{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:55:06Z","timestamp":1760057706494,"version":"build-2065373602"},"reference-count":65,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Purpose: Although several studies have shown a relationship between anti-transgender experiences and binge drinking and\/or hazardous drinking, very little research has examined how these experiences relate to heavy drinking. That is the focus of this study. Methods: This paper uses data from the 2015 National Transgender Survey, and is based on a sample of 17,367 transgender adults residing in the United States. Analyses compare three groups: current \u201cregular\u201d drinkers (drank at least some alcohol during the previous month but no days consuming five or more drinks) (n = 10,496), binge drinkers (consumption of five or more drinks on at least one occasion during the previous month) (n = 4977), and heavy drinkers (five or more drinks per day on five or more days during the previous month) (n = 1894). The paper focuses on how anti-transgender experiences with harassment, discrimination, and\/or violence (a 20-item scale measure, Cronbach\u2019s alpha = 0.76) are related to people\u2019s classification as current drinkers versus binge drinkers versus heavy drinkers. Results: 13.8% of the participants met the criteria for heavy drinking; 26.4% more were classified as binge drinkers. The more anti-transgender experiences people had, the more likely they were to engage in heavy drinking. Multivariate analyses revealed that this relationship was a robust one, holding up even when numerous other potentially confounding control measures were included in the analyses. Conclusions: Anti-transgender experiences are a strong predictor of heavy drinking. This type of minority stressor is an important consideration when understanding what leads many transgender individuals to become heavy drinkers.<\/jats:p>","DOI":"10.3390\/bs15030248","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:47:46Z","timestamp":1740109666000},"page":"248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Relationship Between Anti-Transgender Experiences (A Proxy for Minority Stress) and Heavy Alcohol Use Among Transgender Adults"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1764-668X","authenticated-orcid":false,"given":"Hugh","family":"Klein","sequence":"first","affiliation":[{"name":"Kensington Research Institute, Silver Spring, MD 20910, USA"},{"name":"School of Social Work, California State University, Long Beach, CA 90840, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas Alex","family":"Washington","sequence":"additional","affiliation":[{"name":"School of Social Work, California State University, Long Beach, CA 90840, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref_1","unstructured":"Alcohol Change UK (2024, December 30). Understanding the language around different patterns of drinking, Available online: https:\/\/alcoholchange.org.uk\/policy\/policy-insights\/understanding-the-different-patterns-of-drinking."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1080\/00918369.2016.1236587","article-title":"The impact of social connectedness and internalized transphobic stigma on self-esteem among transgender and gender-nonconforming adults","volume":"64","author":"Austin","year":"2017","journal-title":"Journal of Homosexuality"},{"key":"ref_3","unstructured":"Brooks, V. R. (1981). Minority stress and lesbian women, Lexington Books."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2024, December 30). Available online: www.cdc.gov\/alcohol\/excessive-drinking-data\/index.html."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101544","DOI":"10.1016\/j.eatbeh.2021.101544","article-title":"Rumination and eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress","volume":"42","author":"Cusack","year":"2021","journal-title":"Eating Behaviors"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dolezal, M. L., Decker, M., Higgins, M., and Littleton, H. (2023). Evaluation of the gender minority stress model in transgender and gender diverse college students. Psychology of Sexual Orientation and Gender Diversity.","DOI":"10.1037\/sgd0000669"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1080\/01612840.2021.1961330","article-title":"Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: A systematic review of qualitative studies","volume":"43","author":"Drabish","year":"2022","journal-title":"Issues in Mental Health Nursing"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105849","DOI":"10.1016\/j.psyneuen.2022.105849","article-title":"Lived experience and allostatic load among transmasculine people living in the United States","volume":"143","author":"DuBois","year":"2022","journal-title":"Psychoneuroendocrinology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110880","DOI":"10.1016\/j.drugalcdep.2023.110880","article-title":"Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review","volume":"250","author":"Fahey","year":"2023","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1111\/andr.13052","article-title":"Health and health care access in the U.S. TRansgender population health (TransPop) survey","volume":"9","author":"Feldman","year":"2021","journal-title":"Andrology"},{"key":"ref_11","unstructured":"Ferina, K. S. (2024, December 30). The experiences of stress and resilience on the allostatic load of transgender and gender non-binary individuals during secondary school: How their experiences can inform best practices, Available online: https:\/\/digitalcommons.molloy.edu\/cgi\/viewcontent.cgi?article=1194&context=etd."},{"key":"ref_12","unstructured":"First Step Behavioral Health (2024, December 30). Binge drinking vs. heavy drinking: What is the difference?, Available online: https:\/\/firststepbh.com\/blog\/binge-drinking-vs-heavy-drinking-what-is-the-difference."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.drugalcdep.2018.01.016","article-title":"Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies","volume":"186","author":"Gilbert","year":"2018","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_14","first-page":"51","article-title":"Sexual identity and heavy drinking among adults in Canada by racially minoritized status and income, 2015\u20132020","volume":"12","author":"Gitelman","year":"2024","journal-title":"LGBT Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10935-017-0469-4","article-title":"Demographic characteristics, components of sexuality and gender, and minority stress and their associations to excessive alcohol, cannabis, and illegal (noncannabis) drug use among a large sample of transgender people in the United States","volume":"38","author":"Gonzalez","year":"2017","journal-title":"Journal of Primary Prevention"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000510696","article-title":"Allostatic load and its impact on health: A systematic review","volume":"90","author":"Guidi","year":"2021","journal-title":"Psychotherapy and Psychosomatics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1089\/lgbt.2020.0031","article-title":"Mental health and health risk behaviors of active duty sexual minority and transgender service members in the United States military","volume":"8","author":"Holloway","year":"2021","journal-title":"LGBT Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1080\/00918369.2014.872502","article-title":"A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons","volume":"61","author":"Horvath","year":"2014","journal-title":"Journal of Homosexuality"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/ajcp.12138","article-title":"Depression among transgender older adults: General and minority stress","volume":"59","year":"2017","journal-title":"American Journal of Community Psychology"},{"key":"ref_20","unstructured":"James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., and Anafi, M. (2016). The report of the 2015 U.S. transgender survey, National Center for Transgender Equality."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s10935-021-00646-z","article-title":"Trauma and alcohol use among transgender and gender diverse women: An examination of the stress-buffering hypothesis of social support","volume":"42","author":"Johnson","year":"2021","journal-title":"Journal of Primary Prevention"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.neubiorev.2009.10.002","article-title":"Allostatic load biomarkers of chronic stress and impact on health and cognition","volume":"35","author":"Juster","year":"2010","journal-title":"Neuroscience and Biobehavioral Reviews"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108223","DOI":"10.1016\/j.drugalcdep.2020.108223","article-title":"Association of transphobic discrimination and alcohol misuse among transgender adults: Results from the U.S. transgender survey","volume":"215","author":"Kcomt","year":"2020","journal-title":"Drug and Alcohol Dependency"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1017\/S0033291702006074","article-title":"Short screening scales to monitor population prevalences and trends in non-specific psychological distress","volume":"32","author":"Kessler","year":"2002","journal-title":"Psychological Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.addbeh.2019.04.017","article-title":"Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort of transgender individuals: Implications for culturally-tailored prevention and treatment efforts","volume":"96","author":"Kidd","year":"2019","journal-title":"Addictive Behaviors"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/abac.12172","article-title":"Choosing the level of significance: A decision-theoretic approach","volume":"57","author":"Kim","year":"2021","journal-title":"ABACUS"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kimber, B., Oxlad, M., and Twyler, L. (2024). The impact of microaggressions on the mental health of trans and gender-diverse people: A scoping review. International Journal of Transgender Health, 1\u201321.","DOI":"10.1080\/26895269.2024.2380903"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/10826084.2023.2293731","article-title":"The relationship of anti-transgender discrimination, harassment, and violence to binge drinking among transgender adults","volume":"59","author":"Klein","year":"2023a","journal-title":"Substance Use and Misuse"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1891\/USW-2022-0016","article-title":"Transition milestones and psychological distress in transgender adults","volume":"7","author":"Klein","year":"2023b","journal-title":"Urban Social Work"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"302228231221308","DOI":"10.1177\/00302228231221308","article-title":"Transition milestones, psychological distress, and suicidal ideation among transgender adults: A structural equation analysis","volume":"8","author":"Klein","year":"2023c","journal-title":"OMEGA: Journal of Death and Dying"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1177\/0886260518760015","article-title":"Transphobia-based violence, depression, and anxiety in transgender women: The role of body satisfaction","volume":"36","author":"Klemmer","year":"2021","journal-title":"Journal of Interpersonal Violence"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/S0277-9536(03)00353-8","article-title":"Psychological mechanisms of socioeconomic differences in health","volume":"58","author":"Kristenson","year":"2004","journal-title":"Social Science and Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1089\/lgbt.2022.0039","article-title":"Disparities in mental health and health risk behaviors for LGBT veteran subgroups in a national U.S. survey","volume":"9","author":"Lehavot","year":"2022","journal-title":"LGBT Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1089\/trgh.2020.0042","article-title":"Using a comprehensive proximal stress model to predict alcohol use","volume":"6","author":"Lindley","year":"2021","journal-title":"Transgender Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1080\/10826084.2023.2238305","article-title":"Examining differences in substance use outcomes and related correlates among transfeminine and transmasculine adults using the 2017 New York state patient characteristics survey","volume":"58","author":"Mammadli","year":"2023","journal-title":"Substance Use and Misuse"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1001\/archinte.1993.00410180039004","article-title":"Stress and the individual mechanisms leading to disease","volume":"153","author":"McEwen","year":"1993","journal-title":"Archives of Internal Medicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1037\/sah0000070","article-title":"A minority stress perspective on transgender individuals\u2019 experiences with misgendering","volume":"3","author":"McLemore","year":"2018","journal-title":"Stigma and Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2307\/2137286","article-title":"Minority stress and mental health in gay men","volume":"36","author":"Meyer","year":"1995","journal-title":"Journal of Health and Social Behavior"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1037\/sgd0000545","article-title":"Determinants of mental health outcomes among transgender Latinas: Minority stress and resilience processes","volume":"10","author":"Bacio","year":"2023","journal-title":"Psychology of Sexual Orientation and Gender Diversity"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1002\/eat.23537","article-title":"The effect of misgendering on body dissatisfaction and dietary restraint in transgender individuals: Testing a Misgendering-Confluence Process","volume":"54","author":"Mitchell","year":"2021","journal-title":"International Journal of Eating Disorders"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.beth.2022.02.006","article-title":"Disordered eating and body dissatisfaction in transgender and gender-expansive adults: An evaluation and integration of the gender minority stress and resilience and tripartite influence models","volume":"53","author":"Muratore","year":"2022","journal-title":"Behavior Therapy"},{"key":"ref_42","unstructured":"National Institute on Alcohol Abuse and Alcoholism (2024, December 30). Drinking levels and patterns defined, Available online: www.niaaa.nih.gov\/alcohol-health\/overview-alcohol-consumption\/moderate-binge-drinking."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1037\/sgd0000347","article-title":"Heterogeneity of transgender identity nonaffirmation microaggressions and their association with depression symptoms and suicidality among transgender persons","volume":"6","author":"Parr","year":"2019","journal-title":"Psychology of Sexual Orientation and Gender Diversity"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"102113","DOI":"10.1016\/j.cpr.2021.102113","article-title":"Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis","volume":"91","author":"Pellicane","year":"2022","journal-title":"Clinical Psychology Review"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Pletta, D. R., Chen, J. T., Reisner, S. L., Hughto, J. M. W., and Austin, S. B. (2024). Gender minority stress is associated with past-year suicidal ideation in a national probability sample of transgender and gender diverse adults. Psychology of Sexual Orientation and Gender Diversity.","DOI":"10.1037\/sgd0000760"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.amepre.2021.05.019","article-title":"Cardiovascular disease in a population-based sample of transgender and cisgender adults","volume":"61","author":"Poteat","year":"2021","journal-title":"American Journal of Preventive Medicine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1037\/abn0000814","article-title":"Daily experiences of minority stress and mental health in transgender and gender-diverse individuals","volume":"132","author":"Puckett","year":"2023a","journal-title":"Journal of Psychopathology and Clinical Science"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"109921","DOI":"10.1016\/j.drugalcdep.2023.109921","article-title":"Differential associations between enacted and expected stigma with psychological distress, alcohol use, and substance use in transgender and gender diverse people","volume":"248","author":"Puckett","year":"2023b","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Reisner, S. L., and Hughto, J. M. W. (2019). Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221583"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1037\/ser0000581","article-title":"Approach and avoidant coping among black transgender women who have experienced violence: A qualitative analysis","volume":"19","author":"Sherman","year":"2022","journal-title":"Psychological Services"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1089\/lgbt.2019.0336","article-title":"Association of depression and post-traumatic stress with polyvictimization and emotional transgender and gender diverse community connection among Black and Latinx transgender women","volume":"7","author":"Sherman","year":"2020","journal-title":"LGBT Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"109434","DOI":"10.1016\/j.drugalcdep.2022.109433","article-title":"Disparities in alcohol use and heavy episodic drinking among bisexual people: A systematic review, meta-analysis, and meta-regression","volume":"235","author":"Shokoohi","year":"2022","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_53","unstructured":"SMART Recovery (2024, December 30). Binge drinking vs. heavy drinking: What are the differences? Should I be concerned with either?, Available online: https:\/\/smartrecovery.org\/blog\/binge-drinking-vs-heavy-drinking."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"139","DOI":"10.7326\/ANNALS-24-02157","article-title":"Trends in alcohol use after the COVID-19 pandemic: A national cross-sectional study","volume":"178","author":"Somayajula","year":"2024","journal-title":"Annals of Internal Medicine"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.addbeh.2017.08.017","article-title":"A descriptive analysis of alcohol behaviors across gender subgroups withina sample of transgender adults","volume":"76","author":"Staples","year":"2018","journal-title":"Addictive Behaviors"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"23527","DOI":"10.1177\/08862605211072161","article-title":"Police and transgender and gender diverse people in the United States: A brief note on interaction, harassment, and violence","volume":"37","author":"Stenersen","year":"2022","journal-title":"Journal of Interpersonal Violence"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1037\/sgd0000481","article-title":"A dangerous visibility: Moderating effects of antitrans legislative efforts on trans and gender-diverse mental health","volume":"9","author":"Tebbe","year":"2022","journal-title":"Psychology of Sexual Orientation and Gender Diversity"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"110872","DOI":"10.1016\/j.drugalcdep.2023.110872","article-title":"Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study","volume":"250","author":"Tran","year":"2023","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1080\/15532739.2016.1247405","article-title":"The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample","volume":"18","author":"Trujillo","year":"2017","journal-title":"International Journal of Transgenderism"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/sltb.12432","article-title":"Current and military-specific gender minority stress factors and their relationship with suicide ideation in transgender veterans","volume":"49","author":"Tucker","year":"2019","journal-title":"Suicide and Life-Threatening Behavior"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1080\/26924951.2024.2326614","article-title":"Social-contextual influences on eating pathology in transgender and nonbinary adults of color","volume":"18","author":"Urban","year":"2024","journal-title":"Journal of LGBTQ Issues in Counseling"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1177\/0733464816675819","article-title":"Social context of depressive distress in aging transgender adults","volume":"37","author":"Reisner","year":"2018","journal-title":"Journal of Applied Gerontology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2552","DOI":"10.1177\/15248380231218288","article-title":"Gender minority stress and resilience measure: A meta-analysis of the associations with mental health in transgender and gender diverse individuals","volume":"25","author":"Wilson","year":"2024","journal-title":"Trauma, Violence, and Abuse"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"108508","DOI":"10.1016\/j.drugalcdep.2021.108508","article-title":"Minority stress and drug use among transgender and gender diverse adults: A daily diary study","volume":"220","author":"Flores","year":"2021","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jshs.2016.01.019","article-title":"p < 0.05, <0.01, <0.001, <0.0001, <0.00001, <0.000001, <0.0000001","volume":"5","author":"Zhu","year":"2016","journal-title":"Journal of Sport and Health Science"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/3\/248\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:39:25Z","timestamp":1760027965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/3\/248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":65,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["bs15030248"],"URL":"https:\/\/doi.org\/10.3390\/bs15030248","relation":{},"ISSN":["2076-328X"],"issn-type":[{"type":"electronic","value":"2076-328X"}],"subject":[],"published":{"date-parts":[[2025,2,21]]}}}