Table 3.
Prevalence of health risk behaviors and experiences by transgender identity status and prevalence ratios comparing groups among high school students (N = 98,174) — Youth Risk Behavior Survey, 18 States,* 2021.
| Health Behaviors and Experiences | Gender and sex, column prevalence (95% CI) | aPR‡ (95% CI) | |||
|---|---|---|---|---|---|
| Cisgender male† (N = 45,161) | Cisgender female† (N = 44,240) | Transgender (N = 2948) | Transgender vs. cisgender males | Transgender vs. cisgender females | |
| Total | 49.3 (48.3–50.3) | 47.7 (46.7–48.7) | 3.0 (2.7–3.4) | — | — |
| Experiences of violence | |||||
| Felt unsafe at or traveling to/from school | 7.9 (7.1–8.8) | 12.2 (10.7–13.8) | 27.0 (23.2–31.2) | 3.2 (2.7–3.9) | 2.1 (1.7–2.6) |
| Threatened or injured with a weapon at school | 5.9 (5.3–6.6) | 4.7 (4.2–5.3) | 21.5 (18.0–25.5) | 3.4 (2.7–4.2) | 4.2 (3.3–5.3) |
| Ever forced to have sexual intercourse | 2.8 (2.5–3.1) | 12.6 (11.7–13.6) | 25.8 (21.6–30.6) | 9.4 (7.5–11.7) | 2.1 (1.7–2.6) |
| Experienced sexual violence by anyone | 4.9 (4.5–5.5) | 16.2 (15.2–17.2) | 29.0 (24.2–34.3) | 5.6 (4.6–6.8) | 1.7 (1.4–2.0) |
| Experienced sexual dating violence | 3.1 (2.6–3.6) | 13.2 (12.2–14.2) | 24.2 (19.5–29.6) | 7.2 (5.3–9.9) | 1.7 (1.3–2.1) |
| Experienced physical dating violence | 5.6 (5–6.3) | 8.6 (7.7–9.6) | 22.0 (15.8–29.8) | 3.5 (2.3–5.3) | 2.3 (1.6–3.4) |
| Bullied at school | 10.3 (9.5–11.1) | 15.9 (14.9–17.0) | 33.4 (29.5–37.6) | 3.2 (2.7–3.7) | 2.1 (1.8–2.4) |
| Electronically bullied | 9.5 (8.9–10.1) | 18.3 (17.3–19.3) | 36.7 (32.8–40.8) | 3.8 (3.3–4.3) | 2.0 (1.7–2.2) |
| Substance use | |||||
| Cigarettes, lifetime use | 14.9 (13.7–16.2) | 14.7 (13.8–15.8) | 29.5 (24.6–34.8) | 1.9 (1.6–2.3) | 1.9 (1.6–2.3) |
| Electronic vapor product, current use | 12.9 (11.8–14.1) | 19.9 (18.4–21.5) | 21.9 (17.8–26.7) | 1.5 (1.3–1.9) | 1.0 (0.8–1.2) |
| Alcohol, current use | 12.8 (11.9–13.8) | 24.8 (23.2–26.4) | 28.2 (23.5–33.5) | 1.6 (1.3–1.8) | 1.1 (1.0–1.3) |
| Marijuana, lifetime use | 24.8 (23.3–26.3) | 31.5 (30.0–33.0) | 36.6 (30.4–43.2) | 1.5 (1.3–1.7) | 1.2 (1.0–1.4) |
| Cocaine, lifetime use | 1.8 (1.4–2.2) | 1.3 (1.1–1.5) | 16.4 (11.7–22.5) | 8.7 (5.9–12.9) | 12.3 (8.1–18.6) |
| Heroin, lifetime use | 1.1 (0.8–1.4) | 0.5 (0.4–0.6) | 15.3 (9.7–23.2) | 11.1 (6.7–18.2) | 24.4 (14.7–40.4) |
| Methamphetamines, lifetime use | 1.3 (1.0–1.7) | 0.6 (0.5–0.8) | 15.8 (10.6–22.9) | 9.9 (6.5–15.0) | 21.8 (13.9–34.2) |
| Ecstasy, lifetime use | 2.7 (2.1–3.4) | 1.3 (1.1–1.6) | 15.4 (11.0–21.0) | 4.5 (3.2–6.5) | 9.5 (6.4–14.2) |
| Inhalants, lifetime use | 4.3 (3.5–5.3) | 5.1 (4.3–6.0) | 19.1 (13.2–26.8) | 4.4 (2.9–6.9) | 3.7 (2.5–5.6) |
| Prescription opioid misuse, lifetime | 8.7 (8.0–9.5) | 13.0 (12.1–13.9) | 26.8 (22.9–31.0) | 3.1 (2.6–3.7) | 2.1 (1.8–2.5) |
| Mental health/suicide | |||||
| Mental health not good, past 30 days | 18.5 (17.4–19.8) | 41.6 (40.0–43.1) | 71.5 (66.4–76.2) | 4.0 (3.6–4.3) | 1.8 (1.6–1.9) |
| Felt sad or hopeless, past 12 months | 25.3 (24.3–26.3) | 49.1 (47.6–50.6) | 70.1 (66.2–73.8) | 2.8 (2.7–3.0) | 1.5 (1.4–1.5) |
| Considered attempting suicide, past 12 months | 11.4 (10.8–12.1) | 23.7 (22.6–24.9) | 50.6 (46.8–54.5) | 4.4 (4.0–4.9) | 2.1 (2.0–2.3) |
| Made a suicide plan, past 12 months | 9.2 (8.6–9.8) | 18.9 (17.9–19.8) | 51.3 (46.9–55.6) | 5.6 (4.9–6.3) | 2.7 (2.5–3.0) |
| Attempted suicide, past 12 months | 6.1 (5.4–6.8) | 10.7 (9.9–11.6) | 32.3 (27.2–37.9) | 5.2 (4.2–6.4) | 2.9 (2.5–3.5) |
| Had a suicide attempt treated by a doctor or nurse, past 12 months | 1.4 (1.1–1.7) | 2.4 (2.0–2.8) | 14.2 (9.9–20.0) | 10.5 (7.1–15.7) | 6.1 (4.2–8.8) |
| Sexual behavior | |||||
| Ever had sexual intercourse | 27.6 (26.1–29.1) | 29.1 (27.5–30.8) | 29.5 (25.5–34.0) | 1.1 (1.0–1.3) | 1.0 (0.9–1.2) |
| Had ≥ 4 sexual partners | 6.4 (5.8–7.1) | 5.0 (4.4–5.6) | 10.0 (7.1–14.0) | 1.5 (1.1–2.1) | 2.0 (1.4–2.8) |
| Currently sexually active | 17.9 (16.7–19.1) | 20.9 (19.7–22.2) | 18.2 (14.1–23.2) | 1.0 (0.8–1.3) | 0.9 (0.7–1.1) |
| Used a condom during last sexual intercourse | 60.8 (57.4–64.0) | 48.5 (45.5–51.5) | 31.6 (22.3–42.6) | 0.5 (0.4–0.7) | 0.7 (0.5–0.9) |
| Used birth control pills; an IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon); or a shot (such as Depo-Provera), patch (such as OrthoEvra), or birth control ring (such as NuvaRing) before last sexual intercourse with an opposite-sex partner | 30.5 (27.4–33.9) | 40.9 (38.1–43.7) | 18.0 (10.0–30.4) | 0.7 (0.4–1.2) | 0.5 (0.3–0.9) |
| Ever tested for HIV | 7.7 (6.6–8.9) | 7.1 (6.3–8.0) | 14.6 (9.6–21.6) | 1.8 (1.3–2.5) | 1.9 (1.3–2.9) |
| Tested for STD in past 12 months | 5.6 (4.6–6.8) | 6.2 (5.4–7.1) | 13.6 (8.4–21.2) | 2.3 (1.5–3.6) | 2.1 (1.3–3.3) |
| School connectedness and home environment | |||||
| Felt close to people at school | 67.4 (64.1–70.6) | 54.0 (51.1–56.8) | 32.4 (23.6–42.7) | 0.5 (0.4–0.6) | 0.6 (0.4–0.8) |
| Experienced high parental monitoring | 87.2 (86.2–88.1) | 90.0 (89.2–90.8) | 85.8 (82.9–88.3) | 1.0 (1.0–1.0) | 1.0 (0.9–1.0) |
| Unstable housing | 3.0 (2.4–3.7) | 1.9 (1.6–2.4) | 17.0 (11.1–25.2) | 5.4 (3.7–7.9) | 8.2 (5.4–12.6) |
Abbreviations: aPR = adjusted prevalence ratio; STD = sexually transmitted disease
aPR 95% CIs that do not include 1 are considered statistically significant. Bolded values indicate statistical significance.
*
Delaware, Florida, Hawaii, Iowa, Massachusetts, Maine, Maryland, Michigan, North Dakota, Nebraska, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Virginia, Vermont, Wisconsin
†
Cisgender students were further categorized by sex based on their response to “What is your sex?” Students who were cisgender and responded “male” were categorized as cisgender males; students who were cisgender and responded “female” were categorized as cisgender females.
‡
Prevalence ratio comparing the prevalence of select health behaviors among transgender students to the prevalence among cisgender male students and cisgender female students, adjusted for race/ethnicity and grade.