Homelessness Among Gender Minority Youth: Prevalence and Health Disparities

Background: Existing studies have indicated that LGBT youth experience high rates of homelessness, particularly for gender minorities (transgender and gender questioning individuals). Status as a homeless gender minority youth, consequently, is associated with the health disparities faced by both the homeless and by gender minorities. This study was conducted to identify the health disparities that homeless gender minority youth experience for practitioners to assess the population’s specific needs.

Methods: The study was conducted using the 2017 and 2019 Youth Risk Behavior Surveillance System, a cross-sectional survey of American high school students. The ten states that collected data on both homelessness and transgender status were included in the study. Participants were grouped as cisgender or gender minority. Within each group, participants were divided into “homeless” or “not homeless” based upon their sleeping locations within the 30 days prior to the survey’s administration. Mental health outcomes, sexual risk behaviors, and substance use were compared between homeless cisgender and homeless gender minority youth, as well as between homeless and non-homeless gender minorities. Wald chi-square tests were used to assess the associations between homelessness and health-risk behaviors.

Results: Of the 96,531 respondents included in this analysis, 93,382 (96.7%) reported cisgender status and 3,194 (3.3%) reported gender minority status. Elevated homelessness rates showed statistical significance (p < 0.05) for gender minorities compared to cisgender participants (22.2% vs. 3.3%). Homeless gender minority youth, when compared to homeless cisgender youth, had statistically significant (p < 0.05) higher rates of suicide attempts (48.2% vs. 20.9%), sex with four or more partners (62.6% vs. 25.1%), and cocaine use (64.7% vs. 21.5%). Among all gender minorities, homeless youth had statistically significant (p < 0.05) higher rates of the same behaviors than their non-homeless counterparts: suicide attempts (48.2% vs. 21.4%), sex with four or more partners (62.6% vs. 6.8%), and cocaine use (64.7% vs. 7.4%). There were similar rates of some sexual risk and substance use behaviors between non-homeless cisgender and non-homeless transgender youth, such as sex with four or more partners (6.7% vs. 6.8%), alcohol use (25.3% vs. 23.3%), and marijuana use (18.2% vs. 13.5%).

Conclusion: Homeless gender minority youth are at a higher risk for poor health outcomes and behaviors than homeless cisgender youth and non-homeless gender minorities. These findings highlight the need for the integration of targeted screening and intervention programs in clinical practice to support this vulnerable population. General gender minority health risk behavior rates may be elevated due to the high rates of homelessness within the population, since non-homeless transgender youth have similar health risk behavior rates as non-homeless cisgender youth. Future studies may aim to use qualitative methods to assess the mechanisms linking gender minority status and homeless status to negative health outcomes.