O0618 Oct.5: 2:41pm - Identifying Inequities: Assessing Gender Identity Disparities in a Large Pediatric Emergency Department

Background
Lesbian, gay, bisexual, transgender and queer/questioning (LGTBQ) youth have poorer health outcomes than straight or cisgender youth.1,2 Understanding a child’s gender identity (GI) is an opportunity to intervene in this disparity. As one approach, we sought to describe GI and health behaviors among adolescents in an emergency care setting.
Methods
A survey was conducted in 12-18 year olds presenting at two urban emergency departments in Minnesota between December, 2018 and June, 2019. The survey was adapted from the Minnesota Student Survey2, including questions on GI, mental and sexual health, substance use, and violence. GI responses were categorized into two groups: “Gender diverse youth” (GDY) includes transgender, genderqueer, gender fluid, or gender non-binary youth and “cisgender” consists of youth who did not identify as GDY. Data were analyzed using Chi-square, Fisher’s Exact, and Kruskal-Wallis tests. In total, 411 youth provided data on GI and are included in this analysis.
Results
Gender diverse youth (15.4%) differed significantly from cisgender youth in the following charactersitics: more likely to be African (10% vs. 3.4%, p=0.03), assigned female at birth (78.3% vs. 62.7%, p=0.01), and present equally feminine and masculine (31.7% vs. 7.5%, p<0.01). Reports of being bullied overall were not significantly, however, of those who were bullied GDY were more likely to be bullied for their gender (6.7% vs. 1.8%, p=0.05), gender expression (13.3% vs. 4.6%, p=0.02), and for being or perceived as LGBQ (10% vs. 3.1%, p=0.02).Youth who reported being sexually active did not differ between the GDY and cisgender youth (23.3% vs. 20.8%, p=0.65). However, among the youth that were sexually active the GDY were more likely to have used alcohol or drugs before the last time they had sex (35.7% vs. 4.6%, p<0.01), more likely to have not discussed the prevention of STIs (21.4% vs. 6.2%, p=0.03) and less likely to discuss preventing pregnancy (50% vs. 78.5%, p=0.03) with every partner. In addition, GDY were more likely to be depressed more than half of the days over the past two weeks (25.9% vs.12.6%, p=0.01) and more likely to have tried smoking (23.3% vs. 9.1%, p<0.01). Both GDY (44.1%, p<0.01) and cisgender (69.4%, p<0.01) youth responded as always comfortable with talking about GI with providers. Both GDY (44.1%, p<0.01) and cisgender youth (34.8 %, p<0.01) were more likely to say they wanted to be asked about GI, but not at every visit.
Discussion
Findings can guide emergency department staff in addressing health disparities involving GDY. Given that the prevalence of GDY is over 5x what’s expected in the general population, an ED visit may provide an opportunity for connecting youth with critical resources to address health risks and inequities.