An ecological momentary assessment study of predictors for alcohol outcomes in transgender and gender diverse youth

Background and AimsThis study examined how gender minority stressors and resilience experienced by transgender and gender diverse (TGD) youth relate to daily and momentary occurrences of alcohol use risk processes (e.g., alcohol craving, drinking motives, and distress), alcohol use, and alcohol-related harms. The feasibility of ecological momentary assessment (EMA) was evaluated.MethodsForty TGD youth (mean 22.42 years [SD = 3.03]; range 18-29) completed a baseline interview followed by 21 days of EMA. Daily morning surveys assessed stressors and resilience, alcohol risk processes, use and harms experienced "yesterday" and twice-daily random surveys assessed most of these experiences in the "past 30 min" or "right now."ResultsUsing multilevel models, at the daily (within-person) level, gender minority stressors were significantly related to increased alcohol use (incidence rate ratio (IRR) = 1.16, 95% confidence interval [CI]: 1.03-1.32), drinking to cope (B = 0.16, 95% CI: 0.06-0.26), psychological distress (B = 0.19, 95% CI: 0.03-0.35) and alcohol craving (B = 0.05, 95% CI: 0.01-0.10), but not alcohol harms or negative affect. At the momentary (within-person) level, gender minority stress was associated with increased drinking to cope (B = 0.76, 95% CI: 0.51-1.01), alcohol craving (B = 0.43, 95% CI: 0.31-0.55), and negative affect (B = 2.17, 95% CI: 1.31-3.02). Daily resilience was also associated with increased alcohol use (IRR = 1.32, 95% CI: 1.15-1.52), but not craving or negative affect. Momentary resilience was associated with reduced drinking to cope (B = -0.56, 95% CI: -0.88, -0.23) and negative affect (B = -0.52, 95% CI: -0.81, -0.23), but not craving. Adherence rates and participants' ratings about study acceptability were favorable.ConclusionsGender minority stressors are a risk factor for same-day alcohol use. Resilience factors may be associated with increased alcohol use through other mechanisms (e.g., drinking for social or conformity reasons). Interventions to reduce TGD youth's alcohol use should address gender minority stressors and support TGD youth to cope with these stressors.