Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender‐Nonconforming People

Abstract

Policy Points:r Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not protect against discrimination based on gender identity in public accommodations settings such as transportation, retail stores, restaurants, health care facilities, and bathrooms.r A 2013 survey of Massachusetts transgender and other gender minority adults found that in the past 12 months, 65% had experienced public accommodations discrimination since the law was passed. This discrimination was associated with a greater risk of adverse emotional and physical symptoms in the past 30 days.r Nondiscrimination laws inclusive of gender identity should protect against discrimination in public accommodations settings to support transgender people's health and their ability to access health care.Context: Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, The Milbank Quarterly, Vol. 93, No. 3, 2015 (pp. 484-515) Protecting Transgender People in Public Accommodations 485Massachusetts law has provided protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not, however, protect against discrimination in public accommodations (eg, hospitals, health centers, transportation, nursing homes, supermarkets, retail establishments). For this article, we examined the frequency and health correlates of public accommodations discrimination among gender minority adults in Massachusetts, with attention to discrimination in health care settings. Methods:In 2013, we recruited a community-based sample (n = 452) both online and in person. The respondents completed a 1-time, electronic survey assessing demographics, health, health care utilization, and discrimination in public accommodations venues in the past 12 months. Using adjusted multivariable logistic regression models, we examined whether experiencing public accommodations discrimination in health care was independently associated with adverse self-reported health, adjusting for discrimination in other public accommodations settings.Findings: Overall, 65% of respondents reported public accommodations discrimination in the past 12 months. The 5 most prevalent discrimination settings were transportation (36%), retail (28%), restaurants (26%), public gatherings (25%), and health care (24%). Public accommodations discrimination in the past 12 months in health care settings was independently associated with a 31% to 81% increased risk of adverse emotional and physical symptoms and a 2-fold to 3-fold increased risk of postponement of needed care when sick or injured and of preventive or routine health care, adjusting for discrimination in other public accommodations settings (which also conferred an additional 20% to 77% risk per discrimination setting endorsed).Conclusions: Discrimination in publ...

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

“…Consistent with prior research demonstrating a significant association between prior mistreatment and avoidance of emergency and preventive care among transgender adults in Massachusetts, 3 the current national study found that avoidance of healthcare due to the fear of mistreatment was associated with healthcare refusal, suggesting that fear of mistreatment could stem from prior experiences of mistreatment. Given previous research showing that stigmatized individuals (e.g., those who have been refused care) nervously anticipate, routinely observe, and anxiously react to rejection 6 (e.g., avoid healthcare), intervention strategies are needed to address cognitive, affective, and behavioral responses to stigma among transgender people.…”

“…2 A 2013 survey of 452 transgender people in Massachusetts found that 24% of participants had experienced verbal or physical mistreatment in a healthcare setting in the past 12 months. 3 Among this sample, mistreatment was significantly associated with avoidance of necessary medical care when sick or injured, as well as routine preventive care. The relationship between mistreatment and healthcare avoidance among transgender people has been confirmed by previous studies 4,5 and literature supports a rejection sensitivity model in which stigmatized individuals nervously anticipate (hypervigilance), routinely observe (perceived stigma), and ultimately, anxiously react to rejection (e.g., healthcare avoidance).…”

“…6 While healthcare avoidance may be initially protective against the psychological distress associated with stigmatizing healthcare encounters, avoiding healthcare can have serious adverse health consequences, including delaying care to the point that one experiences a medical emergency. 3 Affordability of care and access to insurance coverage can further limit access to healthcare for transgender people. Many transgender individuals lack health insurance, which may be due, in part, to higher prevalence of unemployment and poverty in this population relative to the general population-a likely product of employment discrimination.…”

The role of gender affirmation in psychological well-being among transgender women.

“…However, even with added legal protections, transgender individuals still experience discrimination in various settings (e.g. retail, restaurants, transportation) including health care (Reisner et al, 2015) thus perpetuating barriers to receiving affirmative supports.…”

The Role of Gender Affirmation in Psychological Well-Being Among Transgender Women

“…This confluence and intersection of oppressions, i.e., transmisogyny, potentially exacerbates mental health risk for transgender women. Indeed, surveys of diverse community samples of transgender women have documented associations between discrimination, depressive symptoms, selfesteem, and suicidal ideation (Bauer, Scheim, Pyne, Travers, & Hammond, 2015;Bockting et al, 2013;Gamarel, Reisner, Laurenceau, Nemoto, & Operario, 2014;Nemoto, Bödeker, & Iwamoto, 2011;Reisner et al, 2015). Some research has suggested that experiences of discrimination among transgender women may lead to greater HIV-risk behaviors (e.g.…”