Impact of structurally transphobic policy environment on harmful alcohol and substance use among transgender and nonbinary adults

Previous studies have demonstrated high prevalence of alcohol and substance use behaviors among transgender and gender-diverse (TGD) communities. Considering the recency of anti-trans policies in the US, it is critical to understand whether structural anti-trans factors are associated with substance use outcomes. To fill this gap, we examined the associations between factors that make up a structurally anti-trans policy environment and unhealthy alcohol use and drug use among TGD adults. Using data from the Priority Assessment in Trans Health (PATH) Project (n = 797), multivariable regression modeling using nonparametric bootstrapping methods (resampling = 1000) were used to assess associations between structurally anti-trans policy environment indicators and harmful alcohol use (HAU) and harmful drug use (HDU) (abuse, dependence, disorders, etc.). The sample was predominately comprised of young adult trans women (81.9%), ages 25-34 (81.7%). Over one-third identified as people of color (39.7%). Overall, 52.8% reported HAU and 5.6% reported HDU. Accurate knowledge of state-level anti-hate-crime laws was associated with reduced odds of HAU (OR = 0.69 [95% CI: 0.53, 0.90]; p = 0.006). In a separate model, higher awareness of anti-trans bills was associated with increased odds of reporting HDU (OR = 1.62 [95% CI: 1.09, 2.40]; p = 0.02). There were no significant differences between concerns about trans rights being taken away and alcohol or drug use. Findings indicate that awareness of anti-trans bills is associated with increased unhealthy drug use, while knowledge of state-level anti-hate-crime laws is associated with decreased unhealthy alcohol use. Protecting social safety should be prioritized for TGD individuals, as this may serve as a protective factor against risk behaviors.