Gender Identity Outness, Gender-Based Bullying, and Substance Use Frequency Among Transgender and Nonbinary Youth.

Transgender and nonbinary (TNB) youth are at increased risk of bullying and substance use, and gender identity outness may play a role. These associations may also differ for subgroups of TNB youth given evidence of gender differences in bullying and substance use. The current study tested the indirect effects of gender identity outness on substance use through gender-based bullying and the differences among TNB subgroups. We used data from a cross-sectional national sample of 3,726 TNB youth collected in 2017 to examine the indirect effects of gender identity outness on substance use (alcohol use, heavy episodic drinking [HED], marijuana use, cigarette use) through gender-based bullying. Moderated mediation analyses tested potential differences in associations by TNB subgroup (transgender boys, transgender girls, nonbinary youth assigned female at birth [AFAB], nonbinary youth assigned male at birth [AMAB]). Gender identity outness was indirectly associated with all substance use outcomes through gender-based bullying. TNB subgroups moderated specific pathways in the models. Greater outness was associated with more gender-based bullying for nonbinary youth AFAB and transgender boys (stronger association for nonbinary youth AFAB). Greater gender-based bullying was associated with more HED and marijuana use for nonbinary youth AFAB and transgender boys (stronger associations for transgender boys). Last, greater outness was associated with more HED only for nonbinary youth AMAB. Gender-based bullying may be an underlying mechanism between gender identity outness and substance use among TNB youth, and outness may be a stronger risk factor for bullying and alcohol use for nonbinary youth than for other transgender youth. [ABSTRACT FROM AUTHOR]