Homelessness experiences and gender identity in a population-based sample of adolescents.

This paper examines the prevalence of homelessness among transgender/gender diverse (TGD) youth in a population-based sample of adolescents. We used data from a statewide sample of 9th and 11th grade adolescents in Minnesota who responded to a school-based survey during 2016 (N = 80,929). Survey questions assessed adolescents' gender identity and experiences of homelessness (either with adult family members or unaccompanied) in the past 12 months. We used chi-square analyses to compare the prevalence of homelessness between gender identity groups. Overall, 2.7% of the sample reported identifying as TGD. Significantly more TGD (vs. cisgender) youth reported experiencing homelessness either with adult family members (6.7% vs. 3.5%) or unaccompanied (3.6% vs. 1.1%; p < .0001). Findings from this population-based survey suggest that TGD youth are more likely to experience homelessness, either with a family member or unaccompanied, than cisgender peers. Ensuring housing stability among this population is critical, given health risks associated with homelessness during adolescence. Data on homelessness experiences of TGD youth are needed to inform practice and policies for this distinct population.

Introduction

Homelessness is associated with adverse outcomes in youth, including poor mental and physical health, high risk health behaviors, poor cognitive and academic functioning, and emergency room visits and hospitalizations (Weinreb et al., 1998; Edidin et al., 2012). Transgender/gender diverse (TGD) youth (i.e., those whose experience of their gender does not match their birth-assigned sex) may be at an increased risk for experiencing homelessness compared to their cisgender peers, due to discrimination and stigma (Pew Research Center, n.d.) or factors such as substance use and mental health issues, which are more prevalent among TGD youth (Eisenberg et al., 2017; McCann and Brown, 2019). Although family homelessness may be due to financial circumstance similar to other youth populations, TGD youth may be at particular risk for being homeless unaccompanied as a result of being asked to leave their family home over conflict surrounding their gender identity (Quintana et al., 2010). The Minority Stress Theory explains how experiences of stigma (e.g., discrimination, expectations of rejection) may lead to poor health outcomes among lesbian, gay, and bisexual populations (Meyer, 2003); such processes may also explain poor health outcomes and increased risk of homelessness among TGD youth.

Much of the available information on the prevalence of TGD youth homelessness comes from non-representative samples of youth or agencies serving youth who experience homelessness. For example, a count of unaccompanied youth aged 16–24 in New York City found that 6% of 182 total respondents identified as transgender (Freeman and Hamilton, 2013). According to a survey of youth homeless service agency providers, approximately 4% of the youth they served identified as transgender or genderqueer (Choi et al., 2015).

Research provides information on youth homelessness and sexual orientation, showing greatly increased risk of homelessness among lesbian, gay, and bisexual youth (LGB) (Corliss et al., 2011; Morton et al., 2018), yet gender identity is only rarely assessed in surveillance studies of youth. Population-based research on the homelessness experiences of TGD youth is needed to better understand this distinct group and make recommendations for appropriate services.

In keeping with Healthy People 2020 goals of understanding and advancing the health of LGBT groups (U.S. Department of Health and Human Services, n.d.), the current study examines the prevalence of homelessness by gender identity in a population-based sample of adolescents. We hypothesized that TGD youth would be more likely to experience homelessness than their cisgender peers, particularly unaccompanied homelessness, based on previous findings from studies focusing on LGB youth.

Methods

Data source

Data come from the 2016 Minnesota Student Survey (MSS), a school-based survey of risk and protective factors among 5th, 8th, 9th, and 11th graders. The MSS is offered to all public and charter schools in the state. In 2016, the school district participation rate for this survey was 85%. The question about gender identity was only included on the high school survey (grades 9 and 11), so the current analysis is restricted to these grades. Of all students enrolled in regular public schools in Minnesota in 2016, 71% of 9th graders and 61% of 11th graders provided data, and the sample reflects the demographic characteristics of in-school adolescents statewide. Approximately 1.2% of students (n = 956) did not indicate their gender identity, resulting in an analytic sample of 80,929. In accordance with state law, data was collected anonymously under passive consent procedures. The University of Minnesota Institutional Review Board exempted this analysis from review.

Measures

Gender identity

One survey item measured gender identity. Participants were asked, “Do you consider yourself transgender, genderqueer, genderfluid, or unsure about your gender identity?” Response options were “yes” (TGD group) or “no” (cisgender group).

Homelessness experience

A single survey item assessed homelessness experience. Participants were asked, “During the last 12 months, have you stayed in a shelter, somewhere not intended as a place to live, or someone else's home because you had no other place to stay? (Mark ALL that apply).” Response options included “no,” “yes – I was with my parents or an adult family member,” and “yes – I was on my own without any adult family members.” For analyses, we categorized youth who indicated “yes” to both types of homelessness in the group experiencing unaccompanied homelessness (n = 126; 0.2%).

Students also self-reported several demographic and personal characteristics including: grade, race/ethnicity, socioeconomic status (as assessed by receipt of free or reduced price lunch), and sexual orientation. We characterized urbanicity based on school location in the seven-county Minneapolis/St. Paul metropolitan area (versus other areas of the state).

Data analysis

Differences in homelessness experiences between gender identity groups were assessed by chi-square tests, with a supplemental logistic regression adjusting for demographic covariates. Analyses were conducted using SAS version 9.4.

Results

Almost 3% of respondents (n = 2168; 2.7%) identified as TGD. As described previously, the sample of TGD youth was 68.1% assigned female at birth, 58.6% were in 9th grade, and 58.7% were white, non-Hispanic; 61.2% received free or reduced-price lunch (Eisenberg et al., 2017). A large majority of TGD youth (81.6%) identified their sexual orientation as lesbian, gay, bisexual or unsure.

Figure 1 shows the prevalence of homelessness experiences between TGD youth and their cisgender peers. The majority of youth in the sample did not experience any type of homelessness in the past year, with 89.8% of TGD youth and 95.5% of cisgender youth responding “No” to the question about homelessness experiences. However, more TGD (vs. cisgender) youth reported experiencing homelessness either with adult family members (6.7% vs. 3.5%) or unaccompanied (3.6% vs. 1.1%); these differences were statistically significant (Χ2 = 168.9, p < .0001). Additionally, among all youth who reported being homeless unaccompanied, 8.2% identified as TGD (compared to only 2.4% of youth who had not experienced homelessness). Odds of experiencing homelessness with adult family members (OR = 1.83, 95% CI = 1.52, 2.21) or unaccompanied homelessness (OR = 3.19, 95% CI = 2.45, 4.17) remained significantly elevated for TGD youth compared to cisgender youth in regression models adjusting for sex assigned at birth, grade, race/ethnicity, receipt of free/reduced lunch and urban location.

Fig. 1

Homeless experience in the past 12 months among adolescents, by gender identity, and type of homelessness, Minnesota Student Survey, United States, 2016.

Note. TGD = Transgender/gender diverse. Bars indicate 95% confidence intervals.

Discussion

In this school-based sample, we found that more than 1 in 10 TGD adolescents reported experiencing homelessness in the past year. Further, significantly more TGD youth than cisgender youth in our sample reported experiencing homelessness either with adult family members or unaccompanied. The finding for unaccompanied homelessness is consistent with Minority Stress Theory and is similar to the results of previous studies focused on LGB or LGBT youth as a combined group (Corliss et al., 2011; Morton et al., 2018), though these studies did not exclusively focus on TGD youth. Given the descriptive nature of this study, we did not adjust for sexual orientation in the present analysis.

In the MSS, 2.7% of participants reported a TGD identity (Eisenberg et al., 2017; Rider et al., 2018). This estimate is higher than reported in other samples, likely due to the inclusion of the terms “genderqueer,” “gender fluid,” and unsure as response options to the item about gender identity. Limitations of this study should be noted. Data were cross-sectional and do not imply causation; they were from a single state, so may lack generalizability to other regions. The homelessness question did not assess duration of homelessness or other contextual information that could be important to understanding youth's experiences. Finally, homelessness may be underreported, as students currently experiencing homelessness may be less likely to be in school, and thus not sampled. Key strengths of this study include data that were collected from a very large statewide sample of youth and included a novel measure of homeless experience that differentiates between being homeless with family or unaccompanied; this distinction is not found in other population-based samples.

Public health implications

Our findings have implications for school personnel, public health practice and policy. Professionals working with TGD youth should be aware that TGD identity is associated with a greater vulnerability to being homeless unaccompanied, as well as with adult family members. Service professionals working with youth experiencing homelessness should also be aware that clientele may identify as TGD and have appropriate practices and policies in place to support these youth, particularly where services are provided based on gender. Because TGD youth are also significantly more likely than cisgender peers to experience emotional distress including suicidality (Eisenberg et al., 2017), school personnel and service providers should be aware of community resources that offer crisis management tailored to this population. TGD-specific and TGD-affirming services are needed for TGD youth experiencing homelessness, as they have unique health, legal, and safety needs related to their gender identity. Staff working with youth experiencing homelessness need training on working with TGD clientele to create a supportive environment, which is essential for youth in accessing and utilizing services (Maccio and Ferguson, 2016).

Funding sources

This study was supported by the Leadership Education in Adolescent Health training program at the University of Minnesota (HRSA #T71MC00006-39-02; PI: Sieving) and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R21HD088757; PI: Eisenberg). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funders had no involvement in study design; collection, analysis and interpretation of data; the writing of the report; or in the decision to submit the article for publication. Minnesota Student Survey data were provided by public school students in Minnesota via local public school districts and are managed by the Minnesota Student Survey Interagency Team.

Declaration of competing interest

None.