Methods of Data Collection

This page includes more details about the methods of the study, including more of the technical information about what we were measuring and how.

In person interviews: Our baseline interviews were conducted in person with participants living in Oregon, Michigan, Nebraska, and Tennessee. These interviews were about 1 hour long and included discussions about what it was like to live in each state as a trans person, recent sociopolitical events participants felt impacted by, and definitions and experiences of resilience. These 158 interviews were audio recorded and transcribed. We are in the process of beginning to code this data so that we can conduct qualitative and mixed-methods analyses. We will be analyzing these data in order to draw comparisons between sites as well as characterizing findings based on the full sample.

For our interviews at Month 12, we are focusing on participants’ stress and resilience experiences since the 2020 presidential election. For this, we are taking a social ecological approach to learn more about participant stress experiences within many layers of relationships – from interpersonal to the larger societal context. We will take the same approach in order to learn about what has helped participants to cope and be resilient during this time.

Survey measures: During that first in-person meeting, participants completed a number of surveys and scale items. These surveys cover the following topic areas: mental and physical health, stress and gender experience, social context and events, and a section on resilience, coping and social support. In the monthly surveys, similar topics are covered, as well as a COVID-19 questionnaire we developed for this study. We are happy to share more details about the measures we used in this study with any who are interested.

Minimally invasive biomarkers of stress and health: In addition to learning more about experience and health through interviews and surveys, we are collecting a number of biomarkers in order to understand how stress becomes embodied and how this can result in overall “wear and tear” on the body – which is called “Allostatic Load.” For transgender people who may face stigma, marginalization and unique challenges and stressors, understanding the relationship between stress experience, resilience, and allostatic load within specific sociopolitical and geographic contexts will enhance our understanding of long-term health and health disparities among trans people.

There are a number of biomarkers of immune, endocrine, and metabolic function that are measurable in ways that are “minimally invasive” compared to, for instance, drawing blood. We think these types of measures are important because they enable participation outside of clinical settings; many of our interviews and health measures were conducted in university offices, community centers, libraries, and in people’s homes. This enables participation from people in the community who may be otherwise disinclined to be involved in a study if it were requiring interactions with health professionals.

Because we are interested in measuring stress and allostatic load, we focused on collecting the following samples to measure multiple systems, including immune function, metabolism, and stress.

From a single finger prick, dried blood spot cards and a point-of-care device we were able to measure:

• C-reactive protein (CRP)  – a marker of inflammation and immune function that is measurable in dried blood spots. Chronically high levels may be associated with increased cardiovascular risk.
• Glycosylated Hemoglobin (HbA1c)  – which provides a measure of metabolic function and screening for diabetes. As a measure of glucose metabolism, it is convenient because it does not require fasting and reflects the previous 2-3 months average blood glucose levels.

Participants also collected three saliva samples on their own, one at waking, one 30 minutes after waking, and one before bedtime. From these samples we will measure:

• Cortisol – this hormone is the product of the hypothalamic-pituitary-adrenal axis and is often measured to assess acute as well as chronic stress response. Because cortisol has many functions beyond stress and is secreted according to a regular daily rhythm, multiple timed measures allow for the evaluation of that daily rhythm.

Other measures of cardiovascular function and health include

• Blood-pressure
• Heart rate
• Height, weight, and waist/hip circumference