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

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.