PONE-D-23-00876Food insecurity in a Brazilian transgender sample during the COVID-19 pandemicPLOS ONE

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Reviewer #1: Partly

Reviewer #2: Partly

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: During your introduction I read about the relationship between gender and food insecurity, nevertheless, this point was not fully addressed during your discussion and how interacts with other related factors.

It is important to include how your results compare to the national ones (as you used the same scale used in the national surveys), from this information it is easier to understand the results with this population.

In general terms, I considered that regarding the information that you had the opportunity to collect you are not fully explaining some interactions between food insecurity and social determinants of health. For example, it is interesting that 55% of your population is above the average schooling level while 68.8% experienced some degree of food insecurity did you check on your models how these two factors interact? Are they related? I encouragingly suggest going deeper inside those SDH that is related to food insecurity then you can explain more about how it is for these group the experience food (in)security.

It is a fact that during your study, there was not a direct correlation between prejudice and food insecurity. Nevertheless, it must be taken into account that food insecurity is a multifactorial problem, and those related to social exclusion are considered part of the causes. I suggest including as a recommendation for further studies to use methodologies that allow showing how prejudice impacts the factors mentioned in line 244 and, as a result, the level of food insecurity in this group.

Reviewer #2: Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic (PONE-D-23-00876)

The manuscript describes results from a cross-sectional, online survey of transgender and gender diverse adults (N = 109) recruited in Brazil. Participants answered questions about food insecurity over the past 3 months, economic factors, demographic information, and perceptions of prejudice. Data were collected between October and December 2020 so participants were reporting about food insecurity relatively early in the COVID-19 pandemic. Results showed high rates of food insecurity -- 68.8% experienced food insecurity, and of these, 20.2% experienced severe food insecurity. Food insecurity was not statistically related to perceptions of prejudice but was predicted by several economic factors including employment status, income, and education. Results were generally expected but the prevalence of food insecurity in this population at this critical time are of value.

Strengths of the manuscript include the investigation of an important problem in a vulnerable population. Limitations include some aspects of the description of the methodology and presentation of findings.

1. In several analyses, such as in Table 1, participants are categorized as having food security or having food insecurity. It was not entirely clear how these were defined. Figure 2 shows that around 30% of the individuals in the food security group reported mild food insecurity and around a similar percentage in the food insecurity group reported mild food insecurity – the latter group also includes individuals with moderate or extreme food insecurity.

2. In the first half of the manuscript, it indicates that “internalized prejudice” was assessed. This normally refers to the attitudes or emotional states of an individual toward themselves which is a reflection of negative attitudes found in the person’s family, community, or country. An example would be a trans person who believes trans people are bad or inferior or has a low self-esteem as a result of being trans because that is what the person has been told by their society.

However, the items in that measure appear to assess the experience of interpersonal discrimination – e.g., from employers, police, or others, rather than the internal state of the individuals.

The second half of the manuscript generally refers to this variable as “perceived prejudice” which seems the more appropriate term. It would be preferable to use just one term for this variable consistently throughout the manuscript.

3. Table 1 shows a marginal association between prejudice and food insecurity (p = .08) and the distributions seem quite different. Given the importance of this variable, were additional analyses conducted, such as assessing if prejudice was associated with extreme food insecurity rather than just food insecurity overall?

4. A minor point, but the Table 1 header does not appear to actually describe the data presented in that table.

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Reviewer #1: No

Reviewer #2: No

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Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic

PONE-D-23-00876R1

Dear Dr. Savio Marcelino Gomes

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Cesar Infante Xibille, Ph.D

Academic Editor

PLOS ONE