Association of transphobic discrimination and alcohol misuse among transgender adults: Results from the U.S. Transgender Survey

•Transphobic discrimination is multifaceted and pervasive.•7 in 10 transgender individuals have experienced discrimination in the past year.•Discrimination is associated with alcohol misuse among transgender people. Alcohol misuse remains a leading preventable risk factor for morbidity and mortality in the United States. Evidence suggests that alcohol misuse is more prevalent among transgender populations. This study examined the association between transphobic discrimination and alcohol use/misuse among a large sample of transgender people. Using the 2015 U.S. Transgender Survey (N = 27,715), logistic regression models were conducted to estimate the adjusted odds ratios (AOR) and 95 % confidence intervals (CI) of current alcohol use, past-month binge drinking (≥1 occasion of consuming ≥5 alcoholic beverages within the past month), and past-month frequent binge drinking (≥5 occasions of binge drinking within the past month) among transgender people. Of the respondents, 60.4 % reported current alcohol use, 24.3 % reported past-month binge drinking, and 8.5 % reported past-month frequent binge drinking. The majority (70.1 %) had experienced some form of past-year transphobic discrimination. Experiencing 3+ forms of transphobic discrimination was significantly associated with past-month binge drinking (AOR = 1.49, 95 % CI = 1.37–1.62) and past-month frequent binge drinking (AOR = 1.57, 95 % CI = 1.37–1.79) than individuals who did not experience transphobic discrimination. Persons who cross-dress showed higher odds of current alcohol use (AOR = 1.52, 95 % CI = 1.32–1.74), past-month binge drinking (AOR = 2.51, 95 % CI = 2.21–2.85), and past-month frequent binge drinking (AOR = 4.13, 95 % CI = 3.45–4.94) than transgender women. Discrimination within public spaces and housing domains had the most robust associations with alcohol misuse. Experiencing transphobic discrimination increased the odds of alcohol misuse among transgender people. Stakeholders and providers should be cognizant of the multifaceted nature of transphobic discrimination as unique social stressors that many transgender persons experience.