Purpose
Research suggests that transgender and gender non-conforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared to cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex.
Methods
This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N=81,885). Students who were transgender, genderqueer, genderfluid or unsure about their gender identity (TGNC) were compared to those who were not using chi-square and t-tests. Outcome measures included four high-risk behaviors and experiences and four protective factors.
Results
The prevalence of TGNC identity was 2.7% (n=2168) and varied significantly across gender, race/ethnicity and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, X2=1959.9, p<.001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males.
Conclusions
This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the U.S., highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development.