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.
Pediatricians, school counselors, LGBTQ+ youth services, substance use prevention designers, and child development researchers.
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Large longitudinal ABCD Study cohort with innovative multidimensional gender classification provides strong developmental evidence for substance use disparities.
When this study was published
Published 2026; uses ABCD Study data 2016-2022.
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.
Questions still open
- 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?
Common questions
Are gender-diverse youth at higher risk for cannabis use?
How many youth are gender-diverse?
Read the original research
Gender Diversity, Substance Cognitions, and Alcohol, Nicotine/Tobacco, and Cannabis Use Among Youth.
LGBT health, 13(1), 1-10
Citation
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
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide