Heavy episodic drinking among transgender persons: Disparities and predictors.

BACKGROUND: Drawing on a survey of transgender people in Canada's most populous province, we estimate the frequency of heavy episodic drinking (HED), compare HED prevalence to the age-standardized background population, and examine associations with socio-demographics, gender transition, and social exclusion.

METHODS: 433 transgender persons aged 16+ completed a respondent-driven sampling survey in 2009-2010. Analyses were weighted using RDS II methods, including frequencies and prevalence ratios. Overall and sex-specific estimates of HED among Ontario residents in the 2009-2010 Canadian Community Health Survey (n=39,980) were standardized to the overall and gender-specific transgender age distributions.

RESULTS: Estimated prevalence of HED at least monthly among transgender Ontarians was 33.2% (95% CI: 26.3, 40.1), 1.5 times greater than expected based on the age-standardized Ontario population. Transmasculine (female-to-male spectrum) persons were more likely than transfeminine persons to report HED (42.2% versus 22.7%), an effect robust to covariate adjustment. Current sex work was associated with greater HED, but gender transition and social exclusion factors were not.

CONCLUSION: Gendered pathways to alcohol misuse, particularly among transmasculine persons, warrant further research and intervention development.