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. Author manuscript; available in PMC: 2021 May 1.
Published in final edited form as: Am J Prev Med. 2020 Mar 5;58(5):e159–e169. doi: 10.1016/j.amepre.2019.12.021

Table 3.

Substance Use Associations, by Gender Nonconformity and Violence Victimizationa Among High School Students

APR
Model 1
 Model 2
Substance use behaviors % APR1 (95% CI) % APR2 (95% CI)
Male students
 Current cigarette useb Model n=2,653 Model n=2,561
  Gender nonconformity
   Gender nonconformingc 7.3 1.28 (0.76, 2.14) 4.9 0.82 (0.47, 1.44)
   Equally feminine/masculined 4.3 0.75 (0.40, 1.41) 4.1 0.69 (0.36, 1.34)
   Gender conforminge 5.7 1.00 (ref) 6.0 1.00 (ref)
  Violence victimizationf
   3 or more 22.1 5.13 (2.37, 11.10)
   1 or 2 8.4 1.95 (1.20, 3.14)
   0 4.3 1.00 (ref)
 Current alcohol useb Model n=2,504 Model n=2,414
  Gender nonconformity
   Gender nonconformingc 21.5 0.90 (0.62, 1.30) 18.3 0.75 (0.50, 1.12)
   Equally feminine/masculined 19.4 0.81 (0.59, 1.11) 19.1 0.78 (0.57, 1.06)
   Gender conforminge 23.9 1.00 (ref) 24.5 1.00 (ref)
  Violence victimizationf
   3 or more 47.6 2.34 (1.64, 3.34)
   1 or 2 32.1 1.58 (1.24, 2.02)
   0 20.3 1.00 (ref)
 Current marijuana useb Model n=2,752 Model n=2,636
  Gender nonconformity
   Gender nonconformingc 17.4 0.82 (0.61, 1.11) 13.7 0.64 (0.44, 0.94)
   Equally feminine/masculined 14.3 0.67 (0.48, 0.95) 14.6 0.68 (0.47, 0.98)
   Gender conforminge 21.2 1.00 (ref) 21.4 1.00 (ref)
  Violence victimizationf
   3 or more 42.0 2.48 (1.65, 3.72)
   1 or 2 28.5 1.68 (1.38, 2.04)
   0 17.0 1.00 (ref)
 Prescription drug misuseg Model n=2,772 Model n=2,645
  Gender nonconformity
   Gender nonconformingc 20.3 1.81 (1.23, 2.66) 17.2 1.60 (1.06, 2.41)
   Equally feminine/masculined 11.3 1.01 (0.65, 1.58) 10.2 0.95 (0.58, 1.54)
   Gender conforminge 11.2 1.00 (ref) 10.8 1.00 (ref)
  Violence victimizationf
   3 or more 22.1 2.11 (1.28, 3.48)
   1 or 2 13.0 1.24 (0.92, 1.67)
   0 10.5 1.00 (ref)
 Cocaine useg Model n=2,754 Model n=2,627
  Gender nonconformity
   Gender nonconformingc 14.3 2.84 (1.81, 4.45) 9.3 1.99 (1.08, 3.66)
   Equally feminine/masculined 6.8 1.36 (0.74, 2.49) 6.7 1.43 (0.74, 2.76)
   Gender conforminge 5.0 1.00 (ref) 4.7 1.00 (ref)
  Violence victimization
   3 or more 17.2 4.35 (2.19, 8.64)
   1 or 2 8.9 2.25 (1.47, 3.46)
   0 4.0 1.00 (ref)
 Methamphetamine useg Model n=2,771 Model n=2,645
  Gender nonconformity
   Gender nonconformingc 12.9 4.47 (2.64, 7.55) 7.4 2.86 (1.48, 5.50)
   Equally feminine/masculined 5.5 1.92 (0.82, 4.50) 4.8 1.87 (0.73, 4.76)
   Gender conforminge 2.9 1.00 (ref) 2.6 1.00 (ref)
  Violence victimization
   3 or more 19.4 9.75 (4.74, 20.07)
   1 or 2 6.1 3.06 (1.76, 5.32)
   0 2.0 1.00 (ref)
 Heroin useg Model n=2,780 Model n=2,653
  Gender nonconformity
   Gender nonconformingc 9.2 4.55 (2.44, 8.46) 5.2 2.96 (1.37, 6.40)
   Equally feminine/masculined 2.5 1.25 (0.56, 2.75) 1.7 0.96 (0.38, 2.45)
   Gender conforminge 2.0 1.00 (ref) 1.8 1.00 (ref)
  Violence victimization
   3 or more 13.7 12.16 (5.37, 27.57)
   1 or 2 4.2 3.72 (2.02, 6.86)
   0 1.1 1.00 (ref)
 Injection drug useg Model n=2,782 Model n=2,660
  Gender nonconformity
   Gender nonconformingc 7.6 7.90 (4.26, 14.65) 4.2 4.72 (1.94, 11.48)
   Equally feminine/masculined 2.6 2.76 (1.23, 6.21) 2.2 2.46 (1.00, 6.04)
   Gender conforminge 1.0 1.00 (ref) 0.9 1.00 (ref)
  Violence victimization
   3 or more 3.8 4.12 (1.04, 16.27)
   1 or 2 3.1 3.39 (1.51, 7.59)
   0 0.9 1.00 (ref)
Female students
 Current cigarette useb Model n=2,644 Model n=2,579
  Gender nonconformity
   Gender nonconformingc 3.0 0.93 (0.40, 2.19) 3.6 1.20 (0.52, 2.77)
   Equally feminine/masculined 3.5 1.09 (0.54, 2.20) 3.5 1.16 (0.55, 2.45)
   Gender conforminge 3.3 1.00 (ref) 3.0 1.00 (ref)
  Violence victimizationf
   3 or more 10.8 4.40 (2.01, 9.62)
   1 or 2 3.3 1.36 (0.76, 2.43)
   0 2.5 1.00 (ref)
 Current alcohol useb Model n=2,486 Model n=2,428
  Gender nonconformity
   Gender nonconformingc 37.3 1.40 (0.95, 2.07) 38.3 1.44 (1.01, 2.05)
   Equally feminine/masculined 22.2 0.83 (0.66, 1.06) 22.0 0.83 (0.65, 1.06)
   Gender conforminge 26.6 1.00 (ref) 26.6 1.00 (ref)
  Violence victimizationf
   3 or more 61.0 2.59 (2.12, 3.15)
   1 or 2 29.0 1.23 (0.95, 1.60)
   0 23.6 1.00 (ref)
 Current marijuana useb Model n=2,689 Model n=2,615
  Gender nonconformity
   Gender nonconformingc 26.4 1.51 (0.96, 2.38) 27.0 1.55 (1.00, 2.38)
   Equally feminine/masculined 19.4 1.11 (0.78, 1.58) 19.3 1.11 (0.77, 1.60)
   Gender conforminge 17.4 1.00 (ref) 17.5 1.00 (ref)
  Violence victimizationf
   3 or more 37.2 2.36 (1.67, 3.32)
   1 or 2 21.3 1.35 (1.04, 1.73)
   0 15.8 1.00 (ref)
 Prescription drug misuseg Model n=2,708 Model n=2,631
  Gender nonconformity
   Gender nonconformingc 8.9 0.91 (0.44, 1.90) 9.5 0.97 (0.48, 1.94)
   Equally feminine/masculined 10.2 1.04 (0.65, 1.69) 9.9 1.01 (0.60, 1.68)
   Gender conforminge 9.8 1.00 (ref) 9.8 1.00 (ref)
  Violence victimizationf
   3 or more 25.0 3.12 (1.98, 4.93)
   1 or 2 11.7 1.47 (1.08, 1.99)
   0 8.0 1.00 (ref)
 Cocaine useg Model n=2,697 Model n=2,622
  Gender nonconformity
   Gender nonconformingc 4.8 1.17 (0.43, 3.19) 5.6 1.48 (0.58, 3.77)
   Equally feminine/masculined 4.6 1.12 (0.53, 2.38) 4.6 1.19 (0.55, 2.60)
   Gender conforminge 4.1 1.00 (ref) 3.8 1.00 (ref)
  Violence victimizationf
   3 or more 13.1 4.66 (2.32, 9.35)
   1 or 2 5.6 2.00 (1.17, 3.41)
   0 2.8 1.00 (ref)
 Methamphetamine useg Model n=2,705 Model n=2,630
  Gender nonconformity
   Gender nonconformingc 1.6 0.80 (0.22, 2.88) 2.1 1.19 (0.34, 4.12)
   Equally feminine/masculined 2.2 1.05 (0.42, 2.63) 2.3 1.29 (0.52, 3.20)
   Gender conforminge 2.1 1.00 (ref) 1.8 1.00 (ref)
  Violence victimizationf
   3 or more 8.3 7.68 (2.80, 21.01)
   1 or 2 2.7 2.48 (1.20, 5.12)
   0 1.1 1.00 (ref)
 Heroin useg Model n=2,710 Model n=2,634
  Gender nonconformity
   Gender nonconformingc 0.8 0.56 (0.13, 2.48) 1.2 1.06 (0.23, 4.91)
   Equally feminine/masculined 0.5 0.35 (0.10, 1.26) 0.4 0.38 (0.12, 1.25)
   Gender conforminge 1.4 1.00 (ref) 1.1 1.00 (ref)
  Violence victimizationf
   3 or more 6.6 18.32 (6.04, 55.56)
   1 or 2 1.4 3.90 (1.54, 9.86)
   0 0.4 1.00 (ref)
 Injection drug useg Model n=2,714 Model n=2,641
  Gender nonconformity
   Gender nonconformingc 1.1 0.66 (0.08, 5.61) 1.4 0.92 (0.10, 8.30)
   Equally feminine/masculined 1.1 0.70 (0.26, 1.90) 0.9 0.58 (0.19, 1.75)
   Gender conforminge 1.6 1.00 (ref) 1.5 1.00 (ref)
  Violence victimizationf
   3 or more 9.2 14.14 (5.57, 35.89)
   1 or 2 1.6 2.48 (0.98, 6.28)
   0 0.6 1.00 (ref)

Note: Boldface indicates statistical significance (95% CI does not include 1.0). Reference groups are gender-conforming students and students with no violence victimization experiences. Model 1: APR 1 is adjusted for race/ethnicity, grade, sexual identity. Model 2: APR 2 is adjusted for race/ethnicity, grade, sexual identity, violence victimization.

a

Violence victimization categories include: (1) not going to school on one or more of the past 30 days because you felt unsafe at school or on the way to or from school; (2) being threatened or injured with a weapon on school property, during the past 12 months; (3) being bullied on school property, during the past 12 months; (4) being electronically bullied, during the past 12 months (Count being bullied through texting, Instagram, Facebook, or other social media); (5) ever being physically forced to have sexual intercourse when you did not want to.

b

Past 30 days.

c

Gender nonconforming: male students who describe themselves as very/mostly/somewhat feminine, and female students who describe themselves as very/mostly/somewhat masculine.

d

Equally feminine/masculine: male and female students who describe themselves as equally feminine and masculine.

e

Gender conforming: male students who describe themselves as very/mostly/somewhat masculine, and female students who describe themselves as very/mostly/somewhat feminine.

f

The number of categories of violence victimization experienced.

g

Ever.

APR, adjusted prevalence ratios.