Substance Use
Realized causal effect of non-specific psychological distress on substance use outcomes among transgender women of color in New York, NY Adam Whalen* Adam Whalen Whalen Whalen Whalen Whalen Whalen Whalen Whalen Whalen Whalen Department of Epidemiology, Columbia University Mailman School of Public Health
Transgender women of color (TWOC) may be particularly vulnerable to the adverse health effects of substance use. Substance use is associated with psychological distress, and TWOC experience higher rates of psychological distress than the general population, partly due to discrimination. We sought to determine the realized causal effect of psychological distress on substance use behaviors in TWOC. We used baseline and 6-month follow-up data from the Trying to Understand Relationships, Networks, and Neighborhoods among Transgender women of color (TURNNT) Study, a 1-year prospective cohort in New York, NY. Exposure and covariate data were taken from baseline and outcome data were taken from 6-month follow-up to ensure temporality. Our exposure was non-specific psychological distress (NSPD) measured as a Kessler-10 score ≥20. We explored two substance use outcomes separately: past 6-month hazardous drinking, defined as at least a few times weekly, and any past 6-month substance use other than alcohol or cannabis. We established positivity using theoretical confounders: age, annual income, HIV serostatus, experience of everyday discrimination, and baseline outcome for each analysis. Analyses used targeted maximum likelihood estimation, a non-parametric doubly robust estimator, via ensemble SuperLearner. We included 168 participants with complete data; at baseline, 63% reported NSPD, 15% reported hazardous drinking, and 19% reported other substance use; at follow-up, 13% reported hazardous drinking and 20% reported other substance use. We found a causal risk ratio of 4.52 for the effect of NSPD on hazardous drinking (95% CI: 1.22–16.74), and a causal risk ratio of 1.44 for other substance use (95% CI: 0.76–2.73). In a population of TWOC, the risk of hazardous drinking would be over 4 times higher if everyone had NSPD compared to if no one had NSPD. Interventions should target psychological distress in TWOC to reduce problematic alcohol consumption and improve health.