The Slatest

How the CDC Is Failing Transgender Youth

Principal Pete Cahall, waves a rainbow flag, symbolizing gay pride, at a rally of about 1000 Woodrow Wilson High School students and gay supporters June 9, 2014 at Woodrow Wilson High School in Washington, DC. The rally was held to counter a planned protest by  Westboro Baptist Church, the Kansas-based organization known for anti-gay picketing at funerals.      AFP PHOTO/Paul J. Richards        (Photo credit should read PAUL J. RICHARDS/AFP/Getty Images)
A 2014 rally at Woodrow Wilson High School in Washington, D.C., was meant to counter a protest from the Westboro Baptist Church.
Paul J. Richards/AFP/Getty Images

Last week, a major survey from the Centers for Disease Control and Prevention reported some disturbing trends among U.S. high school students. Rates of “persistent feelings of sadness or hopelessness,” suicidal ideation, and suicide planning are all up from 2007, according to the results of the Youth Risk Behavior Survey, a biannual effort that gathers data from almost 15,000 teenagers across the country. In 2017, when the most recent iteration of this survey was conducted, almost 14 percent of students reported having made a suicide plan, compared to 11 percent in 2007.

Though rates of alcohol, cocaine, and marijuana use are down from a decade ago, 1 in 7 students say they’ve abused prescription opioids. (This is the first year the question has been posed, but even without a trend-line, that proportion is cause for alarm.) Another bit of dispiriting data: Five percent of students report having been forced to have sexual intercourse. This aggregate statistic masks a wide discrepancy. One in 10 female students said they’d been forced to have sex, compared to 1 in 28 male students.

This is how surveys work—for as much as they illuminate, their averages can also obscure. The CDC’s researchers have painstakingly disaggregated the survey data by gender, race, and geographic location to better illustrate the disparities in American teenage life. But some marginalized demographic groups remain hidden in the data. Until recently, states could choose to opt in to a pair of questions that asked students about their sexual identities and the sexes of their sexual partners, which served to produce more accurate data on the lives of lesbian, gay, and bisexual students. Many states did not. Beginning with the 2015 survey, those sexual minority demographic questions became standard, making last week’s report only the second nationally representative survey of LGBTQ high school students in U.S. history.

The results are rather grim. “For every variable explored in this report, lesbian, gay, or bisexual students were at significantly higher risk than heterosexual students,” the CDC’s report states. Lesbian, gay, and bisexual students, and those who reported having sex with people of the same sex, were more likely than their straight-identified peers to report substance use and abuse, suicidal ideation and attempts, and being victimized by bullying and violence. As a whole, the report paints a picture of an intersection of failing systems—structures of politics, health care, education, and parenthood—that sentence sexual minority youth to adolescent years of fear, loneliness, and bodily harm.

According to the survey results, LGB students are twice as likely as their heterosexual counterparts to have misused prescription opioids, twice as likely to have used any of a select list of illegal drugs (including cocaine, ecstasy, hallucinogens, heroin, and meth), and more than three times as likely to have injected illegal drugs. People not sure of their sexual identity were more than six times as likely as their straight peers to have injected drugs. While the percentage of straight students who reported being forced into sex remained constant from 2015 to 2017 at 5 percent, the rate among LGB-identified students rose 4 percentage points: Now, between 1 in 4 and 1 in 5 LGB students say they’ve been forced to have sexual intercourse, more than twice the overall rate among female students.

LGB students are almost twice as likely as heterosexual ones to miss school because they fear for their safety, and for good reason: They’re also about twice as likely to be threatened with or injured by a weapon at school. Rates of physical and sexual dating violence are down among both straight and LGB-identified students as compared to 2015, but wide gaps remain. More than 17.2 percent of LGB students said they’d experienced physical dating violence, and almost 16 percent reported sexual dating violence. They’re almost three times as likely as their straight peers to suffer either.

The suicide and depression portion of the survey is perhaps the most troubling, both because the disparities are widest there and because the high rates among sexual minority students seem most directly attributable to a homophobic society that diminishes their worth and fails to meet their needs. Sixty-three percent of LGB students said they had recently experienced “persistent feelings of sadness or hopelessness,” compared to just under 28 percent of straight ones. Almost four times as many LGB students as heterosexual ones—a full 38 percent—said they’d made a suicide plan. And, while 1 in 20 straight students reported attempting suicide in the year before the survey, 23 percent of LGB students said the same. When nearly 1 in 4 youths of any defined demographic try to die by suicide in a year’s time, it should qualify as a national emergency.

These survey results present policymakers with a moral imperative to combat this crisis among sexual minorities in U.S. high schools. They also underscore the importance of an additional set of questions the CDC would do well to adopt. Currently, there are no mandatory questions on the Youth Risk Behavior Survey that would identify data from transgender students, a growing population of youths that are even more vulnerable than their lesbian, gay, and bisexual peers.

In the absence of any concerted government effort to track trans wellbeing, NGOs and advocacy groups have attempted to fill the gap. The National Center for Transgender Equality has been at the vanguard of surveying trans Americans in place of federal data-collecting agencies. In 2009, NCTE and the National LGBTQ Task Force broke new ground with its landmark National Transgender Discrimination Survey, the first and most comprehensive record of its kind. NCTE followed up that success in 2015 with the largest trans survey ever, a document that tabulated the experiences of 27,715 transgender people from around the country.

Because of these efforts, advocates and lawmakers have real data to back up their recommendations for policies and programs that improve trans people’s lives. I still remember the chill I got when I read the 2015 survey results, in which 40 percent of the more than 27,000 trans people surveyed reported having attempted suicide in their lifetimes. If you’d asked me to speculate on whether trans people attempt suicide at higher rates than the American population as a whole, I’d have guessed with great confidence that they did. But to put an enormous sample size and a specific number to that fact is to make it more real—and, most importantly, actionable—to those who might otherwise doubt the magnitude of trans suffering and resilience in this country. Because of the CDC’s questions on sexual identity, we know a little bit more about the barriers to a happy, healthy adolescence that LGB students face. Until the agency starts letting trans students identify themselves, we can only wonder and worry about theirs.