Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes.

BACKGROUND AND PURPOSE: Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated. METHODS: Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback. RESULTS: Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms. CONCLUSIONS: TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.

Many transgender and gender diverse (TGD) adults experience discrimination and victimization related to their minoritized gender, referred to as minority stress. Minority stress may put TGD adults at risk of drinking more alcohol and experiencing related harms in order to cope. To examine this possibility, we recruited 25 TGD adults and asked them to complete surveys multiple times per day (i.e., once daily in the morning, and two additional surveys at random times) on their personal cell phones. Using multilevel models, we examined the relations between experiencing minority stressors as well as resilience factors on alcohol-related outcomes. In doing so, we identified that gender minority stress was related to increased alcohol use, alcohol-related harms, negative mood, and drinking to cope motives. Furthermore, it appeared that the increased alcohol use following minority stress could be partly explained by desiring to drink to cope. Resilience did not protect TGD adults from increased alcohol use or harms, and in some cases was related to increased alcohol use. The results support that TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support healthier coping strategies.

A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults.

BACKGROUND AND AIMS: Experiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex- and gender-based cut-offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender-non-inclusive language and cut-offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals. METHODS: We reviewed 22 measures of harmful drinking for gendered language and sex- and gender-based cut-off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations. RESULTS: Six of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex- or gender-based cut-off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT-C) appear reliable for transgender adults (Cronbach's α: AUDIT [0.81-0.87] and AUDIT [0.72-0.8)]). There is initial support for using uniform cut-offs for transgender people for the AUDIT-C (≥3) and binge drinking (≥5 drinks in a sitting). CONCLUSIONS: Most existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut-off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive.