Transgender and Questioning Youth Show Higher Cannabis Curiosity and Use by Age 14
Using a novel multidimensional gender classification, transgender and questioning youth (ages 9-14) showed 1.7-2.5 times higher curiosity about cannabis and up to 1.8 times higher use compared to cisgender peers — identifying a critical early prevention window.
Quick Facts
What This Study Found
In a 4-class model (transgender 2.5%, questioning 9.0%, naïve 36.3%, cisgender 52.1%), questioning and transgender youth were significantly more likely to report curiosity about alcohol, nicotine, and cannabis (aOR range 1.68-2.45) and use of cannabis and nicotine (aOR range 1.16-1.82) compared to cisgender youth.
Key Numbers
N=11,868; 4 gender classes: transgender 2.5%, questioning 9.0%, naïve 36.3%, cisgender 52.1%; curiosity aORs 1.68-2.45; cannabis use aOR up to 1.82; substance use disparities present by age 13-14
How They Did This
Longitudinal analysis of 11,868 ABCD Study youth (ages 9-14, 2016-2022) using latent class models across four gender dimensions (identity, felt gender, expression, non-contentedness), with multivariable logistic regression for substance outcomes.
Why This Research Matters
This is one of the first studies to use a multidimensional gender construct to understand substance use risk in pre-adolescents, revealing that gender-diverse youth need targeted prevention before traditional intervention ages.
The Bigger Picture
With nearly 12% of pre-adolescents classified as transgender or questioning, substance use prevention cannot afford to ignore gender diversity — and the risk emerges before most substance use programs begin.
What This Study Doesn't Tell Us
ABCD Study may not represent all US youth; gender classification at single timepoint doesn't capture fluidity; substance use outcomes by 13-14 are rare events; latent classes are statistical constructs; cannabis use measurement limited at young ages.
Questions This Raises
- ?What drives earlier substance curiosity in gender-diverse youth?
- ?Would affirming environments reduce substance use risk?
- ?Should substance use prevention programs be integrated with gender-supportive services?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large longitudinal ABCD Study cohort with innovative multidimensional gender classification provides strong developmental evidence for substance use disparities.
- Study Age:
- Published 2026; uses ABCD Study data 2016-2022.
- Original Title:
- Gender Diversity, Substance Cognitions, and Alcohol, Nicotine/Tobacco, and Cannabis Use Among Youth.
- Published In:
- LGBT health, 13(1), 1-10 (2026)
- Authors:
- Kcomt, Luisa, Veliz, Philip T, Jardine, John, Evans-Polce, Rebecca J, Clift, Jennifer, McCabe, Sean Esteban, Arslanian-Engoren, Cynthia
- Database ID:
- RTHC-08377
Evidence Hierarchy
Frequently Asked Questions
Are gender-diverse youth at higher risk for cannabis use?
Yes — by ages 13-14, transgender and questioning youth showed 1.7-2.5 times higher curiosity about cannabis and significantly higher rates of use, suggesting prevention programs should begin earlier for gender-diverse youth.
How many youth are gender-diverse?
In this study, about 12% of 9-14 year-olds were classified as transgender (2.5%) or questioning (9.0%) using a multidimensional gender assessment — a substantial population requiring attention in prevention planning.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08377APA
Kcomt, Luisa; Veliz, Philip T; Jardine, John; Evans-Polce, Rebecca J; Clift, Jennifer; McCabe, Sean Esteban; Arslanian-Engoren, Cynthia. (2026). Gender Diversity, Substance Cognitions, and Alcohol, Nicotine/Tobacco, and Cannabis Use Among Youth.. LGBT health, 13(1), 1-10. https://doi.org/10.1177/23258292251385564
MLA
Kcomt, Luisa, et al. "Gender Diversity, Substance Cognitions, and Alcohol, Nicotine/Tobacco, and Cannabis Use Among Youth.." LGBT health, 2026. https://doi.org/10.1177/23258292251385564
RethinkTHC
RethinkTHC Research Database. "Gender Diversity, Substance Cognitions, and Alcohol, Nicotin..." RTHC-08377. Retrieved from https://rethinkthc.com/research/kcomt-2026-gender-diversity-substance-cognitions
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.