Health risk behavior among transgender youth: Data from the 2011 Youth Risk Behavior Survey in San Francisco's public middle and high schools

Background. The derivation of reliable statistics describing the prevalence of health risk behavior within the transgender youth population is fraught with conceptual and operational challenges. These challenges limit public health responses to the needs of this population, which emerging evidence suggests may be very high. The San Francisco Unified School District is the only public district in the nation to include a survey item about gender identity on their middle and high school surveys. Purpose. The purpose of this study was to conduct analyses the 2011 administration of the Youth Risk Behavior Survey in San Francisco's public 22 middle and 20 high schools that focused on describing the health and wellness of transgender youth. Methods. Using a stratified random sampling design, the YRBS was administered to 2,730 middle school and 2,220 high school students, yielding a 74% survey completion rate at both levels. YRBS results are representative of all SFUSD students in grades 6 through 12. Study analysts applied complex samples analysis procedures to derive weighted estimates of risk behavior among self-identified transgender youth. Results. Results show transgender youth report significantly disproportional rates of victimization at school (e.g., harassment, bullying, and other violence) compared to students who reported traditional gender identity (i.e., male sex – male gender identity, female sex – female gender identity). Results also show a consistent pattern of increased engagement in health risk behavior across nearly all survey indicators. Discussion. Emerging data suggest that transgender youth may be at high risk for a myriad of negative outcomes, yet additional data are needed to confirm these results. However, few communities across the nation have included items on gender identity and/or gender expression on their youth health surveys, undermining the ability of policy makers and practitioners to appropriately address the health needs of transgender youth.