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Predictors of Alcohol Use and Consequences in Transgender Adults (PACT) Pilot Study


Researcher bios and how their research backgrounds relate to this study

Dr. Dermody has a PhD in Clinical Psychology and Health Psychology from the University of Pittsburgh (awarded 2015), 2 years of post-doctoral research experience at the Centre for Addiction and Mental Health, and 3 years of experience as a tenure track assistant professor at Oregon State University. She began a tenure track position at Ryerson University on July 1 2020. Over the course of her training and professional experiences, she has been conducting research in the field of addiction and mental health for 12 years. This research has spanned several subdisciplines, one of which being the health and well-being of sexual and gender minority individuals. She has published more than 40 peer reviewed journal articles, many of which focus on sexual and gender minority health and mental health like this study. Alex Abramovich, Ph.D. (Co-Investigator) is a transgender identified Independent Scientist with the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health (CAMH) and an Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto. Dr. Abramovich has made substantial contributions to address the public health needs of sexual and gender minority populations through rigorous health research. He will assist with survey design, recruitment and engagement of transgender participants, and interpretation of findings. Jeffrey Wardell, Ph.D. (Co-Investigator) is an Assistant Professor of Psychology at York University. He holds appointments at CAMH and University of Toronto. He is leading two EMA studies, including one CIHR-funded study of alcohol and cannabis co-use. Dr. Wardell has experience working with the EMA app software to develop surveys, and will support the implementing the EMA protocol and advise Dr. Dermody on the analysis of the data.

Purpose of this research project

Transgender adults experience problematic drinking at concerning rates. Research with prospective methodology is needed to better understand the day-to-day risk and resilience factors that contribute to alcohol use and related harms among transgender adults who drink. The proposed project will be a pilot study to determine the feasibility and acceptability of using an ecological momentary assessment (EMA) design to understand the motivations, contexts, and consequences of alcohol use among transgender adults. Aim 1 will assess the feasibility and acceptability of a 21-day EMA study with 25 transgender adults who drink as a means of prospectively examining alcohol use. The EMA component involves the participant receiving prompts to complete brief surveys several times a day, as well as initiating a survey just prior to drinking alcohol. At the end of the study, we will ask participants about their experiences in the study to help determine feasibility and acceptability of the procedures. Aim 2 will validate and refine measures that we will use to evaluate an adapted Gender Minority Stress and Resilience Model for alcohol outcomes. This will be supported using the EMA data as well as detailed assessments completed at a baseline appointment. Aim 3 will explore interrelations between minority stress, resilience, alcohol use, and alcohol harms. These findings will be used to support and refine our methodology based on the feedback we receive from transgender participants to support applications for funding from federal sources for a larger-scale study. Study risks are minimal and include discomfort when answering some of the survey questions and potential breach of confidentiality. Risks will be mitigated by handling and storing the data securely. There are minimal direct benefits to participants individually. There is some evidence that self-monitoring one’s alcohol use leads to reduced drinking, which could improve participant’s health. We will also provide personalized feedback to participants at the conclusion of the study about their alcohol use and mental health and provide resources about support and treatment for drinking, which may help them make informed decisions about their drinking levels. These findings are important as they will help us refine an adapted Gender Minority Stress and Resilience Model for Alcohol Outcomes that can be used to develop empirically-based, gender-inclusive interventions to reduce harms from drinking.

How this research will help LGBT2SQ people and communities

Participants will have the option to receive personalized feedback at the conclusion of the study about their alcohol use and mental health based on responses to the Baseline Survey (scores and interpretation on PHQ-8, GAD-7, and AUDIT). At the Exit Survey, we will ask each participant if they would like this feedback, and if so, if they would prefer to review it virtually with a research assistant or receive the information by email. All participants will be provided with resources about support and treatment for drinking, as part of the debriefing form. There are no other direct benefits to participants individually; however, there is evidence that self-monitoring one's alcohol use leads to reduced drinking, which could improve participant's health. These findings are important as they will help us refine an adapted Gender Minority Stress and Resilience Model for Alcohol Outcomes that can be used to develop empirically-based, gender-inclusive interventions to reduce harms from drinking.


Inclusion criteria include: 1. adult (age 19 or older) 2. identifies as transgender or non-binary 3. lives in Canada 4. regular alcohol use (drank alcohol two or more times per week or more in past 30 days) 5. recent heavy alcohol use (4 or more drinks on one occasion or more in the past 30 days) 6. owns smartphone compatible with MetricWire app (Android or iPhone)


Compensation will be provided in the form of e-giftcards. Participants will be given a choice of Amazon or PC e-giftcards. Participants can earn up to $170. Participants will be compensated $40 for the Baseline appointment, and $20 for the Exit Survey. Participants who begin the Baseline appointment but are ultimately found to be ineligible during the Baseline surveys (e.g., they reveal that they are not transgender, they report markedly different substance use in the appointment that leads to ineligibility) would be compensated proportionate to their time spent in the appointment (i.e., equivalent of $20/hour prorated to 30 minute increments). To encourage completion of nearly all EMA surveys, the compensation will be paid weekly and based on the proportion of surveys completed. Maximum earning will be $30/week (for 90-100% completion of prompted surveys including daily morning and random surveys), and will decrease for lower completion rates (i.e., $25/week for 80-89% completion, $20/week for 70-79% completion, $15/week for 50 - 69%, $10/week for 20 - 49%, $5/week for 1 - 19%, $0/week for 0%). Participants can earn a $20 bonus at the end for completing >90% of all prompted surveys. Compensation will not be linked to the number of alcohol use episodes reported.

Mitigation measures

They will be asked questions about their substance use, mood, and negative experiences they may have had. Answering some of these questions may cause some discomfort for some participants. Participants have the option to skip questions they do not wish to answer (i.e., there is no forced responses beyond providing consent). Most surveys will be self-administered.

We will ask questions about the use of substances including illegal substances, problems experienced with one's use of legal substances, minority identities, and experiences of victimization. There may be social risk associated with others learning about their responses to their questions, such as potential loss of privacy, being exposed, and damage to one's reputation. We will instruct participants to complete all surveys in a location that ensures privacy. The EMA survey will be labeled by the study acronym "PACT Study" with a general study description of "This study seeks to learn more about your health and daily experiences." Only researchers named in the study will have access to the data collected. Data will be stored in a password protected file. With the exception of the pre-screening survey, all survey responses will be kept separate from identifiable information.

Promoting the Study

Participants will be recruited on a rolling basis through electronic and hard copy distribution of flyers, predominantly through the networks of the research team and community partners (for instance, Rainbow Health Ontario, Centre for Addiction and Mental Health Gender Identity Clinic and Rainbow Services). Electronic version of the flyer will be posted and shared on our CARE lab website, Twitter, Facebook, Rainbow Health Ontario, Kijiji, and other applicable social media or websites. The study will be posted in Kijiji under volunteering. Emails containing study information with the flyer attached will be sent to relevant groups. The study flyer may also be shared via community organizations (e.g., through their newsletters or websites). Printed version of the flyer will be distributed and posted on bulletin boards at Ryerson University, York University, CAMH, and the surrounding community. We will also utilize paid Facebook ads. At the conclusion of their participation in the study, participants will be offered copies of the recruitment flyer to share with individuals in their social networks who may be eligible to participate.