title: Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults.
abstract: BACKGROUND
  Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED).
  
  
  METHODS
  Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females.
  
  
  RESULTS
  Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization.
  
  
  CONCLUSIONS
  Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA. Electronic address: Robert.ws.coulter@gmail.com.
authors.forename: Robert W S
authors.initials: RW
authors.lastname: Coulter
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA; Department of Veterans Affairs, Center for Health Equity Research and Promotion, University Drive C (151C-U), Building 30, Pittsburgh, PA 15240, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Blosnich
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Bukowski
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Herrick
authors.affiliation: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Siconolfi
authors.affiliation: Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.
authors.forename: Ron D
authors.initials: RD
authors.lastname: Stall
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D019548:Crime Victims / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005783:Gender Identity; D006306:Health Surveys; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol use; Alcohol-related problems; Heavy episodic drinking; Transgender; Violence