Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA.
Prev Sci. 2023 Aug;24(6):1128-1141. doi: 10.1007/s11121-023-01521-5. Epub 2023 Apr 22.
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.
跨性别和性别多样化（TGD）的青年经历着严重的负面健康后果风险，但很少有研究关注 TGD 青年的医疗保健体验。本文探讨了在具有不同性别和种族/族裔认同的 TGD 青年样本中，公平获得和利用医疗保健的情况。本分析的数据来自 2018 年青少年关系和转型调查（START）项目的 TGD 子样本（n=1415）。我们评估了五种医疗保健体验：是否有保险、是否有当前的医疗服务提供者、是否向提供者出柜、是否相信提供者了解跨性别问题、以及因性别认同/表达而难以获得医疗保健的障碍。我们使用描述性统计、逻辑回归和预测概率，检查了 TGD 青年中报告这些结果的比例以及按性别认同和种族/族裔划分的组内差异。当按性别认同进行检查时，跨性别女性比其他性别认同的青年更容易遇到公平护理的障碍。种族/族裔差异很少，但双重参照模型表明，公平护理的障碍在黑人和西班牙裔跨性别女性中尤为明显。我们通过交叉性的视角讨论这些发现，并强调开展研究和干预工作的重要性，以减少 TGD 青年公平护理的障碍。
