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Minority Stress, Risky Behaviors, and Sexual Scripting Among MINORITY STRESS, RISKY BEHAVIORS, AND SEXUAL SCRIPTING AMONG TRANSGENDER COLLEGE STUDENTS: A MIXED METHODS STUDY by Melissa Decker July, 2019 Director of Dissertation: Dr. Heather L. Littleton Major Department: Psychology Despite more transgender and gender nonconforming students entering college, little is known about their minority stress and resilience experiences or about how minority stress and resilience factors influence their sexual scripts. Using the gender minority stress and resilience model (GMSR; Testa et al., 2015) and sexual script theory (Simon & Gagnon, 1986), the present study examined the influence of minority stress and resilience on the wellbeing and sexual scripts of an undergraduate transgender and gender nonconforming sample. GMSR theory posits that both distal (gender-based victimization, rejection, and discrimination, and identity nonaffirmation) and proximal (internalized transphobia and identity concealment) minority stress adversely affect the mental and physical health of gender minority individuals, while resilience (pride and community connectedness) factors buffer against this stress. Sexual script theory suggests that cultural norms inform sexual behaviors, attitudes, and expectations, which individuals adapt to fit their own interpersonal experiences (Simon & Gagnon, 1986). Recruitment took place primarily via paid advertisements on social media. The effects of gender minority stress and resilience on psychological outcomes (depression, anxiety, and posttraumatic stress disorder) and health risk behaviors (alcohol and other substance abuse and risky sex) of 265 transgender and gender nonconforming undergraduates were examined. Additionally, sexual scripts provided by a subsample of 169 participants were analyzed. Results supported that minority stress predicted anxiety and depression. Distal stress predicted posttraumatic stress disorder, and proximal stress predicted hazardous alcohol use and sex with uncommitted partners. Minority stress failed to predict probable drug abuse and impulsive sex, altogether. Though resilience factors offered little buffer, when pride was low internalized transphobia had a stronger relationship with depressive symptoms. Sexual script themes resembled the types of sexual relationships found within the cisgender, heterosexual undergraduate population: ongoing romantic, negotiated one-time casual encounter, unplanned one-time casual encounter, and repeated casual encounter. Themes also diverged from those of cisgender peers in terms of gender roles within the sexual context and in a focus on gender- related stigma (e.g., concealment, expected rejection, etc.) and resilience factors, including sexual communication and negotiation, as well as acceptance within a nontraditional sex community or romantic partnership. Clinicians working with this population should strongly consider the role minority stress plays in depression and anxiety. Further, as a number of participants met sexual partners through online advertising, sex education programming should address online safety and STI prevention. More generally, gender minority inclusive policies and transgender specific spaces on campus could help reduce stigma. Future research should continue exploring what minority stress and resilience factors most strongly affect the health and wellbeing of transgender and gender nonconforming undergraduates. Further, researchers may want to investigate how minority stress and resilience factors differentially affect transgender subgroups. Finally, work examining the impact of minority stress and resilience on adjustment and health risk behaviors over time among transgender and gender nonconforming undergraduates is imperative. MINORITY STRESS, RISKY BEHAVIORS, AND SEXUAL SCRIPTING AMONG TRANSGENDER COLLEGE STUDENTS: A MIXED METHODS STUDY A Dissertation Presented to The Faculty of the Department of Psychology East Carolina University In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in Health Psychology by Melissa Decker July, 2019 © Melissa Decker, 2019 MINORITY STRESS, RISKY BEHAVIORS, AND SEXUAL SCRIPTING AMONG TRANSGENDER COLLEGE STUDENTS: A MIXED METHODS STUDY by Melissa Decker APPROVED BY: DIRECTOR OF DISSERTATION: _________________________________________________________ (Heather L. Littleton, Ph.D.) COMMITTEE MEMBER: _________________________________________________________ (Lisa Campbell, Ph.D.) COMMITTEE MEMBER: _________________________________________________________ (Rob Carels, Ph.D.) COMMITTEE MEMBER: _________________________________________________________ (Tony Cellucci, Ph.D., ABPP) COMMITTEE MEMBER: ________________________________________________________ (Brandon Kyle, Ph.D.) CHAIR OF THE DEPARTMENT OF PSYCHOLOGY: _________________________________________________________ (Erik Everhart, Ph.D.) DEAN OF THE GRADUATE SCHOOL: _________________________________________________________ (Paul J. Gemperline, Ph.D.) ACKNOWLEDGEMENTS This project would not have been possible without the support of many others. I would first like to acknowledge all the transgender and gender nonconforming undergraduates who had the courage to disclose their experiences and insights on my survey. Furthermore, I would like to thank all those on social media who willingly shared posts about the project. Facebook deserves recognition for the advertising they gifted me, and I am extremely grateful for the incentives for participation my dissertation chair Dr. Heather Littleton donated. Both Emily Downs and Hannah Tulburt proved pivotal in the qualitative analysis of the script data, and I am particularly thankful for their hours of coding assistance. Moreover, I am grateful to Chelsey Solar and Dr. Christine Jehu at the ECU Counseling Center for making arrangements for me to share my findings with the Transgender Support Group. I cannot thank enough the faculty who have served on my committee, including Drs. Campbell, Carels, Cellucci, Ford, Kyle, and McCammon. Each has shown excitement for the project and provided ongoing input that has undeniably strengthened my skills as a researcher and improved upon this study. These individuals have invested heavily in both my professional and personal growth. Above all, Dr. Littleton deserves my gratitude, as she has not only guided me through the dissertation process, but also has served as my mentor for the past five years. At this point, no one knows my work or motivational style more intimately than her. On a final note, I would like to thank my previous mentors, “Dissertation Thursday” group, friends, and family for their continual encouragement and support. My path certainly has not been a direct one, and I am grateful to every one of them for having helped me find my way. Lastly and most importantly, I want to thank my wife Grace, who has chosen to see this journey through with me and enriched my life in ways that words will always fail to capture. TABLE OF CONTENTS ACKNOWLEDGMENTS…………………………………………………………………. iv LIST OF TABLES………………………………………………………………………… viii CHAPTER I: LITERATURE REVIEW…………………………………………………… 1 The Growth of Gender Nonconformity among Emerging Adults…………………. 1 Gender Dysphoria in Childhood and Adolescence………………………………… 3 Gender Nonconforming Individuals’ Adjustment to College……………………… 8 Transgender Individuals’ Adjustment and Mental Health………………………..... 11 Mental Health and Substance Abuse among Transgender College Students……… 13 Minority Stress Theory…………………………………………………………….. 14 Unified Sexual Stigma Conceptual Framework…………………………………… 15 The Role of Violence and Discrimination…………………………………………. 17 Individual experiences of violence………………………………………… 18 Structural stigma issues…………………………………………………….. 21 Protective Factors…………………………………………………………………... 25 Gender Minority Stress and Resilience Model……………………………………. 26 The Larger Picture of Compromised Sexual Health……………………………….. 30 Sexual Script Theory……………………………………………………………….. 33 Summary and Limitations in the Literature………………………………………... 38 Purpose of the Current Study………………………………………………………. 39 CHAPTER II: METHODS………………………………………………………………… 41 Participants…………………………………………………………………………. 41 Procedures………………………………………………………………………….. 42 Measures…………………………………………………………………………… 43 Demographics……………………………………………………………… 43 Outness……………………………………………………………………... 43 Minority stress……………………………………………………………... 44 Substance use………………………………………………………………. 46 Risky sex…………………………………………………………………… 47 Psychological distress……………………………………………………… 48 Sexual scripts………………………………………………………………. 49 Specific Aims and Hypotheses…………………………………………………….. 50 Missing Data……………………………………………………………………….. 54 CHAPTER III: RESULTS…………………………………………………………………. 56 Demographics……………………………………………………………………… 56 Outness and Gender Affirming Actions Taken …………………………………… 58 Descriptives of Study Variables……………………………………………………. 59 Aim 1: Applicability of Gender Minority Stress and Resilience Model…………... 63 Aims 2 and 3: Sexual Scripts………………………………………………………. 80 Nature of sexual relationships……………………………………………… 84 Gender stigma, trauma, and dysphoria…………………………………….. 87 Open communication, gender identity disclosure, and participation in a nontraditional sex community……………………………………………… 92 CHAPTER IV: DISCUSSION…………………………………………………………….. 97 Sample Characteristics Compared to Previous Studies……………………………. 98 The Impact of Gender Minority Stress on Psychological Health and Health Risk Behaviors…………………………………………………………………………... 101 The Impact of Resilience on the Effects of Minority Stress………………………… 104 The Influence of Minority Stress
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