Introduction
Exposure to violence victimization may help explain disparities of substance use among
gender-nonconforming youth (i.e., those whose gender expression differs from societal
expectations).
Methods
In 2015, three large urban school districts (2 in California and 1 in Florida) conducted
a Youth Risk Behavior Survey that included the assessment of gender expression among
a racially/ethnically diverse population-based sample of 6,082 high school students.
Five categories of violence victimization were assessed (felt unsafe at school, threatened
or injured with a weapon at school, bullied at school, electronically bullied, and
forced sexual intercourse). In 2019, the effect of violence victimization on substance
use disparities was examined by calculating sex-stratified prevalence ratios by gender
nonconformity, adjusted for sexual identity, race/ethnicity, and grade (adjusted prevalence
ratio 1 [APR1]), and comparing these with prevalence ratios adjusted for those variables
plus violence victimization (adjusted prevalence ratio 2 [APR2]).
Results
Among female students, only being threatened or injured with a weapon was significantly
(p<0.05) associated with gender nonconformity and there were no substance use disparities
by gender nonconformity. Among male students, every category of violence victimization
was more prevalent among gender-nonconforming than among gender-conforming students
and most substance use categories demonstrated significant gender nonconformity disparities.
After controlling for violence victimization, these disparities decreased but remained
statistically significant for the use of cocaine (APR1=2.84 vs APR2=1.99), methamphetamine
(APR1=4.47 vs APR2=2.86), heroin (APR1=4.55 vs APR2=2.96), and injection drug use
(APR1=7.90 vs APR2=4.72).
Conclusions
School-based substance use prevention programs may benefit from strategies that support
gender diversity and reduce violence victimizations experienced by gender-nonconforming
students, by providing a safe and supportive school environment.
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Article Info
Publication History
Published online: March 05, 2020
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
