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Differences in Health Care Experiences among Transgender and Gender Diverse Youth by Gender Identity and Race/Ethnicity

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Abstract

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth’s experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today’s Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one’s provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth.

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Data Availability

The data that support the findings of this study are available from the corresponding author, MMJ, upon reasonable request.

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Funding

Jack Andrzejewski was supported by the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) under Award Number T32DA023356. The work of all other authors was supported by their salaries at their respective organizations.

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Authors and Affiliations

  1. Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Michelle M. Johns

  2. NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA

    Michelle M. Johns, Stuart Michaels, Christopher Hansen, Erin Fordyce & Richard Dunville

  3. Boston University School of Public Health, Boston, MA, USA

    Allegra R. Gordon

  4. Harvard Medical School, Boston, MA, USA

    Allegra R. Gordon

  5. San Diego Joint Doctoral Program in Public Health, San Diego State University, University of California, San Diego, CA, USA

    Jack Andrzejewski

  6. Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Christopher R. Harper

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Correspondence to Michelle M. Johns.

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Johns, M.M., Gordon, A.R., Andrzejewski, J. et al. Differences in Health Care Experiences among Transgender and Gender Diverse Youth by Gender Identity and Race/Ethnicity. Prev Sci 24, 1128–1141 (2023). https://doi.org/10.1007/s11121-023-01521-5

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