A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults

Abstract

AbstractBackground and AimsExperiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex‐ and gender‐based cut‐offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender‐non‐inclusive language and cut‐offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals.MethodsWe reviewed 22 measures of harmful drinking for gendered language and sex‐ and gender‐based cut‐off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations.ResultsSix of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex‐ or gender‐based cut‐off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) appear reliable for transgender adults (Cronbach’s α: AUDIT [0.81–0.87] and AUDIT [0.72–0.8)]). There is initial support for using uniform cut‐offs for transgender people for the AUDIT‐C (≥3) and binge drinking (≥5 drinks in a sitting).ConclusionsMost existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut‐off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive.