BackgroundSocial media can be a useful strategy for recruiting hard-to-reach, stigmatized populations into research studies; however, it may also introduce risks for participant and research team exposure to negative comments. Currently, there is no published formal social media recruitment and monitoring guidelines that specifically address harm reduction for social media recruitment of marginalized populations.ObjectiveThe purpose of this research study was to investigate the utility, successes, challenges, and positive and negative consequences of using targeted Facebook advertisements as a strategy to recruit transgender and gender nonconforming (TGNC) people into a research study.MethodsTGNC adults living in the Southeast Unites States were recruited via targeted Facebook advertisements over two cycles in April and June 2017. During cycle 1, researchers only used inclusion terms to recruit the target population. During cycle 2, the social media recruitment and monitoring protocol and inclusion and exclusion terms were used.ResultsThe cycle 1 advertisement reached 8518 people and had 188 reactions, comments, and shares but produced cyberbullying, including discriminatory comments from Facebook members. Cycle 2 reached fewer people (6976) and received 166 reactions, comments, and shares but produced mostly positive comments.ConclusionsResearchers must consider potential harms of using targeted Facebook advertisements to recruit hard-to-reach and stigmatized populations. To minimize harm to participants and research staff, researchers must preemptively implement detailed social media recruitment and monitoring guidelines for monitoring and responding to negative feedback on targeted Facebook advertisements.

Purpose: Transgender and gender nonconforming (TGNC) people experience high rates of poverty, joblessness, and homelessness, which drive risk for food insecurity. TGNC people also face discrimination due to transphobia and cissexism, which may contribute to these drivers. Minimal empirical evidence describes experiences with food insecurity among TGNC people. This project investigated food insecurity among TGNC people and how these experiences relate to their physical and mental health. Methods: Semistructured telephone interviews were conducted with 20 TGNC people residing in the Southeast United States (U.S.), recruited through social media. Interviews were transcribed and qualitatively coded. Results: TGNC people reported living in extreme poverty. They described how the conservative sociopolitical climate of the Southeast United States made it difficult to find and maintain employment, which was a primary driver of food insecurity. Participants experienced discomfort seeking food assistance due to discrimination and concern for reducing emergency food availability for people in greater need. Stress from unemployment and underemployment, inadequate food supplies, and discrimination was reported as a contributor to poor physical and mental health, and weakened support systems. Conclusion: Poverty and food insecurity erode TGNC people's physical and mental health and support systems. TGNC people faced substantial barriers—including unemployment and underemployment and multilevel discrimination—which prevented them from affording adequate food. Public health solutions include implementing employment nondiscrimination policy to protect TGNC people in the workplace and building relationships between local food pantries and LGBT organizations to create safer environments for all persons in need of food assistance.

Background Nearly 40 million American adults report past year food insecurity. This is concerning, as food insecurity is associated with chronic disease morbidity and premature mortality. Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior; SMW) may be at greater risk for experiencing food insecurity disparities. The purpose of this study was to investigate patterns and prevalence of food insecurity and food assistance use in sexual minority and exclusively heterosexual women using population-level health surveillance data. Methods Using pooled 2004–2014 National Health and Nutrition Examination Survey data ( N = 7379), we estimated weighted point prevalence of past 12-month food insecurity, severe food insecurity, Supplemental Nutrition Assistance Program (SNAP) use, and emergency food assistance use. We then used Poisson regression with robust variance to estimate prevalence ratios comparing SMW to exclusively heterosexual women on all outcomes. Women were classified by sexual identity and lifetime same-sex behavior as lesbian ( n = 88), bisexual ( n = 251), heterosexual and reporting same-sex behavior (heterosexual WSW; n = 366), or exclusively heterosexual women (referent; n = 6674). Results Between 20.6–27.3% of lesbian, bisexual, and heterosexual WSW reported past 12-month food insecurity (versus 13.1% of exclusively heterosexual women). All SMW reported greater prevalence of past 12-month food insecurity and severe food insecurity than exclusively heterosexual women: prevalence ratios (PR) ranged from 1.34 (95% confidence interval [CI], 1.05–1.70) to 1.84 (95% CI, 1.13–3.01). No differences were found in SNAP participation by sexual orientation, but more lesbians and heterosexual WSW reported using emergency food assistance in the past 12-months (PR = 1.89; 95% CI, 1.29–2.79 and PR = 1.43; 95% CI, 1.03–2.00 respectively). Conclusions All SMW reported higher prevalence of food insecurity than exclusively heterosexual women. Lesbians and heterosexual WSW were also more likely to rely on emergency food assistance. This is problematic as SNAP use may reduce food insecurity over time, but emergency food resources (e.g., food pantries) do not. More evidence is needed to understand the multilevel factors driving food insecurity in this population to develop policy and community-based efforts to increase SNAP participation and decrease food insecurity.

Background: Transgender and gender non-conforming (TGNC) people face high rates of poverty, joblessness, and homelessness, rendering this population vulnerable to experiencing food insecurity. Yet, there is almost no empirical evidence concerning food insecurity and the use of local and federal food assistance resources in the TGNC community. Food insecurity, the use of local and Federal food assistance resources, and associations with gender-related minority stressors and resilience using the Gender Minority Stress and Resilience (GMSR) scale among TGNC individuals living in the Southeast United States (U.S.) were documented in this study. Methods: A cross-sectional online survey was conducted with TGNC people living in the Southeast U.S. Participants were recruited via targeted Facebook advertisements. Results: In total, 105 TGNC people completed the survey; 79% of survey participants experienced food insecurity, 19% utilized Federal, and 22% utilized local food assistance resources. High levels of minority stress and community resilience were reported. The GMSR resilience scale Pride (aOR = 1.09, 95% CI 1.00-1.19, p = .04) was significantly associated with the use of local food pantries, but minority stressors were not. No significant associations were found between GMSR and food security. Conclusion: TGNC people living in the Southeast U.S. experienced food insecurity, unstable housing, low wages, and social stigma that were a barrier to using emergency food resources. Multi-level public health solutions that address discriminatory legislative policies and create linkages between TGNC people and local and federal food assistance are required to address issues of food insecurity in the TGNC population.

Food insecurity affects 1 in 8 American adults annually, and is more prevalent in Black and sexual minority women. We applied an intersectional approach to investigate food insecurity prevalence in women with intersecting minority race and sexual orientation. We used two United States surveillance systems—National Health Interview Survey (NHIS) 2013–2018 and National Health and Nutrition Examination Survey (NHANES) 2005–2014, to estimate how race and sexual orientation jointly influence food insecurity prevalence in women aged 18–59 years (NHIS: N = 47596; NHANES: N = 5106). All analyses were stratified for Supplemental Nutrition Assistance Program (SNAP) use. Relative measures estimated weighted prevalence ratios (PR) comparing Black and White sexual minority women (SMW) to heterosexual White women. Absolute prevalence measures estimated the excess prevalence of food insecurity due to multiple marginalization. Patterns of food insecurity prevalence were similar across NHIS and NHANES, and differed only for non-SNAP users. Relative prevalence of food insecurity was greater in Black SMW than heterosexual White women in NHIS (PR: 2.16; 95% confidence interval [CI], 1.41–3.30) and NHANES (PR: 2.79; 95% CI, 1.73–4.51). The strength of the association between multiple marginalization and food insecurity was stronger for Black SMW than White SMW. Absolute measures were significant only for NHIS and did not support our a priori hypothesis: For non-SNAP users, being Black and sexual minority reduced the joint disparity in food insecurity by approximately 50% (Synergy Index: 0.52; 95% CI, 0.11–0.93). Overall, our study illuminated population-level differences in food insecurity among women of diverse minority races and sexual orientations. Black SMW experienced high rates of food insecurity, which may contribute to chronic disease disparities. Yet, intersecting minority social positions (race and sexual orientation) reduced food insecurity; these findings are unexpected and must be further investigated. Increasing SNAP use among multiply marginalized women may attenuate food insecurity disparities.