In 2017, for the first time, some states and large school districts added a question about transgender identity to CDC's Youth Risk Behavior Survey. Across the 19 sites, 1.8% of high school students said they were transgender. The survey confirmed, at population level, what smaller studies had found: transgender students were much more likely than cisgender students — those whose gender identity matches their sex — to report being victimized, using substances and attempting suicide.
Credit: CDC, Morbidity and Mortality Weekly Report*.*
Who took part
The question was piloted in 10 states — Colorado, Delaware, Hawaii, Maine, Maryland, Massachusetts, Michigan, Rhode Island, Vermont and Wisconsin — and 9 large urban districts: Boston, Broward County, Cleveland, Detroit, the District of Columbia, Los Angeles, New York City, San Diego and San Francisco.
| "Are you transgender?" | Share of students (range across sites) |
|---|---|
| No | 94.4% (94.0–94.8%) |
| Yes | 1.8% (1.0–3.3%) |
| Not sure | 1.6% (0.9–2.5%) |
| Don't know what the question is asking | 2.1% (1.5–4.7%) |
What transgender students reported
| In the past 12 months, unless noted | Cisgender boys | Cisgender girls | Transgender students |
|---|---|---|---|
| Felt unsafe at or traveling to or from school (past 30 days) | 4.6% | 7.1% | 26.9% |
| Threatened or injured with a weapon at school | 6.4% | 4.1% | 23.8% |
| Ever forced to have sex | 4.2% | 10.5% | 23.8% |
| Experienced physical dating violence | 5.8% | 8.7% | 26.4% |
| Bullied at school | 14.7% | 20.7% | 34.6% |
| Ever used heroin | 2.2% | 0.7% | 26.1% |
| Ever used methamphetamines | 2.3% | 1.0% | 24.9% |
| Ever misused prescription opioids | 11.5% | 12.3% | 35.9% |
| Felt sad or hopeless | 20.7% | 39.3% | 53.1% |
| Seriously considered suicide | 11.0% | 20.3% | 43.9% |
| Attempted suicide | 5.5% | 9.1% | 34.6% |
Every form of violence measured was more common among transgender students than among both cisgender boys and girls. Because victimization is a known risk factor for substance use and suicide, reducing the victimization of transgender teens may be key to improving their overall health.
Sexual health
Transgender students were more likely than cisgender students to report first sex before age 13 (14.9%), four or more partners (16.4%) and no method to prevent pregnancy at last sex (29.7%); more likely than cisgender girls to have ever had sex (43.1% vs. 33.2%) and to have used alcohol or drugs before last sex (30.0% vs. 17.9%); and more likely than cisgender boys to have not used a condom (63.8% vs. 37.6%). Without knowing more about their and their partners' sex and gender identities, the authors caution, what these results mean for risk is uncertain. And transgender students were more likely to have been tested for HIV — only 70.0% had never been tested, against 87.4% of cisgender boys and 86.9% of cisgender girls — an important protective step given this population's higher HIV risk.
What could help
Creating safe learning environments and providing access to culturally competent physical and mental health care may be important first steps, the authors write, along with continued research and effective interventions.
Limits
Because it wasn't clear whether transgender students answered the sex question with their sex or their gender identity, the analysis couldn't look at differences among transgender students. The school-based survey misses students who have dropped out, who may be at the highest risk, and it can't show cause and effect.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
Sources
Based on Michelle M. Johns, Richard Lowry, Jack Andrzejewski, et al., "Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017," Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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