Background: Transgender, nonbinary, and gender diverse (TNG) youth often describe exploring identities and communities online. Studies of cisgender youth connect increased digital technology use with loneliness and decreased body image. Digital technology use in adolescent school experiences has increased over time, and suddenly youth across the U.S. are in completely digital school environments due to the COVID-19 pandemic. With educational systems employing and encouraging these tools, it is critical to understand the technology use of TNG youth and how this affects their health. Objective: To compare features of digital technology use of cisgender and TNG youth, as well as interactions of this use with well-being. Methods: Using Qualtrics panels, we surveyed a nationally representative sample of adolescents (ages 13-18) and their parents about digital technology use. Youth assessment included the Adolescent Digital Technology Interactions and Importance (ADTI) scale, with subscales assessing the purpose of technology use, and the short Problematic and Risky Internet Use Screening Scale (PRIUSS-3). Health-related measures included validated instruments assessing body image, parental support, loneliness, well-being, fear of missing out (FOMO), and parent social media use. We compared ADTI scores between gender groups with analysis of covariance. Generalized estimating equation (GEE) analysis was conducted to compare the proportions of subjects at risk for problematic internet use (PRIUSS-3 >3). All comparisons were adjusted for age and parent social media use. Pearson’s correlation analyses evaluated the correlations between parent support, body image, loneliness, well-being, and FOMO vs. ADTI and PRIUSS-3 scores. Results: Among 4575 adolescent-parent pairs, there were 53 (1.16%) TNG youth. TNG youth showed higher probabilities of problematic internet use than cisgender peers (0.91 vs. 0.69, p=0.004). TNG youth had significantly higher scores for use of technology to explore identity/go outside one’s offline environment (ADTI 2) compared to cisgender youth (mean 18.45 vs. 15.76, p = 0.0085). Parental support correlated positively with ADTI 2 scores for TNG youth (0.05), though correlated negatively with ADTI 2 scores for cisgender youth (-0.22, p=0.043). In a pattern different from cisgender peers, problematic internet use scores for TNG youth correlated positively with body image (0.26 vs. -0.17, p = 0.0025) and well-being (0.33 vs. -0.08, p = 0.0019). Conclusion(s): TNG youth are at increased risk for problematic internet use compared to cisgender peers, though motivations for digital technology use may differ. TNG youth are more likely to use digital technology to explore identity and go outside one’s offline environment. Correlation of digital use measures with positive body image and well-being also suggests that this population may uniquely benefit from digital experiences, which may challenge current definitions of problematic internet use in this population. Future research, screening and intervention efforts should address both positive and problematic digital technology use among TNG youth.

Demographics of Cisgender and TNG Youth Participants Comparison of Correlation Coefficients of Parent Support, Body Image, Loneliness, Well-being, and Fear of Missing Out versus Digital Technology Interactions and Problematic Internet Use Outcomes for Transgender/Nonbinary and Cisgender Youth.