Abstract
INTRODUCTION: This study examined an intersectional perspective on alcohol use disparities within transgender and nonbinary (TGNB) adults. METHODS: We examined the data from the 2015 U.S. Transgender Survey (N = 27,715), a cross-sectional, nationwide survey of TGNB adults. The number of drinking days and the number of binge-drinking days were primary outcomes. Analyses followed a multilevel analysis of individual heterogeneity and discriminatory accuracy approach to examine alcohol disparities across gender identities (transgender, nonbinary and crossdresser) and intersections with race/ethnicity, age, sex assigned at birth and dis/ability status. RESULTS: Significant identity-related differences existed within TGNB communities across all facets of identity. Relative to the sample average, individuals at the intersection of White and crossdressers reported elevated levels of alcohol use. Further, effects were most pronounced across combinations of transgender, nonbinary, White and Black participants to accurately describe alcohol risk in subpopulations relative to examining risk associated with each one of these identities independently. DISCUSSION AND CONCLUSIONS: Disparities in alcohol use among TGNB adults are best understood from an intersectional perspective. Affirming public health initiatives for alcohol use should consider identity-related differences across TGNB communities. SCIENTIFIC SIGNIFICANCE: Results provide the first evidence that alcohol use disparities exist across gender and intersecting identities in a large sample of TGNB adults. Findings lay the groundwork for future research examining mechanisms responsible for these disparities.