Transgender Identity and Experiences Among High School Students

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Author(s): The Centers for Disease Control and Prevention (CDC)

  • Michelle M. Johns, PhD
  • Richard Lowry, MD
  • Jack Andrzejewski, MPH
  • Lisa C. Barrios, DrPH
  • Zewditu Demissie, PhD
  • Timothy McManus, MS
  • Catherine N. Rasberry, PhD
  • Leah Robin, PhD
  • J. Michael Underwood, PhD

Published: Jan. 25, 2019 as part of the Morbidity and Mortality Weekly Report (MWWR)

Report Intro/Brief:
“Overall, 1.8% of students enrolled in the participating 10 state and nine urban school districts identified as transgender. This finding is consistent with previous studies of the prevalence of transgender identity among adolescents and points to the utility of this measure to assess transgender identity broadly in a population-based study. Of note, some researchers recommend use of a sex question that includes a definition of sex as well as a gender identity question with five or more options (i.e., the two-step approach) to reliably characterize an individual’s current gender; such refined measures might benefit researchers in assessing within-group differences among transgender persons and aid in better targeting public health interventions.

The results of this study validate findings from smaller clinical and web-based studies that, at a population level, transgender students are at disproportionately higher risk than are cisgender students for violence victimization, substance use, and suicide risk. The prevalence of reported substance use (e.g., 27.1%, 26.1%, 24.9%, and 35.9% reporting lifetime use of cocaine, heroin, methamphetamines, and prescription opioid misuse, respectively) and suicide risk (e.g., 34.6% attempting suicide in the last 12 months) are concerning. Given that violence victimization is a documented risk factor for substance use and suicide risk, implementation of interventions focused on reducing the victimization of transgender adolescents might be a key strategy for improving overall health.

Some examples of elevated sexual risk emerged among transgender students. More transgender than cisgender students reported first sexual intercourse before age 13 years and having had four or more sex partners, and more transgender students than cisgender female students reported ever having had sexual intercourse and use of alcohol or drugs before last sexual intercourse. Transgender students were more likely than were cisgender students to forego pregnancy prevention at last sexual intercourse and were less likely than were cisgender males to use a condom at last sexual intercourse; however, without further information about the sex and gender identities of these youths and their partners, the risk implications of these results are uncertain and should be interpreted with caution. Transgender students were more likely to have ever received an HIV test, an important protective behavior, given the known higher HIV risk experienced by this population…

Transgender youths in high school appear to face serious risk for violence victimization, substance use, and suicide, as well as some sexual risk behaviors, indicating a need for programmatic efforts to better support the overall health of transgender youths. Taking steps to create safe learning environments and provide access to culturally competent physical and mental health care might be important first steps to improving the health of transgender youths. Continued research into the health of transgender youths and development of effective intervention strategies are warranted.”

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