Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults

Abstract

Background Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). Methods Cross-sectional surveys were completed by 75,192 students aged 18–29 years attending 120 post-secondary educational institutions in the United States from 2011–2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. Results Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28–0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24–0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. Conclusions Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.

Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women

“…Transgender people who have a sex assigned at birth that differs from their current gender identity represent approximately 0.5% of the US population 41 and experience documented disparities in mental health and substance use outcomes, 4,5,8–10,12–17 as supported by the high prevalence estimates in the current study using a brief structured diagnostic interview with young transgender women. The high prevalence of mental health and substance use outcomes among young transgender women is a serious public health problem and necessitates clinical consideration in primary care settings and gender-related treatment.…”

“…1–3 Transgender youth—including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse gender identity on the transfeminine spectrum—represent a vulnerable population at risk for negative mental health 4–7 and substance use 8–11 outcomes in the United States.…”

“…Although community surveys of transgender persons in the United States have found a high prevalence of depression, anxiety, and substance use relative to that of the general adult US population, 4,5,8–10,12–16 studies typically use screening instruments or subthreshold symptom questions and do not use diagnostic interviews, such as the Mini-International Neuropsychiatric Interview (MINI), to assess prevalence of mental health psychopathology and substance dependence, with one exception. 17 Acommunity sample of 571 adult transgenderwomen 17 recruited from the NewYork City metropolitan area (mean age 37 years) used the MINI and found that life-time prevalence of depressionwas54.3%, nearly 3 times higher than the corresponding National Comorbidity Survey estimate for the general population, 19.6% 18 ; lifetime suicide ideation was 53.5% (more than 3 times higher than the corresponding National Comorbidity Survey estimate in the general population, 13.5%), and lifetime suicide plans and attempts (35.0%and 27.9%, respectively)were 7 to 10times higher than corresponding National Comorbidity Survey estimates (3.9% and 4.6%, respectively).…”

Risk and Protective Factors for Substance Use Among Sexual and Gender Minority Youth: a Scoping Review

“…The 2015 YRBSS [5] found further evidence of alcohol and drug use disparities among SMY as compared to heterosexual youth. Although there is notably less research about GMY, existing findings suggest that this group is also at greater risk of heavy episodic drinking (HED), negative alcohol-related consequences, and drug use [8, 9]. Bisexual and questioning youth may be at particularly high risk for hazardous drinking and drug use [10].…”

Improving the analysis and modeling of substance use

“…We suggest that use of additional criteria would improve decision-making, e.g. the Bayesian Information Criterion (BIC) (8,9) and the Vuong (10,11) test (used for identifying whether controlling for a high frequency of zero values is appropriate). Most statistical software packages (e.g.…”