Cary Klemmer | University of Southern California (original) (raw)

Papers by Cary Klemmer

Journal of Traumatic Stress, 2020

Sexual victimization, including sexual harassment and assault, remains a persistent problem in th... more Sexual victimization, including sexual harassment and assault, remains a persistent problem in the U.S. military. Service members identifying as lesbian, gay, bisexual, or transgender (LGBT) may face enhanced risk, but existing research is limited. We examined experiences of sexual harassment, stalking, and sexual assault victimization during service in a sample of LGBT and non-LGBT active duty service members. Service members who identified as LGBT (n = 227 LGB, n = 56 transgender) or non-LGBT (n = 276) were recruited using respondent-driven sampling for an online survey. Logistic regression models examined the correlates of sexual and stalking victimization. Victimization was common among LGBT service members, including sexual harassment (80.7% LGB, 83.9% transgender), stalking (38.6% LGB, 30.4% transgender), and sexual assault (25.7% LGB, 30.4% transgender). In multivariable models, LGB identity remained a significant predictor of sexual harassment, OR = 4.14, 95% CI [2.21, 7.78]; stalking, OR = 1.98, 95% CI [1.27, 3.11]; and assault, OR = 2.07, 95% CI [1.25, 3.41]. A significant interaction between LGB identity and sex at birth, OR = 0.34, 95% CI [0.13, 0.88], suggests an elevated sexual harassment risk among male, but not female, LGB service members. Transgender identity predicted sexual harassment and assault at the bivariate level only. These findings suggest that LGBT service members remain at an elevated risk of sexual and/or stalking victimization. As the military works toward more integration and acceptance of LGBT service members, insight into victimization experiences can inform tailored research and intervention approaches aimed at prevention and care for victims. As the U.S. military continues to face a high burden of sexual victimization, including sexual harassment and sexual assault, among service members, prevention and intervention efforts have stressed the importance of identifying high-risk priority subpopulations (Department of Defense [DoD], 2019). One such population is military personnel who identify as lesbian, gay, bisexual, or transgender (LGBT). The legacy of prior military policy that restricted service for lesbian, gay, and bisexual

Affilia, 2019

There is emerging global agreement that environmental change is one of the greatest threats to ec... more There is emerging global agreement that environmental change is one of the greatest threats to ecosystems, culture, health, and economies of humankind. In response to these environmental changes and the expected human vulnerability they will continue to produce, the American Academy of Social Work and Social Welfare has highlighted intervention to address the human impacts of the changing climate as one of the profession's grand challenges. This article troubles the often anthropocentric worldview from which such responses emerge and proposes a framework informed by the wisdom of deep ecology and ecofeminism. Born from critical methodologies that question the rigid bifurcation and valuation of male/female and human/nonhuman, these perspectives invite social workers to think in novel ways about environmental challenges. We argue that the social work profession, which has historically sought to disturb power dynamics and reprioritize society's needs, is uniquely situated to think holistically about responding to this crisis. By honoring the interrelated nature of human and nonhumankind, social workers can more mindfully lead the social planning and advocacy efforts necessary to meet this grand challenge.

International Journal of Sexual Health, 2019

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (tran... more Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n ¼ 15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.

JAMA Network Open, 2019

Transgender and gender-diverse individuals are those whose gender identity (ie, the deep-seated i... more Transgender and gender-diverse individuals are those whose gender identity (ie, the deep-seated internal sense of gender as a man, woman, or otherwise) differs from that which is socially expected of them given the sex assigned to them at birth. To my knowledge, the scant research literature in the behavioral health sciences on transgender and gender-diverse communities is almost exclusively on populations in the United States and Europe, with a few studies coming from other countries that also have large populations of people with European ancestry (eg, New Zealand). I commend Peng et al 1 for conducting their ground-breaking research in the People's Republic of China (hereafter China). They found that nearly all of the respondents (92.8%) reported at least 1 type of family-based harassment (eg, verbal and physical abuse, economic control), and more than three-quarters (76.5%) reported at least 1 experience of school-based harassment (eg, verbal or cyber bullying, social isolation). Almost half of the study participants (43.8%) were at risk for major depressive disorder, and more than one-third (37.4%) were at risk for an anxiety disorder. Nearly half of the study participants (47.8%) reported experiencing suicidal ideation in their lifetime. 1 Transgender and gender-diverse adolescents in the sample reporting abuse, bullying, or neglect had increased odds of suicidal ideation in their lifetime. These data are concerning, although they are not surprising.

Youth & Society, 2019

Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth experience numerous disp... more Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth experience numerous disparities, including but not limited to access to health care, HIV risk, safety in school, educational opportunities, and family support. Historically, research on this community lumped together LGBQ experiences with experiences of transgender and nonbinary (trans/ NB) individuals, despite sexual orientation and gender identity being unique identities. Using representative statewide data from the 2015 Healthy Kids Colorado Survey (HKCS) (N = 15,970), this study examines sexual behaviors through a more nuanced and intersectional lens. We find that young LGBQ and trans/NB people in Colorado have differential experiences of sexual behavior compared with their heterosexual and cisgender counterparts. Being LGBQ and especially being trans/NB, having current depression, suicidal ideation, and experiencing electronic bullying are all associated with an increase in the likelihood of ever having sex and total number of partners,

Journal of Interpersonal Violence

Although literature documents the experiences of socially assigned gender nonconformity (SAGNC) b... more Although literature documents the experiences of socially assigned gender nonconformity (SAGNC) by minority sexual orientation (i.e., lesbian, gay, and bisexual [LGB]), examination of the role of gender expression on school violence outcomes in the presence of sexual orientation and gender identity is not well understood. This study describes SAGNC among a representative sample of adolescents, accounting for sexual orientation and gender identity (e.g., transgender). A secondary data analysis was conducted using Youth Risk Behavior Survey data from Los Angeles Unified School District high schools in 2013 (N = 1,496). The prevalence of school violence by self-reported SAGNC and gender identity was obtained. Associations between SAGNC and school violence were examined using multivariate logistic regression adjusted for mischievous response bias. Two hundred ninety-one (19.5%) adolescents reported SAGNC. Having missed school due to a safety concern and being bullied in the past year were more common among socially assigned gender nonconforming adolescents than those who conformed to gender expression expectations. Socially assigned gender nonconforming adolescents, regardless of sexual orientation or gender identity, are at greater risk of missed school due to safety concerns, and bullying, as compared with those who conform to norms of gender expression. Future research should measure SAGNC, sexual orientation, gender identity, and expression with larger representative samples of school populations across contexts (urban and rural), and inclusive of structural factors (e.g., school climate) to guide the development of prevention efforts.

Psychological processes may mediate the relationship between minority stress and mental health th... more Psychological processes may mediate the relationship between minority stress and mental health though limited data exist showing this pathway among trans women. Trans women's degree of satisfaction with their body is associated with mental health outcomes. This study used a model of minority stress to explore for indirect effects on the association between transphobia-based victimization and anxiety and depression through one's degree of body satisfaction. Analysis also explored for racial differences. Transgender women ( N = 233) were recruited in 2013 using respondent-driven sampling. Sociodemographics, transphobia-based victimization experiences such as having been physically abused, body satisfaction, and mental health were measured. Analyses assessed for direct and indirect associations while controlling for gender confirmation therapies (i.e., cross-sex hormone therapy and gender confirmation surgeries) and racial identity; 57% reported depression and 42.1% reported anxiety diagnoses. Participants averaged nearly three of six assessed violence experiences. More than 20% reported low body satisfaction. Contrary to authors' expectations, those reporting African American and Other racial identity experienced less transphobia-based violence than whites. Transphobia-based violence was significantly associated with anxiety, depression, and body satisfaction. Body satisfaction was associated with mental health diagnoses. Bootstrapping revealed significant indirect and total effects. Body satisfaction mediated the relationship between transphobia-based violence and mental health. Clinical intervention that promotes body satisfaction including access to gender confirmation therapies, especially hormone therapy, may prevent negative mental health outcomes among trans women. Individual intervention, however, is not a panacea for structural discrimination. Attention to structural interventions that reduce gender minority stressors including transphobia-based violence is necessary.

Reproductive Health Matters, 2018

This roundtable discussion is the result of a research symposium entitled In Transition: Gender [... more This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn. Transgender people must of course lead any sort of initiatives to improve their lives, even as partnerships are needed to build capacity, translate lived experience into usable data, and to make strategic decisions. The SRHR of transgender people can only be addressed with attention to the social, cultural, legal, historical, and political contexts in which people are situated, with social, psychological, medical, and legal gender affirmation as a key priority shaping any intervention. Bringing together nine diverse yet complementary perspectives, our intent is to jumpstart a global and multigenerational conversation among transgender activists, lawyers, policy-makers, programmers, epidemiologists, economists, social workers, clinicians and all other stakeholders to help think through priority areas of focus that will support the needs, rights, and health of transgender populations. Making the changes envisioned here is possible but it will require not only the advocacy, policy, programmatic and research directions presented here but also struggle and action locally, nationally, and globally.

Journal of Traumatic Stress, 2020

Sexual victimization, including sexual harassment and assault, remains a persistent problem in th... more Sexual victimization, including sexual harassment and assault, remains a persistent problem in the U.S. military. Service members identifying as lesbian, gay, bisexual, or transgender (LGBT) may face enhanced risk, but existing research is limited. We examined experiences of sexual harassment, stalking, and sexual assault victimization during service in a sample of LGBT and non-LGBT active duty service members. Service members who identified as LGBT (n = 227 LGB, n = 56 transgender) or non-LGBT (n = 276) were recruited using respondent-driven sampling for an online survey. Logistic regression models examined the correlates of sexual and stalking victimization. Victimization was common among LGBT service members, including sexual harassment (80.7% LGB, 83.9% transgender), stalking (38.6% LGB, 30.4% transgender), and sexual assault (25.7% LGB, 30.4% transgender). In multivariable models, LGB identity remained a significant predictor of sexual harassment, OR = 4.14, 95% CI [2.21, 7.78]; stalking, OR = 1.98, 95% CI [1.27, 3.11]; and assault, OR = 2.07, 95% CI [1.25, 3.41]. A significant interaction between LGB identity and sex at birth, OR = 0.34, 95% CI [0.13, 0.88], suggests an elevated sexual harassment risk among male, but not female, LGB service members. Transgender identity predicted sexual harassment and assault at the bivariate level only. These findings suggest that LGBT service members remain at an elevated risk of sexual and/or stalking victimization. As the military works toward more integration and acceptance of LGBT service members, insight into victimization experiences can inform tailored research and intervention approaches aimed at prevention and care for victims. As the U.S. military continues to face a high burden of sexual victimization, including sexual harassment and sexual assault, among service members, prevention and intervention efforts have stressed the importance of identifying high-risk priority subpopulations (Department of Defense [DoD], 2019). One such population is military personnel who identify as lesbian, gay, bisexual, or transgender (LGBT). The legacy of prior military policy that restricted service for lesbian, gay, and bisexual

Affilia, 2019

There is emerging global agreement that environmental change is one of the greatest threats to ec... more There is emerging global agreement that environmental change is one of the greatest threats to ecosystems, culture, health, and economies of humankind. In response to these environmental changes and the expected human vulnerability they will continue to produce, the American Academy of Social Work and Social Welfare has highlighted intervention to address the human impacts of the changing climate as one of the profession's grand challenges. This article troubles the often anthropocentric worldview from which such responses emerge and proposes a framework informed by the wisdom of deep ecology and ecofeminism. Born from critical methodologies that question the rigid bifurcation and valuation of male/female and human/nonhuman, these perspectives invite social workers to think in novel ways about environmental challenges. We argue that the social work profession, which has historically sought to disturb power dynamics and reprioritize society's needs, is uniquely situated to think holistically about responding to this crisis. By honoring the interrelated nature of human and nonhumankind, social workers can more mindfully lead the social planning and advocacy efforts necessary to meet this grand challenge.

International Journal of Sexual Health, 2019

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (tran... more Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n ¼ 15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.

JAMA Network Open, 2019

Transgender and gender-diverse individuals are those whose gender identity (ie, the deep-seated i... more Transgender and gender-diverse individuals are those whose gender identity (ie, the deep-seated internal sense of gender as a man, woman, or otherwise) differs from that which is socially expected of them given the sex assigned to them at birth. To my knowledge, the scant research literature in the behavioral health sciences on transgender and gender-diverse communities is almost exclusively on populations in the United States and Europe, with a few studies coming from other countries that also have large populations of people with European ancestry (eg, New Zealand). I commend Peng et al 1 for conducting their ground-breaking research in the People's Republic of China (hereafter China). They found that nearly all of the respondents (92.8%) reported at least 1 type of family-based harassment (eg, verbal and physical abuse, economic control), and more than three-quarters (76.5%) reported at least 1 experience of school-based harassment (eg, verbal or cyber bullying, social isolation). Almost half of the study participants (43.8%) were at risk for major depressive disorder, and more than one-third (37.4%) were at risk for an anxiety disorder. Nearly half of the study participants (47.8%) reported experiencing suicidal ideation in their lifetime. 1 Transgender and gender-diverse adolescents in the sample reporting abuse, bullying, or neglect had increased odds of suicidal ideation in their lifetime. These data are concerning, although they are not surprising.

Youth & Society, 2019

Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth experience numerous disp... more Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth experience numerous disparities, including but not limited to access to health care, HIV risk, safety in school, educational opportunities, and family support. Historically, research on this community lumped together LGBQ experiences with experiences of transgender and nonbinary (trans/ NB) individuals, despite sexual orientation and gender identity being unique identities. Using representative statewide data from the 2015 Healthy Kids Colorado Survey (HKCS) (N = 15,970), this study examines sexual behaviors through a more nuanced and intersectional lens. We find that young LGBQ and trans/NB people in Colorado have differential experiences of sexual behavior compared with their heterosexual and cisgender counterparts. Being LGBQ and especially being trans/NB, having current depression, suicidal ideation, and experiencing electronic bullying are all associated with an increase in the likelihood of ever having sex and total number of partners,

Journal of Interpersonal Violence

Although literature documents the experiences of socially assigned gender nonconformity (SAGNC) b... more Although literature documents the experiences of socially assigned gender nonconformity (SAGNC) by minority sexual orientation (i.e., lesbian, gay, and bisexual [LGB]), examination of the role of gender expression on school violence outcomes in the presence of sexual orientation and gender identity is not well understood. This study describes SAGNC among a representative sample of adolescents, accounting for sexual orientation and gender identity (e.g., transgender). A secondary data analysis was conducted using Youth Risk Behavior Survey data from Los Angeles Unified School District high schools in 2013 (N = 1,496). The prevalence of school violence by self-reported SAGNC and gender identity was obtained. Associations between SAGNC and school violence were examined using multivariate logistic regression adjusted for mischievous response bias. Two hundred ninety-one (19.5%) adolescents reported SAGNC. Having missed school due to a safety concern and being bullied in the past year were more common among socially assigned gender nonconforming adolescents than those who conformed to gender expression expectations. Socially assigned gender nonconforming adolescents, regardless of sexual orientation or gender identity, are at greater risk of missed school due to safety concerns, and bullying, as compared with those who conform to norms of gender expression. Future research should measure SAGNC, sexual orientation, gender identity, and expression with larger representative samples of school populations across contexts (urban and rural), and inclusive of structural factors (e.g., school climate) to guide the development of prevention efforts.

Psychological processes may mediate the relationship between minority stress and mental health th... more Psychological processes may mediate the relationship between minority stress and mental health though limited data exist showing this pathway among trans women. Trans women's degree of satisfaction with their body is associated with mental health outcomes. This study used a model of minority stress to explore for indirect effects on the association between transphobia-based victimization and anxiety and depression through one's degree of body satisfaction. Analysis also explored for racial differences. Transgender women ( N = 233) were recruited in 2013 using respondent-driven sampling. Sociodemographics, transphobia-based victimization experiences such as having been physically abused, body satisfaction, and mental health were measured. Analyses assessed for direct and indirect associations while controlling for gender confirmation therapies (i.e., cross-sex hormone therapy and gender confirmation surgeries) and racial identity; 57% reported depression and 42.1% reported anxiety diagnoses. Participants averaged nearly three of six assessed violence experiences. More than 20% reported low body satisfaction. Contrary to authors' expectations, those reporting African American and Other racial identity experienced less transphobia-based violence than whites. Transphobia-based violence was significantly associated with anxiety, depression, and body satisfaction. Body satisfaction was associated with mental health diagnoses. Bootstrapping revealed significant indirect and total effects. Body satisfaction mediated the relationship between transphobia-based violence and mental health. Clinical intervention that promotes body satisfaction including access to gender confirmation therapies, especially hormone therapy, may prevent negative mental health outcomes among trans women. Individual intervention, however, is not a panacea for structural discrimination. Attention to structural interventions that reduce gender minority stressors including transphobia-based violence is necessary.

Reproductive Health Matters, 2018

This roundtable discussion is the result of a research symposium entitled In Transition: Gender [... more This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn. Transgender people must of course lead any sort of initiatives to improve their lives, even as partnerships are needed to build capacity, translate lived experience into usable data, and to make strategic decisions. The SRHR of transgender people can only be addressed with attention to the social, cultural, legal, historical, and political contexts in which people are situated, with social, psychological, medical, and legal gender affirmation as a key priority shaping any intervention. Bringing together nine diverse yet complementary perspectives, our intent is to jumpstart a global and multigenerational conversation among transgender activists, lawyers, policy-makers, programmers, epidemiologists, economists, social workers, clinicians and all other stakeholders to help think through priority areas of focus that will support the needs, rights, and health of transgender populations. Making the changes envisioned here is possible but it will require not only the advocacy, policy, programmatic and research directions presented here but also struggle and action locally, nationally, and globally.