Heavy drinking and drinking harms for cisgender and transgender college students

Objective: We examined alcohol use and harms, and their interrelations among cisgender and transgender college students. Method:  We conducted a secondary analysis a U.S. sample of 4-year college students (n=242,624; M age =20.24, SD=1.67; 12.31% Hispanic/Latinx and 62.11% non-Hispanic/Latinx White, 3.99% Black, 11.88% Asian or Pacific Islander, 0.37% American Indian, Alaskan Native or Native Hawaiian, 9.35% Multiracial/ethnic/other). These outcomes were compared between cisgender women (68.53%) and cisgender men (29.27%), transgender men (0.91%), transgender women (0.23%), and non-binary students (1.06%): level (number of drinks) of recent alcohol use, frequency of binge drinking (≥ 5 drinks) in the past 2 weeks, and occurrence and count of harms while drinking in past year. Gender differences in the association between drinking level and consequences were also examined. Results: Cisgender women were the reference group for all of the comparisons. Cisgender men reported less occurrence of regret, sex without their consent, and unprotected sex when drinking, but greater occurrence of injury and trouble with police. Transgender women and non-binary individuals reported lower odds of regret and unprotected sex when drinking. Transgender men reported increased odds of sex without their consent when drinking. All transgender subgroups reported increased odds of suicidal ideation when drinking. Finally, associations between level of recent drinking and odds of experiencing harms differed by gender identity. Conclusions: Patterns of alcohol use, consequences, and their interrelationship differed for cisgender men, transgender women and men, and non-binary individuals relative to cisgender women. There is a need for gender-inclusive prevention for alcohol harms among students.