Variability in Substance Use Behaviors by Gender Identity: A Nuanced Examination of Subgroups

• In Event: 2-201 - Findings on adolescent substance use when diversity and inclusion are prioritized

Integrative Statement

In comparison to their cisgender peers, transgender youth report higher rates of substance use (e.g., alcohol, tobacco; Day et al., 2017; De Pedro et al., 2017). Yet, much of the literature has only examined differences between transgender and cisgender youth, which potentially masks the variable experiences of transgender youth (i.e., transmasculine, transfeminine, nonbinary, etc..; O’Brien, McManama, et al., 2016). The need to examine variability within transgender populations in health-related behaviors and outcomes is widely recognized but rarely accomplished due to small sample sizes, imprecision in measurement, and inaccuracies in how gender identity is captured in survey research. Further, correlates of substance use may vary across transgender subgroups. Previous research has identified several risk factors for substance use among transgender adolescents and young adults (e.g., bullying, stressful experiences, family rejection; Klein & Golub, 2016; Reisner et al., 2015; Tupler et al., 2017). Yet, these studies have been unable to explore variability across gender subgroups given the limitations noted above. The purpose of this study was to examine differences by gender identity in self-reported past 30-day substance use behaviors, as well as the correlates (i.e., age, parents’ highest level of education, urbanicity, sexual orientation, and race/ethnicity) of substance use.

We conducted secondary analysis of an existing dataset that included 120,617 youth aged 11 to 19 (M = 14.74, SD = 1.78). Prevalence statistics of substance use behaviors (i.e., past 30-day alcohol use, tobacco, and inhalant abuse) were compared across gender identity groups (50.3% female, 47.8% male, 0.2% transfeminine, 0.1% transmasculine, 0.3% nonbinary, 0.9% unsure, 0.4% missing), as well as their correlates.

Transgender youths reported higher levels of past 30-day substance use across all substances compared to cisgender youth (Figure 1; Cohen’s ds = .75-1.31); few differences emerged across transgender identity subgroups (Cohen’s ds = -.20 to .02). When small differences across transgender subgroups did emerge, youth who were questioning their gender identities reported less frequent tobacco use or inhalant abuse in the past 30 days compared to transmasculine, transfeminine, and nonbinary youth (d’s = -.19/-.11, -.17/-.10, and -.13/-.20, respectively). Yet, questioning youth still reported much higher frequencies of tobacco use or inhalant abuse than cisgender youth (dfemales = .99/1.00, dmales = .87/.88). Important subgroup differences emerged when comparing correlates of substance use across gender identity groups (see Table 1 for results for alcohol use; results were consistent across substances). Parental education appeared to be protective for cisgender and nonbinary youth but not for other transgender youth. Identifying as a sexual minority heightened risk for transmasculine and questioning youth. Finally, several interactions emerged between race/ethnicity and gender; for example, Asian identification was associated with lower substance use for cisgender youth but higher substance use for transgender youth (particularly those who identified as transfeminine or nonbinary). Implications for future research and intervention will be discussed.

Authors

• Russell B Toomey, University of Arizona
  Presenting Author

• Brittany A Abeln, University of Arizona
  Non-Presenting Author

• Zhenqiang Zhao, University of Arizona
  Non-Presenting Author

• Jose Rodas, University of Arizona
  Non-Presenting Author

• Amy Syvertsen, Search Institute
  Non-Presenting Author