Spain is divided into territories known as autonomous communities that differ in their socioeconomic characteristics and health indicators. Participants in this study were recruited from five municipalities belonging to two Spanish autonomous communities with similar socioeconomic characteristics: Burela in the northwest and Centelles, Torelló, Sant Joan de Vilatorrada and Sant Fruitós de Bages in the northeast . To select the most similar municipalities, the following indicators were used: personal income tax, number of inhabitants, percentage of population of non-Spanish origin and the distance to the region capital. Burela differs from the other four municipalities by being a multicultural town that harbours more than fifty different nationalities within its 9500 inhabitants.
The multicultural coexistence in Burela raises new challenges in the search for better social integration in Galiza, a context with a short history of immigrants’ reception. Studies have pointed out the various effects of socioeconomic context and ethnicity, as well as the influence of acculturation process on adolescents . As the population of adolescents is very diverse and young, it will be interesting to study the potentially existing inequalities in such a paradigmatic context. Burela is a very different population compared to most of the Galician municipalities with respect to its number of inhabitants. Therefore, we compared Burela to four municipalities, Centelles, Torelló, Sant Joan de Vilatorrada and Sant Fruitós de Bages, that were selected based on their socioeconomic and demographic characteristics and which are more similar to Burela than the rest of municipalities included in the study of Obradors and colleagues . In Spain, the access to health care is universal and free. Burela has one reference public hospital and one center of primary care services. Likewise, each of the four Catalan municipalities have one reference hospital and one center of primary care services.
Through our review of the literature, we identified a comprehensive body of research that analyzed addiction rates among TGD individuals as a single, non-stratified group. The vast majority of these studies reached a similar conclusion: the prevalence of addiction is significantly higher in transgender populations compared to cisgender populations. While we did locate a few studies where prevalence rates were not statistically different between the two populations, and some studies with contradictory results, these other studies were perhaps even more illuminating because they highlighted alternative disparities that are often overlooked in traditional prevalence studies. For instance, a study measuring the prevalence of heavy episodic drinking concluded that transgender participants actually reported lower rates than both cisgender men and cisgender women . However, when measuring the prevalence of alcohol-related problems among the same sample, transgender participants reported higher rates than either of the cisgender reference groups.
Another study reached the conclusion that alcohol consumption did not vary significantly between transgender and cisgender subgroups; however, when researchers measured an individual’s motivation for drinking, it was found that transgender participants were significantly more likely to identify negative reasons , while cisgender participants were much more likely to drink for positive social reasons . Although these types of studies were sparse, they provide additional context for the susceptibility of transgender populations to the downstream effects of addiction and highlight additional disparities that extend beyond traditional prevalence statistics. While there is a strong body of research comparing addiction rates between transgender and cisgender populations, the core purpose of our paper was to expand upon the empirically accepted conclusion that transgender individuals are, as a whole, at increased risk of addiction. Therefore, we focused on establishing the addiction discrepancies that exist between individual TGD subgroups. We identified a growing number of studies that compared addiction rates between TW and TM. Through our analysis of these studies, several differences in prevalence rates became apparent. Most notably, TM appeared to be at a higher risk than TW for most SUD categories . However, in our review of illicit drug use, it became evident that TW may be uniquely susceptible to methamphetamine use as well as injection drug use; the latter being particularly concerning given its association with parenterally transmitted infections such as HIV and Hepatitis C. Through our literature review, we identified a number of high-powered studies that analyzed a single TGD subgroup without the inclusion of a reference group.