Abstract
Transgender and gender diverse young adults (TGDYA) report higher prevalence of substance use than cisgender peers, but little is known about how patterns of substance use may differ among TGDYA subgroups. Understanding heterogeneity in substance use among TGDYA can inform tailored substance use disorder (SUD) prevention. This study described prevalence of seven types of substance use among TGDYA across various social identities and lived experiences. Data were analyzed from 12,525 TGDYA ages 18-25 years from the 2015 United States Transgender Survey. Participants completed a one-time online survey that assessed multiple substance use outcomes (alcohol use, heavy episodic drinking, marijuana use, cigarette, e-cigarette or vape product use, other illicit drug use, non-medical prescription use), social identity correlates (binary vs. nonbinary gender identity, sex assigned at birth, race/ethnicity, sexual orientation), and covariates/confounders. All social identity correlates were significantly associated with increased use of at least one substance, though directionality of subgroup risk varied. For example, nonbinary respondents were more likely than binary respondents to report some types of substance use (e.g., alcohol), but less likely to report other types (e.g., e-cigarette). All covariates were also significantly associated with increased use of at least one substance, with visual gender-nonconformity and sex work evincing the most consistent associations across substances. Findings demonstrate extensive intracommunity diversity in substance use prevalence among TGDYA. Tailored SUD prevention must account for such diversity, and future research must further quantify the impact of intersecting identities, gendered norms, and socioeconomic context on substance use among TGDYA.