Transgender Youth Substance Use Disparities: Results From a Population-Based Sample

J Adolesc Health. 2017 Dec;61(6):729-735. doi: 10.1016/j.jadohealth.2017.06.024. Epub 2017 Sep 21.


Purpose: The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors.

Methods: A statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample of students in California included 335 transgender and 31,737 nontransgender youth. Using multivariate linear and logistic regression, we assessed differences between transgender and nontransgender youth in substance use behaviors related to alcohol, cigarette, marijuana, other illicit drugs, polysubstance use, and heavy episodic drinking. Substance use was assessed with lifetime use, age of onset, and past 30-day use for alcohol, cigarettes, and marijuana. Past 30-day use was also assessed for other illicit drugs and polysubstance use. Models were adjusted for demographics and risk factors including victimization, depressive symptoms, and perceived risk of substance use.

Results: The prevalence of substance use was 2.5-4 times higher for transgender youth compared with their nontransgender peers (depending on the substance). Transgender youth were also at greater risk for early age of onset and recent substance use than nontransgender youth. In addition, psychosocial risk factors related to victimization, depressive symptoms, and perceived risk of substance use partially mediated the relationship between gender identity and substance use.

Conclusions: Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.

Keywords: Gender minority youth; Heavy episodic drinking; Illicit drugs; Tobacco.

MeSH terms

  • Adolescent
  • California / epidemiology
  • Crime Victims / psychology
  • Cross-Sectional Studies
  • Depression / psychology
  • Female
  • Gender Identity*
  • Humans
  • Illicit Drugs / adverse effects
  • Male
  • Prevalence
  • Risk Factors
  • Schools
  • Students / psychology
  • Substance-Related Disorders / epidemiology*
  • Transgender Persons / psychology
  • Transgender Persons / statistics & numerical data*
  • Underage Drinking / statistics & numerical data


  • Illicit Drugs