title: Heavy episodic drinking among transgender persons: Disparities and predictors.
abstract: Drawing on a survey of transgender people in Canada's most populous province, we estimate the frequency of heavy episodic drinking (HED), compare HED prevalence to the age-standardized background population, and examine associations with socio-demographics, gender transition, and social exclusion.
  
  
  
  433 transgender persons aged 16+ completed a respondent-driven sampling survey in 2009-2010. Analyses were weighted using RDS II methods, including frequencies and prevalence ratios. Overall and sex-specific estimates of HED among Ontario residents in the 2009-2010 Canadian Community Health Survey (n=39,980) were standardized to the overall and gender-specific transgender age distributions.
  
  
  
  Estimated prevalence of HED at least monthly among transgender Ontarians was 33.2% (95% CI: 26.3, 40.1), 1.5 times greater than expected based on the age-standardized Ontario population. Transmasculine (female-to-male spectrum) persons were more likely than transfeminine persons to report HED (42.2% versus 22.7%), an effect robust to covariate adjustment. Current sex work was associated with greater HED, but gender transition and social exclusion factors were not.
  
  
  
  Gendered pathways to alcohol misuse, particularly among transmasculine persons, warrant further research and intervention development.
authors.affiliation: Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada. Electronic address: ayden.scheim@schulich.uwo.ca.
authors.forename: Ayden I
authors.initials: AI
authors.lastname: Scheim
authors.affiliation: Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada. Electronic address: greta.bauer@schulich.uwo.ca.
authors.forename: Greta R
authors.initials: GR
authors.lastname: Bauer
authors.affiliation: Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, K201 Kresge Building, ON N6A 5C1, London, Ontario, Canada. Electronic address: mshokooh@uwo.ca.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Shokoohi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D063425:Binge Drinking / Q000453:epidemiology*; D002170:Canada; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D063106:Transgender Persons / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Alcohol use; Heavy drinking; Respondent-driven sampling; Survey research; Transgender