Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity

Abstract

Bullying and substance use represent serious public health issues facing adolescents in the United States. Few large-sample national studies have examined differences in these indicators by gender identity. The Teen Health and Technology Study (N = 5,542) sampled adolescents ages 13 to 18 years old online. Weighted multivariable logistic regression models investigated disparities in substance use and tested a gender minority social stress hypothesis, comparing gender minority youth (i.e., who are transgender/gender nonconforming and have a gender different from their sex assigned at birth) and cisgender (i.e., whose gender identity or expression matches theirs assigned at birth). Overall, 11.5% of youth self-identified as gender minority. Gender minority youth had increased odds of past-12-month alcohol use, marijuana use, and nonmarijuana illicit drug use. Gender minority youth disproportionately experienced bullying and harassment in the past 12 months, and this victimization was associated with increased odds of all substance use indicators. Bullying mediated the elevated odds of substance use for gender minority youth compared to cisgender adolescents. Findings support the use of gender minority stress perspectives in designing early interventions aimed at addressing the negative health sequelae of bullying and harassment.

Acknowledgments

We would like to thank the entire study team from the Center for Innovative Public Health Research; the University of New Hampshire; the Gay, Lesbian, and Straight Education Network (GLSEN); LaTrobe University; and Harris Interactive, who contributed to the planning and implementation of the study. Finally, we thank the study participants for their time and willingness to participate in this study.

Notes

¹While is it possible that some LGBTQ persons completed the survey through both recruitment methods, a lack of financial incentive reduces this likelihood. Moreover, only 0.6% of respondents had the same cookie as another respondent, suggesting very few surveys were completed on the same computer.

²Because the GLSEN LGBTQ sample was more than eight times the size of the HPOL LGBTQ sample, the final weights even after trimming were larger than desired. To examine the possibility that findings were due to extreme weights rather than actual relationships between variables, additional analyses were conducted. An independent random subsample of 597 (only three times the size of the HPOL LGBTQ sample), restricted to exclude respondents with the lowest weights (i.e., those overrepresented in the data), was selected from the GLSEN LGBTQ sample and weighted to represent 50% of the combined LGBTQ sample to create a nationally representative sample of LGBTQ youth with less extreme weights but a smaller total sample size of LGBQT than the combined sample including all GLSEN LGBTQ. All analyses were then conducted with both combined samples and results compared. Results did not vary enough to warrant different conclusions based on the different samples. Therefore, results using the full combined sample are reported.

^a Weighted bivariate analyses compare gender minority youth, cisgender girls, and cisgender boys.

Note. OR = odds ratio; 95% CI = 95% confidence interval.

*p < 0.05. **p < 0.01. ***p < 0.0001. ^a p < 0.10.

Note. OR = odds ratio; 95% CI = 95% confidence interval.

*p < 0.05. **p < 0.01. ***p < 0.0001. ^a p < 0.10.

Note. OR = odds ratio; 95% CI = 95% confidence interval.

*p < 0.05. **p < 0.01. ***p < 0.0001. ^a p < 0.10.

Note. aOR = adjusted odds ratio; 95% CI = 95% confidence interval; referent for gender identity = cisgender boys; cisgender girls not shown (no estimates statistically significant at the alpha 0.05 level). All models adjusted for covariates: age, race/ethnicity (White non-Hispanic versus racial/ethnic minority), family socioeconomic status (low versus high), and geographic context (urban, suburban, rural).

Models without hypothesized mediator = Substance use regressed on gender identity and covariates. Models with hypothesized mediator = Substance use regressed on gender identity, any past-12-month bullying (mediator), and covariates.

Proportion of effect: Estimates the percentage of mediation in the relation between gender identity and substance use provided by bullying. The p value is the probability of rejecting the null hypothesis of no mediation by bullying (test of indirect effects).

*p < 0.05. **p < 0.01. ***p < 0.0001. ^a p < 0.10.