessing health care, including stigma and discrimination. Most residency programs devote little time to this marginalized population. Methods The authors developed a 90-min workshop to enhance residents’ ability to empathize with and professionally treat transgender patients. Attendees comp...
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Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent <1% of the population. Few interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. Qualitative data from the Brothers Connect Study were analyze...
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Purpose of review: This article describes methodological challenges, gaps, and opportunities in US transgender health research. Recent findings: Lack of large prospective observational studies and intervention trials, limited data on risks and benefits of sex affirmation (e.g., hormones and surgical interventions), and inconsistent use of defini...
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Purpose of review: Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for futu...
Article
Researchers have recently begun to examine resiliency among transgender persons with a few studies suggesting that the effects of stigma on psychological distress may be moderated by aspects of involvement with transgender peers. We extended this line of inquiry with a longitudinal study of transgender community involvement as a moderator of a prev...
Conference Paper
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Background. Young Black men who have sex with men (YBMSM) account for approximately 10% of the total HIV infection in the United States but represent less than 1% of the population. Few sexual health interventions exist that address their unique needs, and those that do adopt a narrow, risk-based framework for prevention. Methods. Qualitative data...
Article
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite i...
Article
Internet-based health research is increasing, and often offers financial incentives but fraudulent behavior by participants can result. Specifically, eligible or ineligible individuals may enter the study multiple times and receive undeserved financial compensation. We review past experiences and approaches to this problem and propose several new s...
Article
Researchers currently lack a reliable and valid means of assessing minority stress and resilience factors in transgender and gender-nonconforming (TGNC) people. This study was conducted to develop and evaluate the validity of a tool to better assess these constructs in TGNC populations. The Gender Minority Stress and Resilience (GMSR) measure was d...
Article
In a 3 year prospective study of 230 transgender women from the New York City Area, we further examined associations of gender-related abuse with HIV sexual risk behavior and incident HIV/STI, focusing here and the extent to which these associations are buffered by involvement in a transgender community. Largely consistent with the prior study, gen...
Conference Paper
OBJECTIVE:To assess whether stigmatizing social environments (i.e., structural stigma) were associated with suicide attempts among transgender adults. METHODS:State-level structural stigma was coded using a previously established measure (Hatzenbuehler, 2011) based on a 4-item composite index: (1) density of same-sex couples; (2) proportion of Ga...
Conference Paper
OBJECTIVE: To assess whether stigmatizing social environments (i.e., structural stigma) were associated with HIV risk behaviors among transgender adults. METHODS: State-level structural stigma was coded using a previously established measure (Hatzenbuehler, 2011) based on a 4-item composite index: (1) density of same-sex couples; (2) proportion o...
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Objectives: We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women. Methods: We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area....
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Abstract To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples, but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself re...
Article
Researchers new to online qualitative health research frequently have questions about how to transfer knowledge of offline data collection to an online environment. In this article, we present best-practice guidelines derived from the literature and our experience to help researchers determine if an online qualitative study design is appropriate fo...
Chapter
The existence of transgender and gender-nonconforming people has been documented throughout history and across cultures. In the twentieth century, transgender expression became medicalized and sex reassignment became available, initially enforcing a binary understanding of sex/gender as either male or female, man or woman, and masculine or feminine...
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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 US. Primary findings include: significant differences in ment...
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Objectives: We examined the social and interpersonal context of gender abuse and its effects on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depression among transgender women. Methods: We conducted a 3-year prospective study (2004-2007) among 230 transgender women aged 19 to 59 years from the New York City Metropo...
Article
In this study we applied research examining the hypothesized benefits of masturbation in dealing with sexual problems to the urgent health crisis posed by the HIV/AIDS pandemic. This is the first study to test the hypothesized relationship between masturbation and HIV risk as predicted by the Sexual Health Model, a sex-positive approach to sexual h...
Article
Scientific interest in the measurement of homophobia and internalized homophobia has grown over the past 30 years, and new instruments and terms have emerged. To help researchers with the challenging task of identifying appropriate measures for studies in sexual-minority health, we reviewed measures of homophobia published in the academic literatur...
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Objectives: We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population. Methods: In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by g...
Article
Research reports the perpetuation of communal traits by transgender women, possibly to affirm their core gender identity. Transgender women in the United States are nearly 6 times more likely than the general population to experience significant depressive symptoms. Studies among non-transgender individuals in the United States demonstrate that age...
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The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with s...
Article
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Objectives: We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs). Methods: We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the...