Alcohol Use at the Intersection of Sexual Orientation and Gender Identity in a Representative Sample of Youth in Colorado

Background & Purpose: Alcohol use is the leading cause of injury and death among young people under age 21 in the US, with associated medical costs exceeding $24 billion. Moreover, early alcohol use is associated with depression, memory impairment, and victimization. Research indicates that lesbian, gay, bisexual, and transgender (LGBT) youth engage in more hazardous drinking than their heterosexual and cisgender counterparts, though data on alcohol use and associated factors at the intersection of sexual orientation and gender identity is noticeably absent from the literature. Accordingly, the present study examined the following research questions: 1) Are there differences in alcohol use and misuse rates by intersectional demographics of sexual orientation and gender identity? 2) Are partner and sexual violence victimization and depression significantly associated with alcohol use when controlling for intersectional demographics?   

Methods: This study used data from 27, 621 high school students ages 14-18 (M=15.94, SD=1.17) enrolled in the Healthy Kids Colorado survey using a statewide stratified random sampling design. Overall, 2.12% of participants identified as transgender or unsure of their gender identity, and 13.16% identified as LGB or questioning. Sixty percent of participants were White and 40% were students of color (57% Hispanic, 28% multiethnic). Survey items assessed number of drinking and binge drinking days in the last 30 days, age at first drink, frequency of past year physical partner violence, lifetime forced sex, past year depression, and demographics (sexual orientation, gender identity, sex, ethnicity, age). Analyses examined the intersection of gender identity and sexual orientation, demographics, depressive symptoms, and victimization on alcohol use using negative binomial and linear regressions.      

Results: Negative binomial results indicated that transgender LGB (IRR = 1.96, p<.001), heterosexual (IRR = 2.69, p<.001), and questioning students (IRR = 3.06, p<.001) had significantly higher expected rates of alcohol use than their cisgender heterosexual peers. Similarly, transgender LGB (IRR = 2.31, p<.001), heterosexual (IRR = 3.01, p<.01), and questioning (IRR = 3.83, p<.001) students had significantly higher expected rates of binge drinking compared to cisgender heterosexual students. Students who reported being unsure of their gender identity and sexual orientation experienced significantly higher expected rates of alcohol use (IRR = 2.07, p<.001) and binge drinking (IRR = 2.57, p<.001). Linear regression results indicated that identifying as transgender LGB (β = -.70, p<.001), transgender questioning (β = -.91, p<.001), and being unsure of one’s gender identity and sexual orientation (β = -1.05), p<.001) were associated with a range of approximately 7 to 13 months earlier age of first drink. In all models, depression, partner violence, and forced sex were significantly associated with greater alcohol use and binge rates, and earlier age of first drink when controlling for demographics.  

Conclusions & Implications: The finding that different intersectional identities confer varying levels of risk suggests that interventions targeting youth alcohol misuse should consider the unique identities of transgender youth of various sexual orientations. Additionally, results suggest that youth may use alcohol to cope with victimization and depression and may benefit from trauma-informed integrated services for alcohol use and mental health.