Using data from the first representative study of youth to include a measure of gender identity, we show that transgender youth are at heightened risk for substance use compared with nontransgender peers. Future research is needed to identify the structural and psychosocial mechanisms that drive these disparities.

Objective No representative population-based studies of youth in the US exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, we: (1) examined gender identity-related disparities in the prevalence of suicidal ideation; (2) evaluated whether established psychosocial factors explained these disparities; and (3) identified correlates of suicidal ideation among all youth and stratified by gender identity. Method Data were derived from the 2013–2015 California Healthy Kids Survey (CHKS; N=621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS; N = 28,856]). Results Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared to non-transgender youth (33.73% versus 18.85%; χ2 = 35.48, p <.001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI: 2.25, 3.98) of reporting past-year suicidal ideation compared to non-transgender youth. Among transgender youth, only depressive symptoms (AOR: 5.44, 95% CI:1.81, 16.38) and victimization (AOR: 2.66, 95 CI%: 1.26, 5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95%, and victimization by 14.71%. Conclusion This study uses the first representative population-based sample of youth in the US that includes a measure of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample.

The magnitude of gender identity-related disparities in school-based outcomes is unknown because of a lack of representative studies that include measures of gender identity. By utilizing a representative sample generalizable to a broader population, this study elucidates the size of gender identity-related disparities, independent of sexual orientation, in school experiences associated with school connectedness and perceptions of school climate. Additionally, the inclusion of and comparison to results of a large non-representative sample allows for more direct comparisons to previous studies of the school experiences of transgender youth. The analyses in this study primarily draw on a sample of 31,896 youth representative of the middle and high school population in California who participated in the 2013-2015 California Student Survey (a subsample of the California Healthy Kids Survey, which includes the largest known sample of transgender youth). Over half the sample identified their sex as female (51.3%), and 398 identified as transgender (1.0%). The sample was racially and ethnically diverse: 30.7% identified as multiracial, 33.0% as White, 11.1% as Asian, 7.4% as Black, and 52.9% as Hispanic. Findings from multilevel analyses show that relative to non-transgender youth, transgender youth were more likely to be truant from school, to experience victimization and bias-based bullying, and to report more negative perceptions of school climate, though did not differ in self-reported grades. The findings have implications for improving school policies and practices to create safer and more supportive school climates for all youth.

Gay‐Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias‐based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ‐focused policies, independently and mutually, with experiences bullying and perceived support (n = 1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ‐focused policies; the presence of both GSAs and LGBTQ‐focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ‐focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.

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