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Recruitment and Retention of Transgender and Nonbinary Adolescents: A Pilot Longitudinal Study
Sun, April 24, 8:00 to 9:30am PDT (8:00 to 9:30am PDT), Marriott Marquis San Diego Marina, Floor: North Building, Lobby Level, Rancho Santa Fe 3Abstract
Background. Transgender and non-binary (TNB) youth experience significant disparities in multiple domains, including mental health and school functioning. However, with few exceptions, studies with TNB youth have been restricted in their sampling approaches (e.g., clinic-based recruitment), which has rendered findings ungeneralizable to TNB youth more broadly. The one existing nationally representative study examining transgender adolescents was cross-sectional, thus precluding investigation of protective factors that might buffer negative outcomes over time. In order to fill these gaps, the current study tests the efficacy of online recruitment methods to obtain a longitudinal sample of TNB adolescents, and examines the extent to which baseline results are similar to TNB youth who completed the Youth Risk Behavior Surveillance (YRBS).
Methods. To recruit youth, ads were posted on Facebook and Instagram, and social media influencers (N = 27) were asked to share study information. Ads directed youth to the study’s website, where adolescents were invited to complete a brief screener to determine eligibility criteria (i.e., 14-17 years-old; identify as TNB). The IRB approved a waiver of guardian consent. Eligible participants were invited to complete a 10-minute online survey assessing multiple psychosocial domains including well-being and social and structural supports.
Results. 213 (44% response rate) adolescents have completed valid baseline surveys thus far: 60 transgender male; 53 transgender female; 53 non-binary, assigned female at birth; 47 non-binary, assigned male at birth. Age ranged from 14-18 years (Mean: 15.98, SD = 1.02), with youth primarily identifying as White, non-Hispanic (64%). The geographic distribution of the sample was: 18% Northeast, 29% Midwest, 25% South, and 28% West. 47% of teens (21% transgender, 26% nonbinary) reported living in their affirmed gender most or all of the time. Sample indicators of functioning indicated that youth reported high rates of depression (76%) and self-harm (58%), with approximately 25% reporting substance use (28%) and sexual assault (21%). Preliminary analyses revealed that TNB youth who reported living in their affirmed gender identity most or all of the time were less likely to report depression relative to youth living in their affirmed identity none or some of the time, 𝜒2(1, N = 209) = 6.39, p = .01. Greater perceived social support was associated with reduced odds of reporting substance use (OR: 0.97, 95% CI: 0.95, 0.99), sexual assault (OR: 0.95, 95% CI: 0.93, 0.98), and depression (OR: 0.97, 95% CI: 0.94, 0.99). Subsequent analyses will utilize data from follow-up surveys (completed in April-May 2021) to assess change over time in outcomes (with attention to retention rates and differences between the 4 gender identity groups) and comparisons to YRBS data.
Significance. High rates of psychological distress, substance use and victimization among TNB adolescents underscore the need to elucidate risk and protective factors among TNB youth. Ultimately, study findings will provide valuable insight into how to better recruit and retain TNB youth in longitudinal studies, allowing for better data to identify pathways to support TNB youth well-being using a life-course perspective.