Young people who identify as gender minority (ie, transgender, nonbinary, gender diverse) experience violence at significantly higher rates than their cisgender counterparts (ie, those whose gender identity aligns with their sex category assigned at birth). These experiences of violence include threat or injury with a weapon, forced sexual intercourse, dating violence, and bullying.1 Studies indicate that gender minority youth experience significant discrimination and stigma, which contribute to disparities in substance use, incomplete education, mental health concerns, and suicide.² Prevention of sexual violence requires addressing risk and protective factors across multiple levels, including individual, relational, community, and society, and identifying effective strategies to stop the use of sexual violence.³

Ybarra et al4 conducted a nationally representative online survey using social media, with attention to oversampling sexual and gender minority youth, to better understand variation in the prevalence of use of sexual violence (ie, perpetration) by gender identity. Their primary research questions were to what extent sexual violence rates vary by gender identity and what youth characteristics correlate with perpetration within gender identity categories. This work seeks to fill an important gap in our understanding of differential risk for perpetration. As exposure to violence, including sexual violence, is a well-recognized risk factor for using sexual violence, they examined differences in perpetration of and exposure to sexual violence by gender identity. They examined a broad range of youth characteristics, including protective factors, that could influence use of sexual violence including stressors of being marginalized, such as internalized transphobia and gender inequity, community violence exposure, pornography consumption, and social supports. Consistent with prior literature, they found that gender minority youth had more than twice the odds of ever experiencing sexual violence than cisgender boys and girls. Yet despite the higher prevalence of experiencing violence, gender minority youth were not more likely to ever use sexual violence.

Ybarra et al4 finding that gender minority youth are not more likely to use sexual violence than their cisgender peers has the potential to counter pervasive and harmful narratives central to the ways in which trans identity has been weaponized in contemporary political discourse. Numerous legislative efforts have been enacted nationally that prohibit gender affirmative health care for transgender persons and restrict access to sports and facilities based on sex assigned at birth. Ybarra et al⁴ place this study in the context of the profound stigma and marginalization that transgender individuals experience in the United States, noting the “sensitive and unintentionally political research topic that sexual violence perpetration represents.” Findings from this study counter persistent and harmful stereotypes of sexual deviancy attributed to gender minority individuals.

Key challenges in violence prevention research have been limited attention to the inclusion of gender minority youth in studies and sample sizes large enough to allow for analyses by gender identity, a noteworthy advance with the Ybarra study.4 The challenge of inclusion is amplified by lack of consistent assessment of gender identity in studies of violence and discrimination leading to a lack of clarity about participants’ gender identity. The measurement of gender identity is a major strength Ybarra et al⁴ because the authors used a 2-step process, as recommended in similar studies with youth,⁵ by asking youth who reported having a difference in gender identity compared with sex assigned at birth a follow up question about whether they were of transgender experience. Thus, the authors captured the identities of cisgender youth, transgender youth (distinguished as boys and girls), and nonbinary youth. Future adolescent health research should consider this approach to increase the inclusion of gender minority youth in studies.⁶

So where does this study leave us in terms of direction for sexual violence prevention? The authors note that “being gender inclusive is not equivalent to being gender neutral.”4 In line with multiple studies on gender inequitable attitudes and use of violence (including dating and sexual violence), endorsing attitudes supportive of rape and sexual dominance (what they refer to as hostile masculinity) were associated with use of sexual violence by cisgender, and not gender minority, youth. Implemented much more broadly outside the United States, gender transformative sexual violence prevention programs actively seek to address and challenge rigid gender norms, critically examine gender inequities, and build youth leadership skills in promoting gender equity. Gender transformative practices and programs seek to center intersectional gender justice in measurement, theory, and practice implementation.⁷ Findings from this study draw attention to the need to evaluate the relevance of such gender transformative programs for gender minority youth. Simultaneously, given the high levels of sexual violence exposure highlighted in this study, especially among gender minority youth, there is an urgent need to integrate trauma-sensitive, intersectional, and gender transformative approaches in violence prevention efforts that demand inclusion and equity for all youth. This also means looking beyond individual or peer-level violence prevention programming to examining the very policies and practices that are contributing to marginalization, stigma, and isolation if we are to tackle sexual violence prevention in this country meaningfully and with alacrity.

Published: June 2, 2022. doi:10.1001/jamanetworkopen.2022.15866

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Miller E. JAMA Network Open.

Corresponding Author: Elizabeth Miller, MD, PhD, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave, Ste 302.2, Pittsburgh, PA 15213 (elizabeth.miller@chp.edu).

Conflict of Interest Disclosures: Dr Miller reported receiving royalties for writing content for UpToDate Wolters Kluwer outside the submitted work.

Additional Contributions: I thank Dr Robert Coulter (School of Public Health, University of Pittsburgh) and Dr Rachel Gartner (School of Social Work, University of Pittsburgh) for their critical reading and thoughtful guidance with this commentary. Neither individual was compensated for their time.