糖心vlog

Health disparities among gender minority populations (ie, individuals whose gender identity or expression is different from their sex assigned at birth) have been documented,¹ but most research has focused on gender minority adults. Gender minority youths accounted for nearly 2% of US adolescents in 2017 and reported health disparities likely as a result of 鈥済ender minority stress.鈥�^2-5 We examined risk factors and health outcomes among a large, population-based sample of gender minority adolescents.

The current study used state data sets from the 2017 and 2019 Youth Risk Behavior Surveys. Conducted every 2 years in 46 states (on average), the instrument is a national health survey of high school students in grades 9 through 12. Within states, schools are selected proportional to the size of student enrollment, and then students in required classes are randomly selected to participate. The overall response rate was 60.8% in 2017 and 60.3% in 2019. Starting in 2017,² states were given the option to add a question on gender identity, and 15 states did so. In these states, respondents were given a definition of transgender and asked 鈥淎re you transgender?鈥� Students could respond with the following response options: 鈥淣o, I am not transgender鈥�; 鈥淵es, I am transgender鈥�; 鈥淚 am not sure if I am transgender鈥� (considered gender questioning in this study to be consistent with prior research⁶); or 鈥淚 don鈥檛 know what the question is asking.鈥�

We estimated descriptive statistics and the prevalence of health risk behaviors by gender identity. We examined several domains of health: (1) bullying, (2) sexual and dating violence, (3) mental health and suicidality, (4) sexual risk behaviors, and (5) substance use. The eTable in the Supplement describes question wording. We estimated generalized linear models with a Poisson distribution family and log-link function to compare the adjusted prevalence ratios (aPRs) for each outcome by gender minority category while controlling for demographic covariates. We conducted all analyses in Stata version 16 (StataCorp) using missing data indicators and survey weights for the 15 states to adjust for the complex survey design. Using the Bonferroni correction, we set a new 伪 threshold of .0025, which was used to determine statistical significance based on 2-tailed statistical tests. The study was exempted from review by the Vanderbilt University institutional review board.

There were 4092 transgender respondents (1.8%), 3661 gender-questioning respondents (1.6%), and 189鈥�396 cisgender participants (96.6%) (weighted percentages); 3942 who reported that they did not know what the question was asking and 6131 who skipped the gender identity question were excluded. An estimated 10.2% of cisgender adolescents, 53.2% of transgender adolescents, and 49.3% of gender-questioning adolescents identified as lesbian, gay, or bisexual (Table 1). Transgender adolescents reported differences from cisgender adolescents on most measures in all 5 domains and from gender-questioning adolescents on most measures in all domains except sexual risk behaviors (Table 2). For example, on bullying and suicidality, transgender adolescents were more likely to report bullying at school (41.3% vs 18.0%; aPR, 1.88 [99.75% CI, 1.48-2.38]) and considering (44.8% vs 16.2%; aPR, 1.69 [99.75% CI, 1.41-2.03]), planning (41.6% vs 12.7%; aPR, 1.94 [99.75% CI, 1.57-2.41]), and attempting (30.0% vs 6.9%; aPR, 2.65 [99.75% CI, 1.87-3.74]) suicide than cisgender youths. Gender-questioning adolescents were also more likely to report bullying at school (37.1% vs 18.0%; aPR, 1.62 [99.75% CI, 1.27-2.08]) and considering (43.2% vs 16.2%; aPR, 1.54 [99.75% CI, 1.26-1.89]), planning (37.5% vs 12.7%; aPR, 1.60 [99.75% CI, 1.30-1.96]), and attempting (27.9% vs 6.9%; aPR, 2.26 [99.75% CI, 1.63-3.14]) suicide than cisgender youth. The highest aPRs were for physical dating violence, suicide attempts that required medical treatment, and cocaine use (Table 2).

This study found that transgender and gender-questioning youths reported increased risk factors and worse outcomes in 5 health domains compared with cisgender youths. This analysis extends prior research to gender-questioning youths and reports the demographic characteristics and health status of gender minority adolescents. Future studies should expand gender identity response options to be more inclusive of nonbinary, genderqueer, and gender-nonconforming populations. Limitations to this study include possible response and self-report bias, limited generalizability (only 15 states collected gender identity data), gender identity misclassification, and unmeasured confounders.

Accepted for Publication: February 15, 2022.

Corresponding Author: Gilbert Gonzales, PhD, MHA, Department of Medicine, Health, and Society, 2301 Vanderbilt Pl, PMB #351665, Nashville, TN 37235-1665 (gilbert.gonzales@vanderbilt.edu).

Author Contributions: Dr Gonzales and Mr Deal had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Gonzales.

Statistical analysis: All authors.

Supervision: Gonzales.

Conflict of Interest Disclosures: None reported.