Association of Transphobic Discrimination and Alcohol Misuse Among Transgender Adults: Results from the U.S. Transgender Survey

Background and Purpose: Alcohol misuse is a leading preventable risk factor for morbidity and mortality in the United States. Scant extant studies suggest that alcohol misuse (i.e., binge drinking and frequent binge drinking) is more prevalent among transgender populations compared to cisgender people. The Gender Minority Stress Model explains how discrimination based on gender identity/expression can produce psychological distress among transgender people. They experience transphobic discrimination in multiple domains (e.g., education settings, employment or workplace, housing, healthcare settings, and public spaces). This excess tension in the social environment can influence their health risk behaviors, which can lead to adverse health outcomes.

Transgender populations are not monolithic. While previous studies have compared alcohol misuse between transgender women and transgender men, our study extends the current literature by including additional gender identity/expression subgroups (e.g., non-binary/genderqueer and cross-dressers) as well as other transgender-specific factors in our analyses. The objectives of this study are to: 1) examine the association between transphobic discrimination and alcohol use/misuse among transgender adults; 2) assess transphobic discrimination across multiple social domains as potential correlates of alcohol use/misuse; and 3) examine differences among transgender subgroups in their odds of alcohol use/misuse.

Methods: This study used cross-sectional national data (N=27,715) from the 2015 U.S. Transgender Survey. Data were collected through online surveys from transgender adults (aged 18 and above). The sample was weighted to be more representative of the U.S. population from which it was drawn. We conducted multivariable logistic regression models to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (CI) of current alcohol use, binge drinking, and frequent binge drinking among transgender women, transgender men, non-binary/genderqueer people assigned female at birth, non-binary/genderqueer people assigned male at birth, and cross-dressers.

Results: Of the respondents, 60.4% reported current alcohol use, 24.3% reported past month binge drinking, and 8.5% reported past month frequent binge drinking. The majority (70.1%) of transgender individuals had experienced some form of past-year transphobic discrimination. Experiencing three or more forms of transphobic discrimination was significantly associated with binge drinking (AOR=1.49, 95% CI=1.37-1.62) and frequent binge drinking (AOR=1.57, 95% CI=1.37-1.79) compared to individuals who did not experience transphobic discrimination. Cross-dressers showed higher odds of current alcohol use (AOR=1.52, 95% CI=1.32-1.74), binge drinking (AOR=2.51, 95% CI=2.21-2.85), and frequent binge drinking (AOR=4.13, 95% CI=3.45-4.94) compared to transgender women. Discrimination within the public spaces and housing domains had the most robust associations with alcohol misuse.

Conclusions and Implications: Seven in every 10 transgender individuals experienced transphobic discrimination in the past year. Experiencing transphobic discrimination increased the odds of alcohol misuse among transgender people. Social workers and other health professionals should be cognizant of the multifaceted and pervasive nature of transphobic discrimination as unique social stressors that the majority of transgender persons experience and advocate for non-discrimination policies protecting transgender individuals. Our study provides a strong rationale for embracing gender diversity and lessening transphobic discrimination as a potential pathway for decreasing alcohol misuse among transgender populations.