e13728 Background: Transgender and gender-diverse populations experience disproportionate exposure to healthcare-related violence, which may adversely affect mental health and engagement in cancer prevention behaviors. However, quantitative data integrating healthcare violence, mental health, and cancer-related risk behaviors remain scarce, particularly in middle-income countries. Methods: We conducted a cross-sectional analytic study among transgender, travesti, and non-binary adults in Brazil using an online self-administered questionnaire. Primary exposures included healthcare-related violence, consistent use of social name, and regular access to healthcare. Mental health was evaluated as a key intermediate construct in the conceptual model, and cancer-related risk behaviors included tobacco use, alcohol consumption, illicit drug use, and risky sexual behavior. Associations were estimated using Poisson regression with robust variance, adjusted for sociodemographic characteristics and healthcare access. Results: A total of 170 participants were included. Nearly half of the sample reported a mental health condition (46.6%), with prevalence exceeding 50% in some gender identities. Frequent healthcare violence was independently associated with mental health problems (adjusted prevalence ratio aPR 1.68; 95% CI, 1.05–2.68). Mental health conditions were strongly associated with illicit drug use (aPR 2.15; 95% CI, 1.25–3.70). Tobacco use and risky sexual behavior—both highly relevant for cancer risk—demonstrated marginal associations with mental health after multivariable adjustment, suggesting a potential link attenuated by socioeconomic and access-related factors. Conclusions: Violence in healthcare services emerges as a structural determinant associated with mental health among transgender and gender-diverse individuals, with findings consistent with a pathway connecting psychological distress to behaviors related to cancer risk. Although some adjusted associations with smoking and risky sexual exposures were marginal, the high prevalence of these outcomes suggests relevant implications for equity in cancer prevention. Interventions to reduce institutional violence, expand affirmative practices (including respect for chosen names), and strengthen mental health support may represent low-cost, high-impact strategies for prevention and screening in transgender populations.
Pandolfi et al. (Thu,) studied this question.
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