Substance use among transgender and cisgender high school students

Abstract

Using data from a regional census survey of high school students, we compared substance use patterns between transgender and cisgender students, and students who did not know if they are transgender (DKT). Data from more than 23,000 youth from 26 high schools were used to compare alcohol-related behaviors, marijuana use, and non-medical use of prescription drugs (NMUPD) between these three groups. We also examined differences in substance use behaviors between these groups by grade. Results show that transgender students have significantly higher odds of engaging in most types of substance misuse behaviors including problem drinking, current marijuana use, and NMUPD, compared to cisgender students. DKT students have significantly higher odds of engaging in problem drinking, and NMUPD compared to cisgender students. Furthermore, differences in some substance use behaviors between transgender and cisgender students are greater among students in earlier grades compared to later grades; though this was not the case when comparing cisgender students to DKT students. Results highlight the elevated risk of substance use among transgender youth—especially during early high school years, and students who are not sure about their gender identity. Implications about the need for targeted and early prevention efforts for this vulnerable population are discussed.

Keywords:

• Adolescence
• transgender
• prevention
• substance use

Notes

1 As Table 1 shows, it is important to note that comparisons between cisgender, transgender and DKT are unbalanced due to the larger sample of cisgender students. This issue is further elaborated in the limitations section below.

2 The percent of transgender and DKT youth in our sample is consistent with similar studies using adolescent samples. Percent of samples that report being transgender or DKT in other similar studies range between 1%–3% of total sample (Day et al., 2017; De Pedro et al., 2017; Eisenberg et al., 2017; Kosciw, Greytak, & Diaz, 2009; McGuire et al., 2010).

3 Note the limitations related to gender classification due to the wording of the survey, further elaborated in the limitations section below.

Additional information

Notes on contributors

Shai Fuxman

Shai Fuxman, Ed.D., is an experienced education and public health researcher with expertise in opioid and other substance misuse prevention, youth development, and program evaluation. He is especially interested in the promotion of positive development among youth from marginalized communities. As a training and technical assistance specialist for Prevention Solutions@EDC, Fuxman provides consultation to community and state agencies. He also leads EDC’s Opioid Working Group, which develops and promotes strategies for supporting communities affected by the opioid crisis. In both these roles, Fuxman conducts research, develops tools, and presents on substance misuse prevention topics, including strategic planning, program evaluation, effective strategies for preventing opioid misuse and overdose, and substance use prevention among youth. He is also involved in the evaluation of several education and behavioral health programs. Fuxman is knowledgeable in both quantitative and qualitative research methods, including developing and overseeing data collection procedures, analyzing large data sets, and presenting data findings. He is fluent in Spanish, Hebrew, and English and serves on EDC’s Institutional Review Board. He holds an MEd and EdD in human development and psychology from Harvard University.

Maria Valenti

Maria Valenti, PhD, is an epidemiologist and science writer with SAMHSA’s Center for the Application of Prevention Technologies (CAPT). She has a background in program evaluation with special expertise in sexual minority issues. Valenti delivers training and technical assistance (T/TA) to states in the Northeast United States regarding substance use prevention surveillance activities and data-driven decision making, and she assists with the presentation and dissemination of epidemiological findings. She conducts secondary research to support product development, crafts materials in conjunction with instructional designers, and develops and delivers webinars on critical prevention science topics. Valenti also provides scientific oversight in the development of several of EDC’s T/TA products, including program-level implementation guides for preventing underage drinking and non-medical use of prescription drugs. Previously, Valenti served as the Service to Science lead for the CAPT, where she oversaw the evaluation T/TA provided to participating prevention programs, and she led a team of experts who assisted local program directors, developers, and evaluators in documenting evidence of program effectiveness in the northeastern states. Valenti earned her PhD in ecological-community psychology from Michigan State University.

Shari Kessel Schneider

Shari Kessel Schneider, MSPH has more than 20 years’ experience in public health, survey research, evaluation, intervention development, and training and technical assistance, with a focus on adolescent populations and risk behaviors. She directs EDC’s MetroWest Adolescent Health Survey, which is administered biennially to more than 40,000 students in grades 6–12 to monitor trends in health and risk behaviors including opioid and other substance misuse and to examine emerging adolescent health issues. She also provides technical assistance to school districts in using student survey data to inform educational efforts, prevention programing, and policymaking. Schneider’s research, presentations, and publications focus on public health challenges affecting youth, including opioid and other prescription drug misuse, social media and cyberbullying, smoking initiation and policies affecting youth smoking, and underage drinking and distracted driving. She is consulted by the media for her insights into adolescent behavior and related public health trends and how data can drive more effective programs and practices to improve adolescent physical and mental health. Schneider holds an MSPH from the Harvard University School of Public Health.

Kimberly H. McManama O’Brien

Kimberly H. McManama O’Brien, PhD, is a research scientist at EDC with joint appointments at Boston Children’s Hospital and Harvard Medical School. Her work focuses on the development and testing of brief interventions for suicidal adolescents and their families, with an additional specialization on adolescents who misuse prescription drugs and other substances. Her research also involves training social workers and other health professionals in suicide- and substance-related knowledge and brief interventions. O’Brien was recently funded by NIAAA to develop and test a brief alcohol intervention and mHealth booster for adolescents who have attempted suicide. She is also co-developing and testing a smartphone application intervention for adolescents at risk for suicide. O’Brien is a co-investigator on two other NIMH-funded studies: (1) examining factors that lead sexual minority youth to have higher rates of suicidal and non-suicidal self-injurious behaviors and (2) developing and testing a novel suite of simulated suicide risk assessment trainings. O’Brien received her BA from Harvard University and her MSW and PhD from Boston College. She has also completed her postdoctoral training at Brown University’s Center for Alcohol and Addiction Studies.

Lydia O’Donnell

Lydia O’Donnell, EdD, is a public health expert and behavioral scientist who has conducted extensive research to inform and improve prevention and treatment services for youth and adults. Over a 30-year career at EDC, she has designed and evaluated innovative programs for health systems and providers, schools, families, and community organizations. She has a long-standing commitment to reducing health disparities through community-informed programs that can be successfully implemented and sustained. In the mid-1980s, O’Donnell conducted some of the first research with health care providers to address AIDS stigma and improve the quality of health services. Since then, with funding from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other federal agencies as well as foundations, she has designed multiple community-informed interventions that are included in national best-practices registries and widely disseminated. She has worked extensively with economically disadvantaged Latino and African American communities on issues including sexual and reproductive health, youth development, and behavioral health. O’Donnell has published more than 100 scientific papers and has served on multiple NIH and CDC review and advisory committees. She holds an EdD from Harvard University and completed a postgraduate fellowship in gender roles and mental health.