Transgender and gender nonconforming (TGNC) individuals face a unique set of discriminatory challenges and obstacles in many aspects of their lives as they navigate American society. Whether these be related to healthcare inequality, employment practices, or day-to-day harassment, TGNC identifying adults are placed at an elevated risk for mental and behavioral health concerns due to the nature of these societal barriers to well-being. While the literature concerning the mental and behavioral health of TGNC individuals is limited, it has been suggested that this population may be susceptible to harmful alcohol-related outcomes due to the aforementioned variables, among others. This study aims to identify the associations between discrimination and alcohol use in a sample of TGNC college students.
A sample of 16 students from various undergraduate institutions across the United States was enrolled in the study on a rolling basis from 09/2017-01/2019. Eligibility criteria included being currently enrolled full or part-time at any undergraduate institution in the United States, being 18-29 years old, and identifying as TGNC. Using a qualitative approach, the participants were assigned to complete either one of two focus groups (consisting of three or six total participants) or one of six individual interviews. Demographic measures were recorded for all participants, and the focus group/interviews assessed the following themes: general stressors related to the experience of TGNC identity, coping methods, alcohol use, and recommendations regarding alcohol-related interventions for TGNC individuals. These conversations were transcribed and coded according to an inductive thematic analysis procedure. Data analysis was performed by three study authors of heterogeneous race/ethnicity, sexual orientation, gender identity, and socioeconomic background.
Results of the qualitative analysis found TGNC individuals confirmed an array of stressors related to their day-to-day experiences which included sexual harassment, assault, anxiety, body dysphoria, healthcare inequities, and family rejection. These themes could often be amplified when other characteristics related to race socioeconomic status intersected with gender and sexual identities. Coping was fulfilled positively in the form of social support, but other unhelpful forms of coping were discussed which included self-harm, alcohol use, and use of other substances. As participants described ideal intervention and support settings, the most common theme was that of representation in as many tiers of university structure as possible.
Takeaway: this study helps support the growing body of literature which describes the disproportionate number of challenges TGNC individuals face. Qualitative interview data affirms the suggestion that TGNC populations are placed at an elevated risk for coping-based substance use and inadequate mental healthcare.