Gender Diversity, Substance Cognitions, and Alcohol, Nicotine/Tobacco, and Cannabis Use Among Youth.

Purpose: We aimed to classify youth using a longitudinal, multidimensional construct of gender, and examine associations of gender subgroups with substance cognitions and substance use. Methods: We used data from the Adolescent Brain Cognitive Development study (N = 11,868 youth ages 9-10 years at baseline [2016-2018] through the year 4 follow-up [ages 13-14 years, 2020-2022]) to conduct latent class models using measures of gender identity, felt gender, gender expression, and gender non-contentedness. We used multivariable logistic regression to assess associations of gender classes with curiosity to use, intention to use, and use of alcohol, nicotine/tobacco, and cannabis, respectively, adjusting for sociodemographic factors. Results: A four-class model was selected based on model fit: transgender (2.5%), questioning (9.0%), naïve (36.3%), and cisgender (52.1%). Youth in the questioning and transgender classes were more likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis (adjusted odds ratio [aOR] range 1.68-2.45, p < 0.001) and intention to use alcohol and nicotine/tobacco (questioning youth; aOR range 1.69-1.88, p < 0.01) or nicotine/tobacco and cannabis (transgender youth; aOR range 2.66-3.14, p < 0.001) but not actual use of alcohol, nicotine/tobacco, and cannabis, whereas members of the naïve class were less likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis, intention to use cannabis, and use of alcohol, nicotine/tobacco, and cannabis (aOR range 0.48-0.81, p < 0.001), relative to cisgender youth. Conclusion: These findings suggest that a more nuanced understanding of gender among preadolescent youth and their heterogeneous risk for substance use is critical for the development of early prevention services. The timing of prevention efforts may be ideal during this developmental period.