Publications by authors named "Larry Nuttbrock"

17 Publications

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Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study.

AIDS Behav 2017 Dec;21(12):3328-3335

National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA.

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.
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http://dx.doi.org/10.1007/s10461-016-1509-4DOI Listing
December 2017

Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study.

AIDS Behav 2017 Dec;21(12):3328-3335

National Development and Research Institutes (NDRI), 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA.

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.
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http://dx.doi.org/10.1007/s10461-016-1509-4DOI Listing
December 2017

Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study.

Am J Public Health 2014 Nov 11;104(11):2199-206. Epub 2014 Sep 11.

At the time of this research, Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute/Columbia University, New York, NY. Larry Nuttbrock, Andrew Rosenblum, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Sel Hwahng is with Columbia University.

Objectives: We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women.

Methods: We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links.

Results: Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse.

Conclusions: Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population.
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http://dx.doi.org/10.2105/AJPH.2014.302106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202966PMC
November 2014

Gender abuse and major depression among transgender women: a prospective study of vulnerability and resilience.

Am J Public Health 2014 Nov 12;104(11):2191-8. Epub 2013 Dec 12.

At the time of this research, Larry Nuttbrock, Andrew Rosenblum, Sel Hwahng, Mona Mason, Monica Macri, and Jeffrey Becker were with the National Development and Research Institutes, New York, NY. Walter Bockting was with the Division of Gender, Sexuality and Health, New York State Psychiatric Institute, Columbia University, New York, NY.

Objectives: We examined the social and interpersonal context of gender abuse and its effects on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depression among transgender women.

Methods: We conducted a 3-year prospective study (2004-2007) among 230 transgender women aged 19 to 59 years from the New York City Metropolitan Area. Statistical techniques included generalized estimating equations (logistic regression).

Results: We observed significant associations of psychological and physical gender abuse with major depression during follow-up. New or persistent experiences of both types of abuse were associated with 4- to 7-fold increases in the likelihood of incident major depression. Employment, transgender presentation, sex work, and hormone therapy correlated across time with psychological abuse; the latter 2 variables correlated with physical abuse. The association of psychological abuse with depression was stronger among younger than among older transgender women.

Conclusions: Psychological and physical gender abuse is endemic in this population and may result from occupational success and attempts to affirm gender identity. Both types of abuse have serious mental health consequences in the form of major depression. Older transgender women have apparently developed some degree of resilience to psychological gender abuse.
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http://dx.doi.org/10.2105/AJPH.2013.301545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202964PMC
November 2014

Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City.

J Homosex 2014 ;61(5):691-713

a Columbia University/Beth Israel Medical Center , New York , New York , USA.

Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.
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http://dx.doi.org/10.1080/00918369.2014.870439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711521PMC
December 2014

Culturally competent substance abuse treatment with transgender persons.

J Addict Dis 2012 ;31(3):236-41

National Development and Research Institutes, New York, New York, USA.

Transgender individuals are misunderstood and inadequately treated in many conventional substance abuse treatment programs. This article reviews current concepts regarding the definition and diversity of transgenderism and summarizes the existing literature on the prevalence and correlates of substance use in transgendered populations. Examples of culturally competent and gender-sensitive treatment in specialized settings are cited, with a call to extend these initiatives throughout the gamut of service venues that engage transgender individuals. Cultural competence combined with gender sensitivity should improve the effectiveness of substance abuse treatment for transgender individuals and will contribute to the goal of providing effective services in an increasingly diverse society.
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http://dx.doi.org/10.1080/10550887.2012.694600DOI Listing
December 2012

Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study.

Am J Public Health 2013 Feb 14;103(2):300-7. Epub 2012 Jun 14.

National Development and Research Institutes, New York, NY, USA.

Objectives: We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs).

Methods: We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the New York Metropolitan Area. Statistical techniques included Cox proportional hazards analysis with time varying covariates.

Results: Among younger MTFs (aged 19-30 years), gender abuse predicted depressive symptoms (Center for Epidemiologic Studies Depression score ≥ 20), and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior (unprotected receptive anal intercourse) and incident HIV/STI. These associations were independent of socioeconomic status, ethnicity, sexual orientation, hormone therapy, and sexual reassignment surgery.

Conclusions: Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs. Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior. Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse.
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http://dx.doi.org/10.2105/AJPH.2011.300568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558792PMC
February 2013

A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria.

Arch Sex Behav 2011 Apr 29;40(2):247-57. Epub 2009 Dec 29.

National Development and Research Institutes, 71 West 23rd Street, New York, NY 10010, USA.

In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.
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http://dx.doi.org/10.1007/s10508-009-9579-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894986PMC
April 2011

A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria.

Arch Sex Behav 2011 Apr 29;40(2):247-57. Epub 2009 Dec 29.

National Development and Research Institutes, 71 West 23rd Street, New York, NY 10010, USA.

In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.
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http://dx.doi.org/10.1007/s10508-009-9579-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894986PMC
April 2011

Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons.

J Acquir Immune Defic Syndr 2009 Nov;52(3):417-21

National Development and Research Institutes, New York, NY 10010, USA.

Objectives: To describe and evaluate risk factors for HIV/sexually transmitted infections (STIs) among male-to-female (MTF) transgender persons.

Methods: Using the life chart interview, potential lifetime risk factors for HIV/STIs among MTFs were measured and evaluated in conjunction with lifetime exposures for HIV, syphilis, hepatitis B, and hepatitis C. The participants were 517 MTFs between the ages of 19 and 59 years from the New York metropolitan area.

Results: HIV/STIs were low among white Americans and very high among Hispanics and African Americans. In the latter groups, HIV and hepatitis B were associated with an androphilic sexual orientation, lifetime number of commercial sex partners (sex work), and the social expression of transgender identity; syphilis was associated with lifetime number of casual sex partners; and hepatitis C was associated with injection drug use, unemployment, and social expression of transgender identity. In multivariate models, the social expression of transgender identity was the strongest and most consistent predictor of HIV/STIs. Consistent with their lower levels of infections, white Americans reported significantly lower levels of the risk factors found to be predictive of HIV/STI among Hispanics and African Americans.

Conclusions: HIV/STI prevention in this population should be targeted at Hispanic and African Americans. Prevention programs should incorporate multiple components designed to address the diverse issues confronting ethnic minority transgender persons, with an emphasis on the social expression of transgender identity.
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http://dx.doi.org/10.1097/QAI.0b013e3181ab6ed8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784264PMC
November 2009

Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City.

Sex Res Social Policy 2007 Dec;4(4):36-59

This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.
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http://dx.doi.org/10.1525/srsp.2007.4.4.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597809PMC
December 2007

Psychometric utility of the childhood trauma questionnaire with female street-based sex workers.

J Trauma Dissociation 2004 ;5(3):33-41

Cherie L. Villano, Charles Cleland, Andrew Rosenblum, Chunki Fong, Larry Nuttbrock, and Marie Marthol are affiliated with the National Development and Research Institutes, Inc. (NDRI, Inc.), New York, NY. Joyce Wallace was Executive Director of the Foundation for Research on Sexually Transmitted Diseases (FROST’D), New York, NY.

The present study examines the psychometric properties of a verbal, face-to-face administration of the Childhood Trauma Questionnaire (CTQ) with female street-based sex workers (N = 171). Confirmatory Factor Analysis (CFA) indicated a poor fit between our data and the instrument's established 5-factor structure. Exploratory Factor Analysis (EFA) yielded four stable and usable factors corresponding to the Emotional Abuse, Emotional Neglect, Physical Abuse, and Sexual Abuse subscales of the CTQ; the Physical Neglect subscale did not emerge as a stable factor. Cross loading of many CTQ items onto more than one factor most likely produced the poor CFA fit, and indicated that abuse/neglect constructs were not conceptually distinct for our sample. Mean trauma scores did not differ significantly from published scores for female substance abusers. According to the CTQ Minimization/Denial scale, 42% of participants minimized their childhood maltreatment experiences. A combination of qualitative and quantitative methods may be optimal for the acquisition of sensitive trauma information with wary and vulnerable street populations.
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http://dx.doi.org/10.1300/j229v05n03_03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560176PMC
October 2012

Linking female sex workers with substance abuse treatment.

J Subst Abuse Treat 2004 Oct;27(3):233-9

National Development and Research Institutes, New York, NY, USA.

We evaluated mobile street-based outreach as a modality for linking street-walking female sex workers with substance abuse treatment in New York City. Sex workers (N = 179) approaching an existing outreach facility were randomly assigned to receive usually provided services, or to receive an enhanced version of these services. Among the 144 women successfully followed for 6 months, 35.0% were detoxified; 43.1% of the 78 current heroin users received methadone maintenance; and 35.4% of the followed-up clients received some other type of treatment. Intervention group differences in these outcomes were not significant. Detoxification during followup was associated with heroin dependence and lifetime detoxification. Methadone maintenance (among heroin users) was associated with Hispanic ethnicity and legally mandated treatment. Other types of treatments were negatively associated with the degree of involvement in the sex trade. We conclude that a variety of factors affect motivation for substance abuse treatment among female sex workers, and that street-based outreach is a highly effective modality for linking this population with much needed treatment.
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http://dx.doi.org/10.1016/j.jsat.2004.08.001DOI Listing
October 2004

Broadening perspectives on mobile medical outreach to homeless people.

J Health Care Poor Underserved 2003 Feb;14(1):5-16

Using data collected by Project Renewal's mobile medical services to homeless people in New York City, this paper discusses a tension between an emergency medicine model of outreach and that of primary care. In the former model, clinicians evaluate clients on the basis of presenting complaints and refer them, as necessary, for specialized treatment. The latter is a broader model of comprehensive outreach and/or treatment, where clinicians screen clients and assess them for various conditions offering ongoing evaluation and treatment on site. The model of outreach is applicable for some homeless clients, but the prevalence and overlap of physical complaints, infectious diseases, substance abuse, and psychiatric symptoms among homeless people in New York City has resulted in an evolution toward broader approaches to outreach in this population. Improvements in diagnostic testing and increasingly portable medical technology may make the mobile delivery of medical care to homeless persons increasingly feasible.
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February 2003

Medical outreach to homeless substance users in New York City: preliminary results.

Subst Use Misuse 2002 Jun-Aug;37(8-10):1269-73

National Development and Research Institutes, Inc., NY, NY 10010, USA.

An innovative, experimental, medical out-reach initiative, using a fully-equipped mobile medical van with a staff of 2 part-time physicians, a physician assistant, a social worker, and a driver/medical aid serving the needs of 1048, mostly male, minority group, high-level, homeless New York City substance users with infectious diseases is described. The study sample (N = 250) was divided into experimental S's who received Intensive case management and a control group who could choose to refer themselves to the SW. Biological tests revealed high rates of cocaine use and infectious diseases. Preliminary 4-month outcomes (N = 128) showed reductions in drug use, homelessness and health complaints in both groups; experimental subjects compared with controls received more Public Assistance and had fewer emergency room visits.
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http://dx.doi.org/10.1081/ja-120004184DOI Listing
February 2003

Psychotic ideation and receipt of government entitlements among homeless persons in New York City.

Psychiatr Serv 2002 Jun;53(6):719-23

National Development and Research Institutes, New York, NY 10048, USA.

Objective: This study compared changes in receipt of government entitlements by homeless persons with and without psychotic ideation in New York City between January 1997 and July 1998, a period characterized by changing state government policies and greater bureaucratic monitoring of eligibility.

Methods: In conjunction with an experimental study of the efficacy of social work services provided to homeless persons in Manhattan by a mobile medical van, 25 persons who were assessed as having experienced psychotic ideation in the previous year and 134 nonpsychotic persons were followed up after four months to identify changes in their receipt of Medicaid benefits, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), food stamps, and home relief (state welfare for single persons). The social work intervention was designed to help eligible clients gain access to entitlements and substance abuse treatment.

Results: The proportion of clients with psychotic ideation who received Medicaid, food stamps, or home relief decreased during the study period, while the proportion of nonpsychotic clients who received these entitlements increased. Little change was observed in receipt of SSI or SSDI by either group.

Conclusions: Psychotic ideation among homeless persons may be a significant factor in access to and maintenance of government entitlements. In the context of an increasingly restrictive and bureaucratic welfare system, providing assistance to homeless persons who have severe psychopathology presents new challenges to service providers.
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http://dx.doi.org/10.1176/appi.ps.53.6.719DOI Listing
June 2002