Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population. Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at schools) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously. Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one‟s community protected against depression and suicidality; teacher connectedness buffered risk of substance use. Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse–friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use.
Researchers should adopt data analysis strategies that allow for comparisons of all perceived gender presentation categories rather than assigning a reference group. Those working with TGD youth should be particularly attuned to youth perceived as gender incongruent as they may be more likely to experience bullying victimization and emotional distress.
Introduction: Nurses and physicians receive minimal training about providing competent care to transgender and gender diverse (TGD) patients, and training specific to TGD youth is particularly lacking. This qualitative study examined healthcare providers' experiences and attitudes about working with TGD youth to identify specific training needs.Method: Semi-structured interviews were conducted with 14 nurses and physicians who work with adolescents. Thematic analysis was used to characterize participants' responses.Results: Five themes summarized participants' responses to interview questions: 1) training regarding gender diversity, 2) discomfort with gender-related topics, 3) reasons for not asking about gender, 4) talking about gender with patients, and 5) need for resources.Discussion: Findings highlight multiple opportunities to improve provider education and care experiences of TGD youth. Specific training is needed to assist providers with managing discomfort with gender-related topics while simultaneously developing their knowledge and skills to discuss gender issues.
Transgender and gender-diverse (TGD) youth experience significant health and well-being disparities compared to their cisgender peers. However, disparities experienced at a population level might be mitigated by individuallevel factors such as strong family relationships. Discrete aspects of strong family relationships may impact the health and well-being of TGD youth differently. To date, no systematic review known to us has explored the state of the science regarding the association between family relationships and the health and well-being of TGD adolescents and young adults. As such, our review aimed to (1) compile and present the scientific literature addressing the connection between family relationships and the health and well-being of TGD youth in those families;(2) sort results utilizing the Family Strengths Model; and (3) assess the strength of the literature with evidencebased appraisal tools. Sixteen articles met eligibility criteria (10 quantitative and 6 qualitative). These articles discussed family relationship qualities influencing health and well-being outcomes, including mental health, homelessness, sexual health, and substance use. Three of six qualities of strong families-coping ability, appreciation and affection, and positive communication-were represented in the literature. The risk for bias and study strength appraisals suggest that the available literature is moderately strong overall. Certain characteristics of strong families (commitment, enjoyable time spent together, and spiritual well-being) were underrepresented in the literature. Future research should explore these gaps to ensure that health care and community service providers can deliver the most effective support and care for TGD youth and their families.
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