Binge drinking disparities by gender identity, race, and ethnicity in California secondary schools

Abstract

Our objective was to estimate disparities in binge drinking among secondary school students in California at the intersection of gender identity, race, and ethnicity, without aggregating racial and ethnic categories. We combined two years of the statewide middle and high school California Healthy Kids Survey (n = 951,995) and regressed past month binge drinking on gender identity (i.e., cisgender, transgender, or not sure of their gender identity), race (i.e., white, American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, or multiracial), and ethnicity (i.e., Hispanic/Latinx or non-Hispanic/Latinx), and their interaction. Transgender students had greater odds of reporting past month binge drinking than cisgender students, with greater magnitudes among students with minoritized racial or ethnic identities compared to non-Hispanic/Latinx white students. For example, among non-Hispanic/Latinx white students, transgender students had 1.3 times greater odds (AOR = 1.30, 95% CI = 1.12—1.50), whereas among Hispanic/Latinx Black or African American students, transgender students had 5.3 times greater odds (AOR = 5.33, 95% CI = 3.84—7.39) of reporting past month binge drinking than cisgender students. Transgender adolescents, particularly those with minoritized racial or ethnic identities, may be at disproportionate risk of binge drinking. Interventions that address systemic racism and cisgenderism from an intersectional perspective are needed.

Keywords:

• gender identity
• transgender
• race
• ethnicity
• alcohol use
• binge drinking
• health disparities
• adolescents

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Jack Andrzejewski is supported by the National Institute of Drug Abuse (NIDA), National Institutes of Health (NIH) under Award Number T32DA023356. Jennifer Felner is supported by the CA Tobacco-Related Disease Research Program under Award Number T29FT0265 and the National Institute on Minority Health and Health Disparities (NIMHD), NIH under Award Number U54MD012397. Laramie. R. Smith is supported by the National Institute of Mental Health (NIMH), NIH under Award Number R01MH123282. The funders/sponsors did not participate in the work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. National Institute on Drug Abuse.

Notes on contributors

Jack Andrzejewski

Jack Andrzejewski (pronouns: they/them/theirs) is currently a student in the San Diego State University—University of California, San Diego Joint Doctoral Program in Public Health, Health Behavior Track. Their work focuses on mental health, substance use, and sexual health among transgender populations. In particular they are interested in how social determinants of health such as racism, cisgenerism, and access to gender affirming health care shape health outcomes for transgender folks.

Jerel P. Calzo

Jerel P. Calzo (pronouns: he/him/his) is an Associate Professor in the Division of Health Promotion and Behavioral Science and Associate Director for Academic Affairs in the School of Public Health at San Diego State University. He is a developmental psychologist with postdoctoral training in social epidemiology. His current research interests include partnering with school and community-based programs to develop evidence-based practices to support positive youth development and resilience among LGBTQIA + youth, and using survey and mixed method research designs to examine and address health inequities among LGBTQIA + populations, particularly in the areas of eating disorders and substance use.

Laramie R. Smith

Laramie Smith (pronouns: she/her/hers) is an Associate Professor in the Division of Infectious Diesease and Global Public Health in the School of Medicine at UC San Diego. She is also the co-director of the San Diego State University—University of California, San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use. Her work focuses on identifying intersectional stigma intervention targets for people who inject drugs and social network approaches to study the effects of stigma on HIV prevention among Latino men who have sex with men.

Heather L. Corliss

Heather L. Corliss (pronouns: she/her/hers) is a Professor in the Division of Health Promotion and Behavioral Science in the School of Public Health at San Diego State University. She is a social and behavioral epidemiologist whose research focuses primarily on identifying and addressing health disparities among LGBTQ + populations.

Jennifer K. Felner

Jennifer K. Felner (pronouns: she/her/hers) is an Assistant Professor and Undergraduate Program Director in the School of Public Health at San Diego State University. In her research, Jennifer partners with community-based organizations and community members to identify and address social and structural determinants of health inequities among LGBTQ + youth and youth experiencing homelessness. She has experience as a public health practitioner addressing child maltreatment via community- and clinically- based education and has been a long-time volunteer for youth- and adult- serving community-based organizations.