Association between gender diversity and substance use experimentation in early adolescents

Background: Gender diversity, encompassing gender identity beyond traditional binary frameworks, has been associated with substance use during adolescence. However, there is a paucity of studies that consider different dimensions of gender diversity. This study investigates associations between multiple dimensions of gender diversity and substance experimentation in early adolescents. Methods: Data from 10,092 adolescents aged 12–13 years from the Adolescent Brain Cognitive Development (ABCD) study were used to assess the relationship between gender diversity and substance experimentation. Gender diversity was measured using multiple dimensions, including identity (transgender), felt gender (congruence between gender identity and assigned sex), gender non-contentedness (dissatisfaction with one's gender), gender expression (adherence to gender expression norms), and place on the gender spectrum (masculine to feminine). Substance use was evaluated using self-reported lifetime and new experimentation (past year) of alcohol, nicotine, and cannabis use. Logistic regression models adjusted for sociodemographic factors were analyzed. Results: More gender-diverse responses for felt gender, gender non-contentedness, gender expression, and gender spectrum were associated with higher odds of lifetime alcohol experimentation. More gender-diverse responses for gender identity and gender non-contentedness were associated with higher odds of new nicotine experimentation, and more gender-diverse responses for gender identity, felt gender, gender non-contentedness, and gender expression were associated with higher odds of lifetime and new cannabis experimentation. Conclusion: Gender diversity is differentially associated with new and lifetime substance experimentation in early adolescence. Different dimensions of gender diversity may be uniquely associated with substance use behaviors, highlighting the need for targeted interventions in gender-diverse adolescents.