Research Article
Violence Victimization, Substance Use Disparities, and Gender-Nonconforming Youth

https://doi.org/10.1016/j.amepre.2019.12.021Get rights and content

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.

Section snippets

INTRODUCTION

Gender-nonconforming adolescents, that is, those whose appearance or behaviors do not align with the societal expectations of their gender,1,2 may experience higher risk for substance use than gender-conforming youth.3, 4, 5 Given the well-documented negative effects of adolescent substance use on developmental, social, and health outcomes,6 disproportionate rates of substance use raise important questions about what factors may be driving this trend. One potential explanatory mechanism may be

Study Sample

As part of the Youth Risk Behavior Surveillance System, conducted by the Centers for Disease Control and Prevention (CDC), approximately 20 large urban school districts conduct the Youth Risk Behavior Survey (YRBS) biennially using a 2-stage cluster sample design to produce a representative sample of public high school students in Grades 9–12 within each jurisdiction. In 2015, three of these large urban school districts included an optional question on their YRBS questionnaire for assessing

RESULTS

Among the total student population, 76.8% of male and 82.5% of female students were gender conforming; 10.2% of male and 13.5% of female students were equally feminine/masculine; and 13.0% of male and 4.0% of female students were gender nonconforming (Table 1). Both male and female students experienced violence victimization, with some variation in the types of violence victimizations experienced. The prevalence of violence victimization categories ranged from 6.5% to 12.8% among male students,

DISCUSSION

Gender nonconformity may have implications for a substantial segment of this population, with approximately 1 in 5 (23.2% of male and 17.5% of female) high school students reported having an equally feminine/masculine or a gender-nonconforming expression. The present findings are consistent with previous research that has shown gender-nonconforming youth experience high rates of harassment and victimization, as well as increased substance use, compared to their gender-conforming peers.4,5,16, 17

CONCLUSIONS

The findings suggest that some substance use among gender-nonconforming male students may occur in response to the greater prevalence of violence victimizations they experience. Developing support systems within schools and linking school and community resources for gender-nonconforming students may be an important avenue to improve mental health and reduce substance use in this population. Possible interventions include providing safe spaces and school staff contacts who are knowledgeable and

ACKNOWLEDGMENTS

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

No financial disclosures were reported by the authors of this paper.

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