Prevalence and correlates of substance use among trans*female youth ages 16–24 years in the San Francisco Bay Area

Abstract

Background Substance use is highly prevalent among transgender (trans*) females and has been associated with negative health outcomes, including HIV infection. Little is known about psychosocial risk factors that may influence the onset of substance use among trans*female youth, which can contribute to health disparities during adulthood. Methods We conducted a secondary data analysis of a study on HIV risk and resilience among trans*female youth (N=292). Prevalence of substance use was assessed and multivariable logistic regression models were used to examine the relationship between posttraumatic stress disorder (PTSD), psychological distress, gender-related discrimination, parental drug or alcohol problems (PDAP) and multiple substance use outcomes. Results Most (69%) of the trans*female youth reported recent drug use. In multivariable analyses, those with PTSD had increased odds of drug use [AOR=1.94 (95%CI=1.09–3.44)]. Those who experienced gender-related discrimination had increased odds of drug use [AOR=2.28 (95%CI=1.17–4.44)], drug use concurrent with sex [AOR=2.35 (95%CI=1.11–4.98)] and use of multiple drugs [AOR=3.24 (95%CI=1.52–6.88)]. Those with psychological distress had increased odds of using multiple heavy drugs [AOR=2.27 (95%CI=1.01–5.12)]. Those with PDAP had increased odds of drugs use [AOR=2.62 (95%CI=1.43–4.82)], drug use concurrent with sex [AOR=2.01 (95%CI, 1.15–3.51)] and use of multiple drugs [AOR=2.10 (95%CI=1.22–3.62)]. Conclusions Substance use is highly prevalent among trans*female youth and was significantly associated with psychosocial risk factors. In order to effectively address substance use among trans*female youth, efforts must address coping related to gender-based discrimination and trauma. Furthermore, structural level interventions aiming to reduce stigma and gender-identity discrimination might also be effective.

Risk Factors for Non-Suicidal Self-Injury Among Trans Youth

“…The first was to investigate the rates of NSSI among young trans individuals referred to a national gender identity clinic service during a 30-month period. As per previous studies, young people were defined as those below the age of 25 years [21,24]. The second aim was to collect and analyse information regarding the possible risk factors for NSSI focusing on those previously described in the general and older trans population, such as natal gender, general psychopathology, levels of depression, interpersonal problems, levels of self-esteem, social support, and transphobia experiences [5,18,19,20,25].…”

Substance use and treatment of substance use disorders in a community sample of transgender adults

“…Indeed, the association between demographic characteristics and substance use among transgender people has not yet been well characterized. Studies have often focused on youth rather than the entire adult lifespan (Garofalo et al, 2006; Kecojevic et al, 2012; Rowe et al, 2015). In addition, gender differences in SUD treatment utilization between transgender people on the male-to-female spectrum (MTF/transgender women) versus female-to-male spectrum (FTM/transgender men) have not been described, as existing reports have focused primarily on substance use among transgender women in the context of HIV risk (Nemoto et al, 2004; Nuttbrock et al, 2014b; Reback and Fletcher, 2014; Rowe et al, 2015; Santos et al, 2014).…”

“…Studies have often focused on youth rather than the entire adult lifespan (Garofalo et al, 2006; Kecojevic et al, 2012; Rowe et al, 2015). In addition, gender differences in SUD treatment utilization between transgender people on the male-to-female spectrum (MTF/transgender women) versus female-to-male spectrum (FTM/transgender men) have not been described, as existing reports have focused primarily on substance use among transgender women in the context of HIV risk (Nemoto et al, 2004; Nuttbrock et al, 2014b; Reback and Fletcher, 2014; Rowe et al, 2015; Santos et al, 2014). Moreover, reporting of non-binary gender identity (i.e., gender identity which is not defined as either male or female, and may be defined as “genderqueer” or “gender variant”) in published substance use research is minimal (Flentje et al, 2015), and differences in substance use and SUD treatment between transgender people with binary versus non-binary gender identity have not been investigated.…”

“…Experiencing psychological or physical abuse as a result of one’s nonconforming gender expression or identity is associated with a three- to four-fold higher odds of alcohol, marijuana, or cocaine use, as well as an 8-times higher odds of any drug use, among transgender women (Nuttbrock et al, 2014b). Among MTF transgender youth, gender-related discrimination is associated with increased odds of alcohol and drug use (Rowe et al, 2015). Research suggests that substance use may be a means of coping with discrimination, as a national study found that 35% of transgender people who experienced school-related verbal harassment, physical assault, sexual assault, or expulsion reported using substances to cope with transgender- or gender nonconformity-related mistreatment (Grant et al, 2011).…”

“…In the context of such common interpersonal trauma, a recent report showed that posttraumatic stress disorder (PTSD) symptoms are associated with increased odds of drug use among MTF youth (Rowe et al, 2015). Previous research also indicates that transgender people have high prevalence of depression (Clements-Nolle et al, 2001; Reisner et al, 2015) and, among transgender women, gender nonconformity-related abuse has been associated with higher likelihood of major depression (Nuttbrock et al, 2014a).…”