All Publications


  • "We Followed their Lead": Exploring Relational Change and Support among Caregivers of Transgender and Gender Diverse Youth. SSM. Qualitative research in health Tarantino, M. R., Tham, R. L., Quint, M. R., Kremen, J., Kane, K., Rangel-Gomez, M., Boskey, E., Xu, R., Reisner, S. L. 2024; 5

    Abstract

    Transgender and gender diverse youth and young adults (TGDY) experience higher mental health morbidity, including self-harm, suicide ideation, and suicide attempts, as compared to cisgender peers. Support from family members is associated with improved mental health outcomes for TGDY. However, little is known about the process that caregivers who consider themselves supportive undergo and how caregiver-youth relationships evolve through a TGDY's gender journey. Through a reflexive thematic analysis of 14 interviews conducted with caregivers of TGDY from April-July 2022, we sought to understand how caregivers who considered themselves supportive of TGDY navigated shifting relationships with themselves, their children, and their communities. Applying theories of Ambiguous Loss and Thriving Through Relationships, findings coalesced around several themes including reflecting on change, re-negotiating interpersonal relationships, and educating through relationships. The gender journeys of TGDY required caregivers to navigate relationships with self (feeling loss and wrestling with worry for their child), negotiate relationships with others (disclosing to extended family and social networks), and educate themselves and others through relationships (connecting through personal narratives from other families, parents supporting parents, learning to advocate for their child). The process of caregivers learning to support their children was facilitated through profound intrapersonal and interpersonal reflection, connection, and community. Understanding this process is important to inform educational interventions and programs that help caregivers learn to support and advocate effectively for TGDY.

    View details for DOI 10.1016/j.ssmqr.2024.100429

    View details for PubMedID 38778873

  • TRANSforming Gender Identity Data Collection and Representation for Gender Diverse Youth. Pediatrics Quint, M., Reece-Nguyen, T. L. 2024

    View details for DOI 10.1542/peds.2024-065932

    View details for PubMedID 38752290

  • Exploring gender euphoria in a sample of transgender and gender diverse patients at two U.S. urban community health centers. Psychiatry research Reisner, S. L., Pletta, D. R., Harris, A., Campbell, J., Asquith, A., Pardee, D. J., Deutsch, M. B., Aguayo-Romero, R., Quint, M., Keuroghlian, A. S., Radix, A. 2023; 329: 115541

    Abstract

    Transgender and gender diverse (TGD) people are affected by mental health inequities. Gender euphoria-positive emotions or joy in gender-may be associated with positive mental health. Between February 2019-July 2021, we surveyed 2,165 adult TGD patients (median age=28 years; 29.2% people of color; 29.6% nonbinary; 81.0% taking hormones) evaluating gender euphoria and mental health. Overall, 35.0% self-reported gender euphoria, 50.9% gender dysphoria, 23.5% alcohol misuse, and 44.5% resilience. Gender euphoria differed by race, gender, insurance, and hormone use, and was associated with reduced gender dysphoria (adjusted Odds Ratio[aOR]=0.58; 95% confidence interval [95%CI]=0.47-0.72) and alcohol misuse (aOR=0.75; 95%CI=0.60-0.95), and increased resilience (aOR=1.31; 95%CI=1.07-1.61). The construct of gender euphoria may be a promising mental health target.

    View details for DOI 10.1016/j.psychres.2023.115541

    View details for PubMedID 37857133

  • A qualitative exploration of how to support PrEP adherence among young men who have sex with men AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Psaros, C., Hill-Rorie, J., Quint, M., Horvitz, C., Dormitzer, J., Biello, K. B., Krakower, D. S., Safren, S. A., Mimiaga, M. J., Sullivan, P., Hightow-Weidman, L. B., Mayer, K. H. 2023: 1-12

    Abstract

    New HIV infections disproportionately affect young men who have sex with men (YMSM). PrEP is effective in preventing HIV acquisition; however, adherence is critical and is often suboptimal among YMSM. Interventions addressing the unique PrEP adherence challenges faced by YMSM are needed. We conducted qualitative interviews with 20 HIV-negative, YMSM (ages 15-24) with a PrEP indication and 11 healthcare professionals to inform adaption of a PrEP adherence intervention (Life-Steps for PrEP) for YMSM. We explored environmental, healthcare, and individual factors influencing uptake, adherence, attitudes, and perspectives (including desired modifications) on the Life-Steps intervention. Interviews were analyzed using content analysis. Of YMSM study participants (mean age 21.6) 55% were White, 15% Hispanic, and 5% Black. Most YMSM were PrEP-experienced (70%). Healthcare professionals (6 prescribers, 1 nurse, 2 health educators, 2 other/unspecified) averaged 6.9 years of experience caring for YMSM. All described stigma as a barrier to PrEP; YMSM expressed concern around being perceived as "risky" and concern about inadvertent PrEP disclosure if family/friends found their medication, or if parental insurance was used. Difficulty with planning for potential adherence challenges were identified by both groups. YMSM highlighted benefits of a nurse-led intervention (i.e., adding "legitimacy"), but stressed need for nonjudgmental, "savvy" interventionists. YMSM expressed a desire for comprehensive YMSM-specific sexual health information. These findings informed modification and expansion of Life-Steps content. Results highlight key potential barriers, many of which center around privacy. Content that addresses PrEP stigma, disclosing PrEP use, navigating insurance, and planning ahead in a nonjudgmental environment by trusted providers emerged as important components of a YMSM-focused delivery of Life-Steps for PrEP.

    View details for DOI 10.1080/09540121.2023.2240070

    View details for Web of Science ID 001070203000001

    View details for PubMedID 37748111

  • 'Wow, That's Me': Uneven Access To Gender-Affirming Care. Health affairs (Project Hope) Quint, M. 2023; 42 (9): 1304-1307

    Abstract

    A nonbinary/genderqueer person reflects on their experience pursuing a chest reduction as gender-affirming care.

    View details for DOI 10.1377/hlthaff.2023.00333

    View details for PubMedID 37669484

  • Hepatitis C Virus Testing and Care Cascade Among Transgender and Gender Diverse Individuals AMERICAN JOURNAL OF PREVENTIVE MEDICINE Wolfe, H. L., Hughto, J. W., Quint, M., Hashemi, L., Hughes, L. D. 2023; 64 (5): 695-703

    Abstract

    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 study is to compare the prevalence of HCV diagnoses, testing, and care engagement between transgender and gender-diverse and cisgender individuals.Using Optum's de-identified Clinformatics® Data Mart Database, in 2022, the unadjusted prevalence of HCV testing among all adults and people who inject drugs from January 2001 to December 2019 was measured. Multivariable logistic regression was used to compare the adjusted odds of HCV diagnoses and care engagement by gender subgroup.The overall unadjusted frequency of HCV diagnoses among transgender and gender-diverse individuals was approximately 3 times that of cisgender individuals (1.06% vs 0.38%, p<0.001), including among people who inject drugs (6.36% vs 2.36%, p=0.007). Compared with cisgender women, transfeminine/nonbinary individuals had over 5 times the adjusted odds of a HCV diagnosis and approximately 3.5 times the odds of being tested for HCV. In addition, compared with cisgender women, transfeminine/nonbinary individuals had significantly increased odds of having a HCV‒related procedure (e.g., abdominal ultrasounds, liver biopsies, Fibroscans). Cisgender men had significantly increased odds of receiving HCV medication compared with cisgender women.Although testing was higher among transgender and gender-diverse individuals, the higher overall frequency of HCV diagnoses among transgender and gender-diverse than among cisgender individuals signals persistent health disparities. Interventions are warranted to prevent HCV and increase ongoing testing and treatment uptake among transgender and gender-diverse populations.

    View details for DOI 10.1016/j.amepre.2023.01.005

    View details for Web of Science ID 000985818500001

    View details for PubMedID 36759228

    View details for PubMedCentralID PMC10121731

  • Digital-Assisted Self-interview of HIV or Sexually Transmitted Infection Risk Behaviors in Transmasculine Adults: Development and Field Testing of the Transmasculine Sexual Health Assessment JMIR PUBLIC HEALTH AND SURVEILLANCE Reisner, S. L., Pletta, D. R., Pardee, D. J., Deutsch, M. B., Peitzmeier, S. M., Hughto, J. W., Quint, M., Potter, J. 2023; 9: e40503

    Abstract

    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, and accurate manner.This study aimed to report on the community-based process of developing, piloting, and refining a digitally deployed measure to assess self-reported sexual behaviors associated with HIV and STI transmission for research with TM adults.A multicomponent process was used to develop a digital-assisted self-interview to assess HIV and STI risk in TM people: gathering input from a Community Task Force; working with an interdisciplinary team of content experts in transgender medicine, epidemiology, and infectious diseases; conducting web-based focus groups; and iteratively refining the measure. We field-tested the measure with 141 TM people in the greater Boston, Massachusetts area to assess HIV and STI risk. Descriptive statistics characterized the distribution of sexual behaviors and HIV and STI transmission risk by the gender identity of sexual partners.The Transmasculine Sexual Health Assessment (TM-SHA) measures the broad range of potential sexual behaviors TM people may engage in, including those which may confer risk for STIs and not just for HIV infection (ie, oral-genital contact); incorporates gender-affirming language (ie, genital or frontal vs vaginal); and asks sexual partnership characteristics (ie, partner gender). Among 141 individual participants (mean age 27, SD 5 years; range 21-29 years; n=21, 14.9% multiracial), 259 sexual partnerships and 15 sexual risk behaviors were reported. Participants engaged in a wide range of sexual behaviors, including fingering or fisting (receiving: n=170, 65.6%; performing: n=173, 66.8%), oral-genital sex (receiving: n=182, 70.3%; performing: n=216, 83.4%), anal-genital sex (receptive: n=31, 11.9%; insertive: n=9, 3.5%), frontal-genital sex (receptive: n=105, 40.5%; insertive: n=46, 17.8%), and sharing toys or prosthetics during insertive sex (n=62, 23.9%). Overall barrier use for each sexual behavior ranged from 10.9% (20/182) to 81% (25/31). Frontal receptive sex with genitals and no protective barrier was the highest (21/42, 50%) with cisgender male partners. In total, 14.9% (21/141) of participants reported a lifetime diagnosis of STI. The sexual history tool was highly acceptable to TM participants.The TM-SHA is one of the first digital sexual health risk measures developed specifically with and exclusively for TM people. TM-SHA successfully integrates gender-affirming language and branching logic to capture a wide array of sexual behaviors. The measure elicits sexual behavior information needed to assess HIV and STI transmission risk behaviors. A strength of the tool is that detailed partner-by-partner data can be used to model partnership-level characteristics, not just individual-level participant data, to inform HIV and STI interventions.

    View details for DOI 10.2196/40503

    View details for Web of Science ID 000976765100033

    View details for PubMedID 36930204

    View details for PubMedCentralID PMC10131935

  • Gender Affirmation-Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study JMIR FORMATIVE RESEARCH Boskey, E. R., Quint, M., Xu, R., Kremen, J., Estrada, C., Tham, R., Kane, K., Reisner, S. L. 2023; 7: e45952

    Abstract

    Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet.We aim to understand ways TGD young adults look for web-based information about gender and health.In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled.Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people.There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community.

    View details for DOI 10.2196/45952

    View details for Web of Science ID 001051210800001

    View details for PubMedID 37581925

    View details for PubMedCentralID PMC10466148

  • Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study BMC PUBLIC HEALTH Rusow, J. A., Hidalgo, M. A., Calvetti, S., Quint, M., Wu, S., Bray, B. C., Kipke, M. D. 2022; 22 (1): 2312

    Abstract

    While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research.A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit.Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom).This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

    View details for DOI 10.1186/s12889-022-14585-9

    View details for Web of Science ID 000897499200005

    View details for PubMedID 36496355

    View details for PubMedCentralID PMC9737736

  • Lessons from Ciencia Viva: how teaching human genetics to XXIst century students must go beyond the classroom EUROPEAN JOURNAL OF HUMAN GENETICS Quint, M., Amaral, O. 2020; 28 (5): 533-534

    View details for DOI 10.1038/s41431-019-0541-z

    View details for Web of Science ID 000527343000001

    View details for PubMedID 31740734

    View details for PubMedCentralID PMC7171134