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Latent Class Analysis of Substance Use Behaviors and Associations of Class Membership With Gender Affirmation, Social Determinants of Health, and HIV Status Among Transfeminine Adults in the Eastern and Southern United States

Year: 2026
Type: article
Abstract: OBJECTIVE: The purpose of this study was to identify latent classes of substance use behaviors (i.e., alcohol and illicit drug use) and their correlates among transgender women and transfeminine nonbinary adults. METHOD: = 1,614) from The LITE Study were used to identify latent substance use classes and report latent class membership probabilities (γ) and item-response probabilities (ρ). We assigned participants to the class with their highest probability of class membership and assessed associations with socioeconomic conditions. We reported adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for each correlate. RESULTS: = 12.1), and 45.3% were non-Latina/e, White. We identified four classes: no illicit drug use (γ = .63), alcohol misuse and cannabis use (γ = .26), polysubstance use (γ = .062), and opioid and cannabis use (γ = .046). Compared with the "no illicit drug use" class, the need for medical gender affirmation was associated with lower odds of being in the polysubstance use and opioid and cannabis use classes, and housing security and lack of arrest were associated with lower odds of being in the alcohol misuse and cannabis use, polysubstance use, and opioid and cannabis use classes. For example, compared with those who were food insecure most or all of the time, those who were never food insecure had lower odds of being in the polysubstance use class (aOR = 0.22, 95% CI [0.09, 0.52]) versus the no illicit drug use class. Living with HIV was associated with greater odds of polysubstance use. CONCLUSIONS: For transfeminine adults, having met need for medical gender affirmation and better socioeconomic conditions may be protective for alcohol misuse and/or polysubstance use. Interventions aimed at improving socioeconomic conditions among transgender women and transfeminine nonbinary adults may improve substance use outcomes.
DOI: 10.15288/jsad.25-00133
Authors: Jack Andrzejewski, Heather L. Corliss, Heather A. Pines, Ravi Goyal, Eileen Pitpitan, Britt Skaathun, Andrea L. Wirtz, Sari L. Reisner, American Cohort To Study HIV Acquisition Among Transgender Women (LITE) Study Group
Institutions: University of California, Los Angeles, San Diego State University, University of California San Diego, Johns Hopkins University, Harvard University, University of Michigan
Language: English
Field: Psychology
Open Access status: green
Awards: American Cohort to Study HIV Acquisition among Transgender Women in High Risk Areas, District of Columbia Center for AIDS Research, Training Program in Substance Use, HIV and Related Infections, San Diego Center for AIDS Research (SD CFAR), The Johns Hopkins Center for AIDS Research (JHU CFAR), Center for AIDS Research at Emory University, Harvard University Center for AIDS Research, Miami Center for AIDS Research
OpenAlex ID: W7124151082
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