Heterogeneity in Protective Factors as a Buffer for Unique Risk Factors and Daily Smoking Among Transgender Adults

Introduction: Transgender individuals often face significant interpersonal and systemic gender-identity-related stressors, which can confer risk of poor health behaviors, including cigarette use. Despite these adversities, social factors (e.g., family acceptance and work support) and gender-identity milestones (e.g., affirming medical care) can buffer against stressors. Because transgender individuals live under different circumstances from one another, protective factors vary among individuals. We aimed to derive distinct classes of protective factors and explore whether the associations between gender-identity-based stressors and combustible cigarette use varied across these classes. Methods: We analyzed data from the National Transgender Discrimination Survey (N = 6456; 76.0% white; 46.5% feminine/trans-feminine). Results: Using latent class analysis, we identified five classes of gender-identity-related protective factors. Class membership moderated associations between stressors and smoking. Interpersonal gender-identity-based stressors were associated with greater odds of daily smoking relative to never smoked status for all classes, except for a class characterized by not living congruently with gender identity but having family support and correct IDs. State inequality was associated with higher odds of daily cigarette smoking relative to never smoked for the class living congruently with their gender identity who had not undergone surgery. Conclusions: These findings highlight the complexity of protective factor constellations and their differential protective impact on smoking risk. Prevention efforts should recognize that social factors and gender-identity milestones are unevenly distributed and cultivate factors that are congruent with an individual’s gender identity.