School Absenteeism Among Racially and Ethnically Minoritized Transgender High School Students and Their Peers: A Cross-Sectional Study

To explore absenteeism among racially and ethnically minoritized transgender youth (trans REMY) compared to their White transgender (trans WY) and racially and ethnically minoritized cisgender (cis REMY) peers and identify associated psychosocial factors. Biennial California Healthy Kids Survey 2017-2019 data was analyzed with a weighted sample of California's secondary school population. Students reported past 30-day absences due to mental health and harassment, depressive symptoms, suicidal ideation, cyberbullying, victimization, and school connectedness. Poisson and linear regression compared absenteeism and psychosocial factors among peer groups. For trans REMY, Poisson regression assessed associations between absenteeism and psychosocial factors. Analyses were adjusted for grade, sex, and socioeconomic status. The analytical sample (n = 25,085) included 206 trans REMY, 64 trans WY, and 24,815 cis REMY. Trans REMY had higher relative risk of absenteeism due to mental health concerns and harassment compared to cis REMY (adjusted relative risk 2.9, 95% confidence interval 2.1–4.0 and adjusted relative risk 8.1, 95% confidence interval 4.0–16.6, respectively) but similar risk when compared to trans WY. For trans REMY, depressive symptoms, suicidal ideation, and victimization were associated with higher relative risk of absenteeism due to mental health concerns. Cyberbullying was associated with a higher risk of absenteeism due to harassment. Higher school connectedness was associated with lower risk of absenteeism due to mental health concerns. Trans REMY reported higher rates of school absenteeism due to mental health concerns and harassment compared to some of their peers. Mental health symptoms, victimization, cyberbullying, and school connectedness were associated with absenteeism among trans REMY.