Table 4.

Adjusted Logistic Regression Models Testing the Association Among Sex, Gender Identity, and Substance Use

	Alcohol						Marijuana				Cigarette
	Lifetime use		Recent use		Binge drinking		Lifetime use		Recent use		Lifetime use		Recent use
	aOR (95% CI)	p	aOR (95% CI)	p	aOR (95% CI)	p	aOR (95% CI)	p	aOR (95% CI)	p	aOR (95%CI)	p	aOR (95% CI)	p
FULL SAMPLE MAIN EFFECTS
Sex assigned at birth
Assigned male	1.00
Assigned female	1.06 (0.97–1.17)	0.212	0.97 (0.87–1.08)	0.578	0.89 (0.77–1.04)	0.146	0.99 (0.89–1.10)	0.860	0.98 (0.85–1.12)	0.736	0.92 (0.82–1.03)	0.149	0.84 (0.70–1.01)	0.071
Gender identity
Cisgender	1.00
Transgender	1.25 (1.09–1.43)	0.002	1.07 (0.92–1.24)	0.412	1.11 (0.89–1.38)	0.366	1.73 (1.49–2.00)	<0.001	1.55 (1.30–1.85)	0.001	1.95 (1.68–2.26)	<0.001	2.35 (1.89–2.91)	<0.001
Nonbinary/genderqueer	1.10 (1.00–1.21)	0.062	0.93 (0.83–1.04)	0.195	0.82 (0.69–0.98)	0.025	1.16 (1.03–1.29)	0.011	1.01 (0.87–1.16)	0.937	1.27 (1.13–1.43)	<0.001	1.17 (0.96–1.43)	0.111
FULL SAMPLE INTERACTION
Sex assigned at birth
Assigned male	1.00
Assigned female	1.02 (0.91–1.13)	0.744	0.92 (0.82–1.03)	0.165	0.90 (0.76–1.06)	0.205	0.99 (0.88–1.12)	0.916	0.96 (0.83–1.12)	0.642	0.85 (0.75–0.97)	0.014	0.72 (0.58–0.89)	0.002
Gender identity
Cisgender	1.00
Transgender	1.04 (0.72–1.50)	0.848	0.93 (0.61–1.40)	0.726	1.22 (0.71–2.13)	0.471	1.52 (1.02–2.27)	0.039	1.58 (0.99–2.51)	0.055	0.84 (0.53–1.34)	0.470	0.95 (0.47–1.93)	0.891
Nonbinary/genderqueer	0.89 (0.69–1.16)	0.387	0.68 (0.50–0.92)	0.013	0.80 (0.52–1.24)	0.319	1.26 (0.95–1.68)	0.106	0.91 (0.63–1.33)	0.636	1.21 (0.90–1.63)	0.215	0.80 (0.48–1.35)	0.405
Sex assigned at birth × gender identity
AMAB × cisgender	1.00
AFAB × transgender	1.24 (0.84–1.85)	0.282	1.18 (0.76–1.84)	0.453	0.89 (0.49–1.62)	0.698	1.15 (0.75–1.77)	0.514	0.99 (0.60–1.63)	0.955	2.60 (1.59–4.25)	<0.001a	2.84 (1.36–5.97)	0.006b
AFAB × nonbinary/genderqueer	1.27 (0.96–1.69)	0.089	1.44 (1.04–2.00)	0.029c	1.03 (0.64–1.64)	0.915	0.90 (0.66–1.23)	0.518	1.12 (0.75–1.67)	0.587	1.08 (0.78–1.49)	0.645	1.61 (0.92–2.82)	0.096
AMAB only
Cisgender	1.00
Transgender	0.95 (0.65–1.40)	0.804	0.82 (0.54–1.26)	0.373	1.09 (0.62–1.92)	0.769	1.19 (0.79–1.78)	0.410	1.27 (0.79–2.05)	0.326	0.72 (0.44–1.16)	0.176	0.78 (0.37–1.63)	0.514
Nonbinary/genderqueer	0.84 (0.64–1.11)	0.220	0.63 (0.46–0.86)	0.004	0.75 (0.48–1.18)	0.220	1.10 (0.82–1.47)	0.517	0.78 (0.52–1.15)	0.203	1.08 (0.79–1.47)	0.630	0.71 (0.40–1.21)	0.209
AFAB only
Cisgender	1.00
Transgender	1.30 (1.12–1.50)	0.001	1.10 (0.94–1.30)	0.246	1.08 (0.85–1.38)	0.506	1.80 (1.54–2.11)	<0.001	1.59 (1.31–1.93)	<0.001	2.23 (1.90–2.62)	<0.001	2.82 (2.23–3.56)	<0.001
Nonbinary/genderqueer	1.15 (1.03–1.28)	0.009	0.99 (0.88–1.12)	0.867	0.83 (0.69–1.00)	0.052	1.17 (1.04–1.33)	0.011	1.05 (0.90–1.23)	0.555	1.33 (1.17–1.52)	<0.001	1.34 (1.08–1.66)	0.008

All models were adjusted for sexual identity, race/ethnicity, parental education, age, and region. Missing data on covariates were handled using multiple imputation with 50 imputations. Bold coefficients indicate statistical significance at p < 0.05. Referent group for “Sex assigned at birth × Gender identity” interactions is cisgender AMAB adolescents.

^aSee Figure 1, panel C.

^bSee Figure 1, panel A.

^cSee Figure 1, panel B.

aOR, adjusted odds ratio; CI, confidence interval.