The Intersection of Gender Identity and Violence: Victimization Experienced by Transgender College Students

Abstract

College students disproportionately experience victimization, stalking, and relationship violence when compared with other groups. Few studies explore victimization by the gender identity of college students, including those who identify as transgender. The purpose of this study is to explore the rates of violence experienced by transgender students compared with male and female college students. This study utilized the National College Health Assessment–II (NCHA-II) and included data from students (n = 82,538) across fall 2011, 2012, and 2013. Bivariate statistics and binary logistic regression were conducted to test the relationships between gender identity and victimization. Transgender students (n = 204) were compared with male (n = 27,322) and female (n = 55,012) students. After adjusting for individual factors, transgender students had higher odds of experiencing all nine types of violence when compared with males and higher odds of experiencing eight types of violence than females. Transgender students experienced the highest odds in crimes involving sexual victimization, including attempted sexual penetration (adjusted odds ratio [aOR]: 9.49, 95% confidence interval [CI] = [6.17, 14.59], d = 1.00), sexual penetration without consent (aOR: 9.06, 95% CI = [5.64, 14.53], d = 0.94), and being in a sexually abusive relationship (aOR: 6.48, 95% CI = [4.01, 10.49], d = 0.48), than did male students. Findings reveal increased odds of victimization among transgender students when compared with male and female students. Results demonstrate the need for more comprehensive violence prevention efforts in college settings.

Keywords

GLBT domestic violence sexual assault violence against

College and university students are at increased risk of experiencing victimization, stalking, and relationship violence. Many college students experience victimization, with 21% of college students reporting being verbally threatened in the last 12 months and 3% experiencing physical assault in the past 12 months (American College Health Association [ACHA], 2016). In addition to high rates of victimization in this age group, differences exist between men and women. Data from 2015 show 6% of college women and almost 3% of college men report experiencing stalking and almost 15% of college women and 8% of college men reported physical, sexual, or emotional abuse by a partner (ACHA, 2016). Coupled with stalking and partner violence, sexual assault also occurs at high rates among college students. Previous studies show as many as 34% of college women and 31% of college men have experienced being sexually touched without their consent, and sexual penetration without consent has been experienced by up to 8% of college women and approximately 1% of college men (Fedina, Holmes, & Backes, 2018). With a majority of victimization occurring before the age of 25 in both men and women, these data suggest an increased potential for victimization to occur during college age years, indicating higher education as an area for intervention (Breiding et al., 2014).

Students identifying as sexual minorities (lesbian, gay, bisexual) are a specific high-risk group for victimization among the college population (Walters, Chen, & Breiding, 2013), yet there is much less research among gender minority students. While the concept of gender identity is unique to each individual, for the purposes of this article, the term transgender is used to describe an individual whose gender identity (their personal sense of being a man or a woman) differs from the biological sex (male or female) they were assigned at birth (Diemer, Grant, Munn-Chernoff, Patterson, & Duncan, 2014; Institute of Medicine, 2011). Although transgender students are a unique population, they are frequently grouped into a category with lesbian, gay, and bisexual (LGB) students, suggesting uniform health concerns based on sexual orientation; however, transgender (T) students may not identify as a part of this subgroup and may identify themselves as heterosexual (Institute of Medicine, 2011; Worthen, 2013). In addition, transgender students report notable differences in experiences of violence and other health concerns when compared with the LGB population, suggesting a need to disaggregate and further analyze this subgroup (Institute of Medicine, 2011). The distinction between these complex interrelated, but independent, factors in identity has not been made in the current violence or college health literature and a focus on transgender students is essential to better understand the victimization experienced by this population.

Victimization of Transgender Individuals

Although transgender people are in the statistical minority, population-based samples have indicated that up to 0.5% of the population identify as transgender, which is estimated to be about one million people (Crissman, Berger, Graham, & Dalton, 2017; Meerwijk & Sevelius, 2017). Individuals identifying as transgender experience health disparities in regard to a range of outcomes, but these disparities are especially pronounced in the rates of violence. Almost half (46%) reported being verbally harassed in the past year, 9% were physically attacked, 10% were sexually assaulted, and 54% had experienced partner violence, 24% of which reported physical partner violence (James, Herman, Rankin, Keisling, & Anafi, 2016). The transgender population is unique and may experience these increased rates of violence due to a lack of knowledge about transgender individuals, which has been linked with fear, misunderstanding, and stigma from the nontransgender identified population (Grant et al., 2011). In addition to this lack of knowledge, there is also a lack of respect and an unwillingness to promote a cultural shift toward the use of a person’s preferred pronouns (Landers & Kapadia, 2017). An individual’s transgender identity may be coupled with other social locations that increase violence and discrimination, including race, living in poverty, HIV status, and immigration status (Crissman et al., 2017; Meerwijk & Sevelius, 2017).

In addition to higher rates of victimization across these types of violence, transgender individuals experience significantly more health concerns than their male or female counterparts, including depression, suicide attempts, and alcohol misuse (Institute of Medicine, 2011). Research suggests partner violence among transgender young adults has been associated with sexual risk-taking and mental health concerns, which compounds the existing health concerns of this population (Reuter, Newcomb, Whitton, & Mustanski, 2016). Transgender individuals who have experienced victimization were more likely to report suicide attempts and alcohol abuse than those who had not been victimized (Coulter et al., 2015; Testa et al., 2012). In addition, victimization has been associated with illicit drug use among transgender women (Testa et al., 2012).

Transgender Identity and Education

While homophobia has decreased and sexual minority populations are experiencing increased public acceptance, there is a delay in the cultural acceptance of transgender individuals and transphobia remains a highly controversial issue in schools (Barbir, Vandevender, & Cohn, 2017; Cicero & Wesp, 2017). The educational setting is a potential area to intervene and improve the health of transgender students by reducing violence, as transgender students report a more hostile school climate then their LGB counterparts (Gay Lesbian and Straight Education Network, 2015). Transgender students as young as primary and secondary school (grades K-12) report experiencing violence while in school, with 54% being verbally harassed, 24% physically attacked, and 13% experiencing sexual assault (Grant et al., 2011; James et al., 2016).

However, based on college survey data, a majority of the one million transgender individuals are either in the college age group (ages 18-24) or the age group that will soon be college age (ages 13-17; Flores, Herman, Gates, & Brown, 2016; Herman, Flores, Brown, Wilson, & Conron, 2017). While a majority of transgender individuals are college age, they are less likely to attend college than nontransgender identified individuals (Crissman et al., 2017; Meerwijk & Sevelius, 2017). As many sources have documented the low rates of both college attendance by transgender individuals and graduation among transgender students that do attend college, it is important to promote college enrollment, attendance, and completion (Crissman et al., 2017; Grant et al., 2011). One approach to accomplish this is by reducing gender-based violence at colleges and universities. Transgender students are more likely to experience four types of violence (physical fights, physical assault, verbal threats, and sexual assault) than their nontransgender counterparts (Coulter et al., 2015) and 35% reported experiencing harassment in school (Grant et al., 2011). As many as 87% of transgender students reported that the reason for their harassment was based on their gender identity, compared with just 20% of those who did not identify as transgender (Rankin, Weber, Blumenfeld, & Frazer, 2010). Transgender students who have been victimized or mistreated during college were more likely to experience incarceration, homelessness, participation in sex work, unemployment, and increased rates of health concerns, including smoking, drug and alcohol use, HIV diagnoses, and suicide later in life (Grant et al., 2011).

Many transgender students are forced to drop out of higher education due to their experiences of harassment, which increases the social and educational impact associated with this violence (Grant et al., 2011; James et al., 2016). Among transgender students who leave higher education, only 30% return to receive a degree (Grant et al., 2011). Furthermore, transgender students consider leaving higher education at high rates and report being fearful of physical harm on campus due to their gender identity (Rankin et al., 2010). Even with these concerns, transgender students were less likely to report their universities responded positively to incidents of harassment (Rankin et al., 2010).

To address the high rates of violence among college students, professional organizations have developed guidance to reduce violence on college campuses. Healthy Campus 2020, a framework for improving college health developed by the ACHA, has objectives focusing on violence prevention for all students. These include reducing the proportion of students who report (a) physical assault, (b) emotional partner violence, (c) physical partner violence, (d) sexual partner violence, (e) sexual touching without consent, and (f) sexual penetration without consent (ACHA, 2014). In addition, to protect this marginalized subgroup, the ACHA has developed guidelines for Trans-Inclusive College Health Programs (ACHA, 2015). One specific guideline is to develop prevention strategies addressing concerns that impact transgender students, including violence prevention (ACHA, 2015). These guidelines developed by organizations that focus on college health signify violence and victimization as priority public health issues on campuses, specifically for the transgender population. There is a need to explore patterns and rates of violence among transgender populations, including relationship violence, to understand the best prevention strategies to reduce these outcomes (Ristock, 2011).

Although previous studies have documented the rates of victimization among college students overall, research to date has not fully examined the following: (a) transgender students independent from sexual minority populations; (b) transgender students currently attending college; and (c) how experiences of violence may differ between transgender students and male and female students. Thus, the purpose of this study was to compare the rates of violence (partner violence, sexual violence, and other types of violence) experienced by transgender students with female and male students during the prior 12 months.

Method

To explore the rates of victimization and violence experienced by college students, this study utilized the National College Health Assessment–II (NCHA-II), a national dataset administered by the ACHA. The survey includes seven health content areas: safety, alcohol and other drugs, sexual behavior, nutrition and exercise, mental health, health effects on academics, and demographics (Rahn, Pruitt, & Goodson, 2016). The NCHA-II is an opt-in assessment, distributed to colleges across the nation, including both 2-year and 4-year institutions, public and private schools, and those that are religious-affiliated (ACHA, 2013). Participating schools can choose to survey all students, only survey randomly selected students, or randomly select courses or classrooms from which to survey; however, only those who randomly sample students are included in the dataset (ACHA, 2013). Each institution participating in the data collection must have institutional review board approval and includes an informed consent document which is provided to participants before beginning the survey (ACHA, 2013). Participation in data collection procedures must be voluntary, and ACHA will not administer surveys that are mandatory (ACHA, 2013).

This assessment has been shown to be both valid and reliable in previous studies (ACHA, 2013). For this analysis, data from the fall 2011, fall 2012, and fall 2013 semesters were aggregated (n = 88,975) to explore the rates of violence experienced by college students in the prior 12 months. In fall 2011, 44 institutions participated, with 42 utilizing online survey administration and two using paper-based methods (ACHA, 2012). In fall 2012, 51 schools participated in the survey, with 47 administering the survey online (ACHA, 2013). In fall 2013 assessment, 57 institutions participated and 53 of those administered the survey online (ACHA, 2014). Average response rate for this sample was 20% across the 3 years (ACHA, 2012, 2013, 2014).

Measures

For this study, five demographic items and nine violence or victimization items were used.

Demographics

The primary comparison variable for this study, gender identity, was determined by one item: “What is your gender?” Response options were (1) female, (2) male, and (3) transgender. This dataset did not contain a measure of biological sex to compare with gender identity; therefore, we are unable to determine if these individuals are cisgender (congruence between biological sex and gender identity) and therefore describe them as such. Participants were unable to select multiple options for this item, limiting more specific descriptions of their gender identity, such as male-to-female transgender or genderfluid. Although the terms male and female are typically used to represent biological sex rather than gender identity, based on the wording of the NCHA item measuring gender, these terms will be used throughout the article.

The item “What is your sexual orientation?” was used to indicate the sexual orientation of the student. The response options were (1) heterosexual, (2) gay/lesbian, (3) bisexual, or (4) unsure. “What is your year in school?” was used to determine level of education. Response options were first-year undergraduate to fifth-year undergraduate, graduate or professional, not seeking a degree, or other. Relationship status was grouped as not in a relationship, in a relationship but not living together, or in a relationship and living together. Race and ethnicity were measured by one item, “How do you usually describe yourself (mark all that apply)?” Response options were (a) White, (b) Black, (c) Hispanic or Latino/a, (d) Asian or Pacific Islander, (e) American Indian, Alaskan Native, or Native Hawaiian, (f) biracial or multiracial, or (g) other. Missing data were removed listwise from the primary predictor variable, gender (n = 1,786), sexual orientation (n = 643), year in school (n = 711), relationship status (n = 224), and race (n = 737). Complete case analysis and use of listwise deletion are an acceptable approach as the number of cases missing are a small amount, and therefore not likely to significantly bias or reduce power (Graham, 2009).

Victimization

Four forms of partner violence, three forms of sexual violence, and two other forms of violence experienced in the prior 12 months were measured with yes or no response options. Partner violence included emotional abuse (have you been in an intimate [coupled/partnered] relationship that was emotionally abusive—for example, called derogatory names, yelled at, ridiculed?), physical abuse (have you been in an intimate [coupled/partnered] relationship that was physically abusive—for example, kicked, slapped, punched?), sexual abuse (have you been in an intimate [coupled/partnered] relationship that was sexually abusive—for example, forced to have sex when you didn’t want it, forced to perform or have an unwanted sexual act performed on you?), and stalking (were you a victim of stalking—for example, waiting for you outside your classroom, residence, or office; repeated emails/phone calls?). When used as a scale, the partner violence measures had a reliability of .56 based on spring 2010 data (ACHA, 2013). However, these measures are analyzed individually in this analysis, and the NCHA instrument was developed as a surveillance tool and test–retest reliability has not been measured for each individual item (Rahn et al., 2016).

Sexual violence measures included sexual touching without consent (were you sexually touched without your consent?), attempted sexual penetration (was sexual penetration attempted [vaginal, anal, oral] without your consent?), and sexual penetration (were you sexually penetrated [vaginal, anal, oral] without your consent?). When used as a scale, these measures of sexual assault had a reliability of .76 in spring 2010 but test–retest reliability of these individual items has not been measured (ACHA, 2013).

Types of physical violence included in this study were physical assault (were you physically assaulted [do not include sexual assault]?) and verbally threatened (were you verbally threatened?). These two measures were part of a larger scale with a reliability of .63 in spring 2010; however, one of the measures was removed as it was not a direct measure of victimization (have you been in a physical fight?) and test–retest reliability has not been measured for the two individual items. Missing data from the outcome victimization variables were deleted listwise (n = 2,336), for a final sample size of 82,538 students, including 204 transgender students, 27,322 male students, and 55,012 female students. Complete case analysis was used due to the small number of missing cases and the tendency for victimization to be underreported (Berzofsky & Biemer, 2017; Graham, 2009).

Analysis

Frequencies, bivariate statistics, and binary logistic regression models testing the relationships between gender identity and nine types of victimization were calculated. Unadjusted odds ratios (OR), adjusted odds ratios (aOR), and corresponding 95% confidence intervals (CI) are reported, controlling for race, sexual orientation, year in school, year of study, and relationship status, based on previous literature suggesting these factors impact victimization and the availability of these variables in the dataset (ACHA, 2016; Walters et al., 2013). A standardized measure of effect size based on the OR, Cohen’s d, is reported, with 0.2 indicating a small effect size, 0.5 indicating a moderate effect size, and 0.8 indicating a large effect size (Chen, Cohen, & Chen, 2010). In this study, males were used as the reference group as previous data have shown they experience lower rates of sexual victimization than females and transgender students (ACHA, 2016). Statistical Package for the Social Sciences (SPSS V22) and SAS (V9.3) were used for these analyses.

Results

Most of this sample identified as female (67%), heterosexual (91%), White (66%), and not in a relationship (51%), and the mean age of the sample was 22.22 years old (SD = 6.08). Demographic data are presented in Table 1. Overall, in the prior 12 months, 4% of students reported experiencing a physical assault, 18% were verbally threatened, 6% were sexually touched without consent, 3% experienced attempted sexual penetration without consent, 1.5% were sexually penetrated without consent, and 6% experienced stalking. In terms of relationship violence in the prior 12 months, 9% were in an emotionally abusive relationship, 2% were in a physically abusive relationship, and 2% were in a sexually abusive relationship. In the bivariate analyses, transgender students reported consistently higher percentages of victimization experiences than both males and females.

Table 1.

Frequencies and Percentages of Sample Demographics From NCHA-II, 2011-2013 (n = 82,538).

	Total
	n (%)
Gender
Male	27,322 (33.1)
Female	55,012 (66.7)
Transgender	204 (0.2)
Sexual orientation
Heterosexual	75,398 (91.3)
Gay/Lesbian	2,240 (2.7)
Bisexual	3,180 (3.9)
Unsure	1,720 (2.1)
Race/ethnicity
White	54,964 (66.6)
Black	4,491 (5.4)
Hispanic	8,663 (10.5)
Asian or Pacific Islander	8,005 (9.5)
American Indian or Alaskan Native	1,241 (1.5)
Biracial or Multiracial	2,711 (3.3)
Other	2,463 (3.0)
Year in school
First-year undergraduate	20,765 (25.2)
Second-year undergraduate	15,720 (19.0)
Third-year undergraduate	16,324 (19.8)
Fourth-year undergraduate	13,067 (15.8)
Fifth-year undergraduate or more	4,408 (5.3)
Graduate/professional	11,520 (14.0)
Not seeking a degree	195 (0.2)
Other	539 (0.7)
Relationship status
Not in a relationship	42,409 (51.4)
In a relationship, not living together	27,230 (33.0)
In a relationship, living together	12,899 (15.6)

Note. NCHA = National College Health Assessment–II.

Unadjusted ORs revealed that when compared with male students, transgender students reported significantly higher odds of experiencing all nine types of victimization, with highest odds noted in attempted sexual penetration (OR: 17.95, 95% CI = [11.88, 27.10], d = 1.21) and sexual penetration without consent (OR: 20.33, 95% CI = [12.96, 31.91], d = 1.36). In the unadjusted models, transgender students also reported significantly higher odds of all nine types of victimization than did female students. Female students had significantly higher odds of experiencing seven of the nine types of victimization when compared with male students; however, females reported lower odds of experiencing physical assault (OR: 0.71, 95% CI = [0.66, 0.77], d = 0.15) and verbal threats (OR: 0.58, 95% CI = [0.56, 0.60], d = 0.28) than males.

After adjusting for sexual orientation, race, year in school, year of study participation, and relationship status, the strength of the association for victimization of transgender students was attenuated, but transgender students remained significantly higher in their odds of experiencing violence when compared with males on all nine types of victimization, including being sexually touched without consent (aOR: 4.45, 95% CI = [3.09, 6.39], d = 0.77), attempted sexual penetration (aOR: 9.49, 95% CI = [6.17, 14.59], d = 1.00), and sexual penetration (aOR: 9.06, 95% CI = [5.64, 14.53], d = 0.94). When compared with females, transgender students were more likely to report eight of the nine types of victimization with the exception of being in an emotionally abusive relationship. Females reported higher odds of experiencing six types of victimization when compared with male students in the adjusted models. Female students reported significantly lower odds of physical assault (OR: 0.68, 95% CI = [0.63, 0.74], d = 0.19) and verbal threats (OR: 0.55, 95% CI = [0.53, 0.57], d = 0.31) when compared with males. Full results of the regression models are presented in Table 2.

Table 2.

Percentage of Victimization Experienced by Gender, Crude (OR), and Adjusted OR for Victimization Among Transgender Students Compared With Male and Female Students, NCHA-II, 2011-2013.

	n (%)	Crude OR (95% CI)	Cohen’s d	Adjusted OR (95% CI)	Cohen’s d
Partner violence
Emotionally abusive relationship
Male	1,792 (6.6)	(ref)	(ref)	(ref)	(ref)
Female	5,790 (10.5)	1.68 [1.59, 1.77]	0.27	1.62 [1.53, 1.71]	0.24
Transgender	38 (18.6)	3.26 [2.28, 4.65]^{* †}	0.58	2.02 [1.41, 2.91]*	0.35
Physically abusive relationship
Male	514 (1.9)	(ref)	(ref)	(ref)	(ref)
Female	1,184 (2.2)	1.15 [1.03, 1.27]	0.07	1.07 [0.96, 1.19]	0.04
Transgender	21 (10.3)	5.99 [3.78, 9.48]^{* †}	0.82	2.93 [1.81, 4.73]^{* †}	0.48
Sexually abusive relationship
Male	246 (0.9)	(ref)	(ref)	(ref)	(ref)
Female	1,112 (2.0)	2.29 [1.99, 2.63]	0.27	2.21 [1.92, 2.55]	0.27
Transgender	22 (10.8)	13.31 [8.40, 21.07]^{* †}	1.00	6.48 [4.01, 10.49]^{* †}	0.82
Stalking
Male	949 (3.5)	(ref)	(ref)	(ref)	(ref)
Female	3,603 (6.5)	1.95 [1.81, 2.09]	0.32	1.90 [1.77, 2.05]	0.30
Transgender	32 (15.7)	5.17 [3.53, 7.58]^{* †}	0.81	3.25 [2.19, 4.82]^{* †}	0.53
Sexual violence
Sexually touched without consent
Male	820 (3.0)	(ref)	(ref)	(ref)	(ref)
Female	3,952 (7.2)	2.50 [2.32, 2.70]	0.51	2.53 [2.34, 2.74]	0.51
Transgender	41 (20.1)	8.13 [5.73, 11.53]^{* †}	1.03	4.45 [3.09, 6.39]^{* †}	0.77
Attempted sexual penetration
Male	250 (0.9)	(ref)	(ref)	(ref)	(ref)
Female	1,828 (3.3)	3.72 [3.26, 4.25]	0.56	3.83 [3.35, 4.38]	0.56
Transgender	29 (14.2)	17.95 [11.88, 27.10]^{* †}	1.21	9.49 [6.17, 14.59]^{* †}	1.00
Sexual penetration
Male	178 (0.7)	(ref)	(ref)	(ref)	(ref)
Female	1,057 (1.9)	2.99 [2.55, 3.50]	0.44	3.03 [2.58, 3.57]	0.44
Transgender	24 (11.8)	20.33 [12.96, 31.91]^{* †}	1.36	9.06 [5.64, 14.53]^{* †}	0.94
Other violence
Physically assaulted
Male	1,208 (4.4)	(ref)	(ref)	(ref)	(ref)
Female	1,758 (3.2)	0.71 [0.66, 0.77]	0.15	0.68 [0.63, 0.74]	0.19
Transgender	27 (13.2)	3.29 [2.19, 4.96]^{* †}	1.36	1.93 [1.27, 2.95]^{* †}	0.94
Verbally threatened
Male	6,372 (23.3)	(ref)	(ref)	(ref)	(ref)
Female	8,248 (15.0)	0.58 [0.56, 0.60]	0.28	0.55 [0.53, 0.57]	0.31
Transgender	80 (39.2)	2.12 [1.59, 2.81]^{* †}	0.37	1.39 [1.04, 1.87]^{* †}	0.18

Note. Adjusted OR control for sexual orientation, race, year in school, year of survey, and relationship status. OR = adjusted odds ratio; NCHA = National College Health Assessment–II; CI = confidence interval.

Transgender students have a significant difference from male students at p < .05.

†

Transgender students have a significant difference from female students at p < .05.

Discussion

This study adds to the violence prevention literature by comparing victimization rates among transgender students with female and male college students over a 3-year period. Strengths of the study include the representation of a variety of students from across the country, a diverse sample in terms of race and sexual orientation, and a cross-sectional view of the rates of violence experienced by college students of three gender identities. Despite the small number of transgender students participating in this survey compared with male and female students, this study indicates that disparate rates of victimization exist across gender identities. Overall, these analyses show significant differences in these experiences based on gender and significantly higher odds of victimization among transgender students across all of the types of victimization measured.

Transgender students reported higher overall percentages and odds of all nine victimization variables when compared with males. However, the highest were those involving sexual victimization, including attempted sexual penetration, sexual penetration without consent, and being in a sexually abusive relationship. In addition, transgender students experienced significantly higher odds of all types of victimization, with the exception of being in an emotionally abusive relationship, than did females. These findings confirm previous studies suggesting transgender students experience higher rates of violence than cisgender students (Coulter et al., 2015; Edwards et al., 2015). Research has suggested that victimization of transgender individuals occurs because of systemic, familial, and environmental discrimination and microaggressions; societal discomfort with transgender identities; denial of bodily privacy (Nadal, Skolnik, & Wong, 2012); and a clinical view of transgender people as having a mental disorder (Winter et al., 2016). Sexual assault of transgender individuals may be due in part to societal perceptions, particularly the unique combination of hypersexualization and stigmatization of transgender people by the larger society (Human Rights Campaign, 2017).

By recognizing the impact victimization has on individuals during college and by determining the subpopulations of college students who are at the greatest risk for victimization, college-based programs and interventions can improve health and safety, and reduce negative outcomes for these students.

With a focus being drawn to this community from the recent media attention on transgender celebrities such as Caitlyn Jenner and Laverne Cox, and from North Carolina’s House Bill 2, which forbids transgender individuals from using the public restroom corresponding to their gender identity, future studies may discover an impact on victimization among this population due to increased awareness (Gordon, Price, & Peralta, 2016; Landers & Kapadia, 2017). However, the direction in which victimization will change due to this awareness is unclear. Another area warranting more research which this study was unable to address is victimization experienced by transgender people of color. The ACHA (2012) Standards of Health Promotion in Higher Education suggests that race and ethnicity should be acknowledged, as they may compound discrimination faced by transgender people. As a majority of participants in this study were White, future research should explore the interaction of race and victimization among transgender students.

Another area warranting further exploration is the issues related to reluctance in reporting. Previous research suggests a lack of access to victimization resources and a lack of legal protections in place may negatively influence transgender students’ perceptions of safety in accessing treatment or reporting these incidents after they have occurred (Grant et al., 2011). However, longitudinal data exploring the changes since implementation of legislation specifically focusing on gender identity would provide a more comprehensive picture of current victimization experienced by transgender college students. The findings of this study demonstrate the need for campus-based violence prevention efforts specifically focused on gender identity as a key influence on victimization. Future studies should explore differences in rates of violence between specific gender identities and should work to oversample gender minority students for an equal comparison group, or one more representative of the true population (Crissman et al., 2017; Meerwijk & Sevelius, 2017).

Previous studies have indicated differences in the victimization experienced by subgroups under the transgender umbrella. For example, male to female (MtF) transgender young adults experienced higher rates of victimization when compared with female to male (FtM) transgender young adults, which suggests a need to explore transgender students’ experiences with violence separately from LGB students, and also considers the impact of subgroups of gender identity (Reuter et al., 2016). Studies have indicated that the term transgender as an umbrella term may not capture the true gender nonconforming population, and therefore underestimates the true population (Meerwijk & Sevelius, 2017). Data suggest that the population of gender nonconforming people may be twice as large as population estimates for transgender people (Meerwijk & Sevelius, 2017). In addition, there is a need to address the cultural resistance to transgender identities occurring on college campuses (Barbir et al., 2017).

Although evaluating victimization across more diverse gender nonconforming categories is beyond the scope of the current study, a recent change to the demographics section of the 2015 NCHA-II creates a more comprehensive assessment of gender identity. The survey was modified to include biological sex (male or female), transgender identification (yes or no), and gender identity (woman, man, trans-woman, trans-man, genderqueer, or another identity), which is more inclusive and also allows for a better understanding of what specific groups may be experiencing in respect to violence. In addition, these changes allow for disaggregation of transgender students from the LGB group and remove the conflation of gender identity with sexual orientation. Next steps should further explore changes in education and resources that have promoted these modifications and implement similar programs to reduce sexual victimization.

Male students were used primarily as a reference group for this study; however, males were more likely to experience physical assault and verbal assault than female students. This finding may be associated with perceptions of masculine norms, including stereotypical violence and aggression to assert power over others (Berke, Wilson, Mouilso, Speir, & Zeichner, 2015). Among college men, these types of violence are typically associated with alcohol use (Iwamoto, Corbin, Lejuez, & MacPherson, 2014; Sonderlund et al., 2014). Female students in this sample experienced significantly lower physical assault and verbal assault when compared with male students, but were at higher odds of experiencing stalking, emotional partner violence, and all forms of sexual victimization measured. The higher rates of sexual victimization are consistent with previous reports that women are significantly more likely to experience this type of victimization than men (Hines, Armstrong, Reed, & Cameron, 2012) and are indicative of areas for improvement on college campuses. In addition, males were more likely to experience physical and verbal assault than females, but experienced significantly lower rates of all types of victimization when compared with transgender students, suggesting gender identity should be evaluated as an influence in regard to other health concerns.

There is hope, however, for the future. Many transgender people report increasing acceptance from family members and co-workers, and of transgender students in K-12 grade who were out at school, most (56%) felt supported by their fellow students, a number that can increase over the college years (James et al., 2016). In addition, specific recommendations have been made to improve the experiences of transgender students in school settings. In 2016, the Departments of Justice and Education released joint guidance to create safe environments for transgender students, including the obligation to promptly and effectively address sex-based harassment, including harassment based on transgender status or gender transition (Department of Justice, 2016). Transgender students also report increases in the perceptions of safety on campus when information about gender identity or transgender identity is covered in courses (McGuire, Anderson, Toomey, & Russell, 2010), which may be difficult to incorporate into primary or secondary education, as parents can opt younger students out of these programs (Centers for Disease Control and Prevention, 2016) and some states and school districts are prohibited from including transgender-related content (Gay Lesbian and Straight Education Network, 2016). This education may be easily incorporated into university-level curricula, as colleges have the academic freedom and responsibility to conduct teaching, research, and service activities that are responsive and inclusive to all populations without interruption of morality politics (American Association of University Professors, 2015; Association of American Colleges & Universities, 2006). Including sexual orientation material in college-level curricula has reduced homophobia in the past (Rogers, McRee, & Arntz, 2009), and may indicate a way forward to reduce transphobia.

However, policy-level changes on college campuses may have a more immediate impact than increasing knowledge. When asked about specific policies of concern to transgender people, 21% wanted legislation to make schools safer (Grant et al., 2011), 84% reported bullying and discrimination in schools as a very important issue, and 94% identified violence against transgender people as an important issue (James et al., 2016). Although transgender college students are protected from victimization on college campuses by many layers of federal legislation including Title IX, The Clery Act, The Violence Against Women Act (VAWA), and the Campus Sexual Violence Elimination (SaVE) Act, these results indicate that rates of victimization among this population remain high (Campus SaVE Act, 2013; Drysdale, Modzeleski, & Simons, 2010; Title IX of the Education Amendments, 1972; Violence Against Women Reauthorization Act, 2013). In addition to legislation, campus climate and student development literature suggest lesbian, gay, bisexual, and transgender (LGBT) resource centers, student groups, and supportive individuals within the campus context are of particular importance to promote success and retention among transgender students (Pitcher, Camacho, Renn, & Woodford, 2018).

The findings of this study must be considered in context with its limitations. The terms used for gender in this study, male and female, are typically associated with biological sex rather than gender identity, which should be considered in future studies. Similarly, this dataset also lacks a demographic item to differentiate between transgender men, transgender women, and those who identify as other gender identities aside from transgender. By defining transgender as only those who marked the transgender category, transgender individuals who identified as either male or female were not included in the transgender group for analysis, introducing the potential for error from differential misclassification. In addition, no method exists to verify a students’ previous participation in the survey. Thus, because this study uses aggregated data from 3 years, it is possible that a student’s responses may be duplicated across the years. While this dataset does provide a large sample of college students, the sample size of transgender students is small, which may have reduced the precision and contributed to the wide CIs seen in this study. Also, previous studies have noted the use of the term transgender rather than more inclusive terms can lead to a lower estimate of the true gender nonconforming population (James et al., 2016). Low response rates may have biased the results, and data suggest that victimization is underreported on surveys (Berzofsky & Biemer, 2017), indicating the true rates of victimization may be higher than reported here. This study does not consider the impact of other social locations combined with gender identity that might impact victimization, such as race, socioeconomic status, documentation status, or those with disabilities (James et al., 2016). Finally, the NCHA requires the university to pay a fee to participate in data collection, and therefore, the sample in this study may not be representative of the nationwide college population.

In conclusion, this study serves to extend the interpersonal victimization literature and adds to a comprehensive view of college population as a whole, filling in previous gaps where the literature has only focused on nontransgender students or sexual orientation. These data suggest transgender students are at greater risk for victimization than both females and males, and are at a much higher risk of experiencing sexual victimization specifically than their male and female counterparts. By considering the intersection of gender identity and victimization, universities can promote the health and safety of transgender students and provide an opportunity for the general population to gain sensitivity and understanding to reduce the gender-based violence experienced by this marginalized population. Ultimately, reducing rates of victimization will promote positive institutional changes and improve campus climate.

Footnotes

Authors’ Note

The opinions, findings, and conclusions reported in this article are those of the authors, and are in no way meant to represent the corporate opinions, views, or policies of the American College Health Association (ACHA). ACHA does not warrant nor assume any liability or responsibility for the accuracy, completeness, or usefulness of any information presented in this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Stacey B. Griner, MPH, is a doctoral student and research assistant in the Department of Community and Family Health at the University of South Florida. Her research and teaching interests focus on the health of college students and lesbian, gay, bisexual, and transgender (LGBT) populations with an emphasis on sexual health. She is a representative to the university’s Title IX Committee.

Cheryl A. Vamos, PhD, MPH, is an assistant professor in the Department of Community and Family Health in the College of Public Health. Her research and teaching interests focus on health literacy and sexual and reproductive health.

Erika L. Thompson, PhD, MPH, is a postdoctoral fellow in the Department of Community and Family Health, College of Public Health, University of South Florida. Her research interest is reproductive decision making with an emphasis on HPV vaccination and contraception.

Rachel Logan, MPH, is a doctoral student in the Department of Community and Family Health, College of Public Health, University of South Florida. Her research interests relate to sexual and reproductive health communication between patients and providers.

Coralia Vázquez-Otero, JD, MPH, is a doctoral student at the University of South Florida College of Public Health. Her research interests include women’s health, HPV vaccination, cancer prevention, and health disparities.

Ellen M. Daley, PhD, MPH, is a professor and the Associate Dean for Research and Practice at the College of Public Health. Her research interests include women’s health, sexual and reproductive health, and HPV vaccination.

References

American Association of University Professors. (2015). Academic freedom of students and professors, and political discrimination. Retrieved from https://www.aaup.org/academic-freedom-students-and-professors-and-political-discrimination

American College Health Association. (2012). Standards of practice for health promotion in higher education. Retrieved from http://www.acha.org/documents/resources/guidelines/ACHA_Standards_of_Practice_for_Health_Promotion_in_Higher_Education_May2012.pdf

American College Health Association. (2013). American College Health Association—National College Health Assessment II: Reliability and Validity Analyses 2011. Hanover, MD: Author.

American College Health Association. (2014). Healthy campus 2020. Retrieved from https://www.acha.org/HealthyCampus/HealthyCampus/Student_Objectives.aspx

American College Health Association. (2015). ACHA guidelines: Trans-inclusive college health programs. Hanover, MD: Author. Retrieved from https://www.acha.org/documents/Resources/Guidelines/Trans-Inclusive_College_Health_Programs.pdf

American College Health Association. (2016). American College Health Association-National College Health Assessment II: Reference group undergraduates executive summary fall 2015. Hanover, MD: Author. Retrieved from http://www.acha-ncha.org/docs/NCHA-II_FALL_2015_UNDERGRADUATE_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

Association of American Colleges & Universities. (2006). Academic freedom and educational responsibility. Retrieved from https://www.aacu.org/about/statements/academic-freedom

Barbir

L. A.

Vandevender

A. W.

Cohn

T. J.

(2017). Friendship, attitudes, and behavioral intentions of cisgender heterosexuals toward transgender individuals. Journal of Gay & Lesbian Mental Health, 21, 154-170.

Berke

Wilson

Mouilso

Speir

Zeichner

(2015). Isolating the gendered component of men’s physical aggression. Sex Roles, 72, 509-520.

10.

Berzofsky

M. E.

Biemer

P. P.

(2017). Classification error in crime victimization surveys. In Biemer

P. P.

de Leeuw

Eckman

Edwards

Kreuter

Lyberg

L. E.

. . . West

B.T.

(Eds.), Total survey error in practice (pp. 387-412). Hoboken, NJ: John Wiley & Sons, Inc.

11.

Breiding

Smith

Basile

Walters

Chen

Merrick

(2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—National Intimate Partner Violence and Sexual Violence Survey, United States, 2011, surveillance summaries. Morbidity and Mortality Weekly, 63, 1-18.

12.

Campus SaVE Act (2013). 112th Congress.

13.

Centers for Disease Control and Prevention. (2016). School health policies and practices study: Health education. Retrieved from http://www.cdc.gov/healthyyouth/data/shpps/pdf/2014factsheets/health_education_shpps2014.pdf

14.

Chen

Cohen

Chen

(2010). How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics—Simulation and Computation, 39, 860-864. doi:10.1080/03610911003650383

15.

Cicero

E. C.

Wesp

L. M.

(2017). Supporting the health and well-being of transgender students. The Journal of School Nursing, 33, 95-108.

16.

Coulter

R. W. S.

Blosnich

J. R.

Bukowski

L. A.

Herrick

A. L.

Siconolfi

D. E.

Stall

R. D.

(2015). Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug and Alcohol Dependence, 154, 251-259. doi:10.1016/j.drugalcdep.2015.07.006

17.

Crissman

H. P.

Berger

M. B.

Graham

L. F.

Dalton

V. K.

(2017). Transgender demographics: A household probability sample of US adults, 2014. American Journal of Public Health, 107, 213-215.

18.

Department of Justice. (2016). U.S. Departments of Justice and Education Release Joint Guidance to Help Schools Ensure the Civil Rights of Transgender Students. Retrieved from https://www.justice.gov/opa/pr/us-departments-justice-and-education-release-joint-guidance-help-schools-ensure-civil-rights

19.

Diemer

E. W.

Grant

J. D.

Munn-Chernoff

M. A.

Patterson

D. A.

Duncan

A. E.

(2014). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57, 144-149. doi:10.1016/j.jadohealth.2015.03.003

20.

Drysdale

Modzeleski

Simons

(2010). Campus attacks: Targeted violence affecting institutions of higher education. Washington, DC: U.S. Secret Service, U.S. Department of Homeland Security, Office of Safe and Drug-Free Schools, U.S. Department of Education, and Federal Bureau of Investigation, U.S. Department of Justice.

21.

Edwards

K. M.

Sylaska

K. M.

Barry

J. E.

Moynihan

M. M.

Banyard

V. L.

Cohn

E. S.

. . . Ward

S. K.

(2015). Physical dating violence, sexual violence, and unwanted pursuit victimization: A comparison of incidence rates among sexual-minority and heterosexual college students. Journal of Interpersonal Violence, 30, 580-600. doi:10.1177/0886260514535260

22.

Fedina

Holmes

Backes

(2018). Campus sexual assault: A systematic review of prevalence research from 2000 to 2015. Trauma, Violence, & Abuse, 19, 76-93. doi:10.1177/1524838016631129

23.

Flores

A. R.

Herman

J. L.

Gates

G. J.

Brown

T. N.

(2016). How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute.

24.

Gay Lesbian and Straight Education Network. (2015). The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. Retrieved from https://www.glsen.org/sites/default/files/2015%20National%20GLSEN%202015%20National%20School%20Climate%20Survey%20%28NSCS%29%20-%20Full%20Report_0.pdf

25.

Gay Lesbian and Straight Education Network. (2016). Including LGBT-content in sex education: Four wrong ways (and one right one). Retrieved from https://www.glsen.org/blog/including-lgbt-content-sex-education-four-wrong-ways-and-one-right-one

26.

Gordon

Price

Peralta

(2016, March). Understanding HB2: North Carolina’s newest law solidifies state’s role in defining discrimination. The Charlotte Observer. Retrieved from http://www.charlotteobserver.com/news/politics-government/article68401147.html

27.

Graham

J. W.

(2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549-576.

28.

Grant

Mottet

Tanis

Harrison

Herman

Keisling

(2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

29.

Herman

J. L.

Flores

A. R.

Brown

T. N.

Wilson

B. D.

Conron

K. J.

(2017). Age of individuals who identify as transgender in the United States. Los Angeles, CA: The Williams Institute.

30.

Hines

Armstrong

Reed

Cameron

(2012). Gender differences in sexual assault victimization among college students. Violence and Victims, 27, 922-940.

31.

Human Rights Campaign. (2017). Sexual assault and the LGBTQ community. Retrieved from http://www.hrc.org/resources/sexual-assault-and-the-lgbt-community

32.

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.

33.

Iwamoto

Corbin

Lejuez

MacPherson

(2014). College men and alcohol use: Positive alcohol as a mediator between distinct masculine norms and alcohol use. Psychology of Men & Masculinity, 15, 29-39.

34.

James

S. E.

Herman

J. L.

Rankin

Keisling

M. L. M.

Anafi

(2016). The report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

35.

Landers

Kapadia

(2017). The health of the transgender community: Out, proud, and coming into their own. American Journal of Public Health, 107, 205-206.

36.

McGuire

J. K.

Anderson

C. R.

Toomey

R. B.

Russell

S. T.

(2010). School climate for transgender youth: A mixed method investigation of student experiences and school responses. Journal of Youth and Adolescence, 39, 1175-1188.

37.

Meerwijk

E. L.

Sevelius

J. M.

(2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107, e1-e8.

38.

Nadal

K. L.

Skolnik

Wong

(2012). Interpersonal and systemic microaggressions toward transgender people: Implications for counseling. Journal of LGBT Issues in Counseling, 6, 55-82. doi:10.1080/15538605.2012.648583

39.

Pitcher

E. N.

Camacho

T. P.

Renn

K. A.

Woodford

M. R.

(2018). Affirming policies, programs, and supportive services: Using an organizational perspective to understand LGBTQ+ college student success. Journal of Diversity of Higher Education, 11, 117-132. doi:10.1037/dhe0000048

40.

Rahn

R. N.

Pruitt

Goodson

(2016). Utilization and limitations of the American College Health Association’s National College Health Assessment instrument: A systematic review. Journal of American College Health, 64, 214-237.

41.

Rankin

Weber

Blumenfeld

Frazer

(2010). 2010 state of higher education for lesbian, gay, bisexual, and transgender people. Retrieved from www.campuspride.org/wp-content/uploads/campuspride2010lgbtreportssummary.pdf

42.

Reuter

Newcomb

Whitton

Mustanski

(2016). Intimate partner violence victimization in LGBT young adults: Demographic differences and associations with health behaviors. Psychology of Violence, 7(1), 101-109.

43.

Ristock

J. L.

(2011). Intimate partner violence in LGBTQ lives ( Ristock

J. L.

, Ed.). New York, NY: Routledge.

44.

Rogers

McRee

Arntz

D. L.

(2009). Using a college human sexuality course to combat homophobia. Sex Education, 9, 211-225. doi:10.1080/14681810903059052

45.

Sonderlund

O’Brien

Kremer

Rowland

De Groot

Staiger

. . . Miller

(2014). The association between sports participation, alcohol use and aggression and violence: A systematic review. Journal of Science and Medicine in Sport, 17, 2-7.

46.

Testa

Sciacca

Wang

Hendricks

Bradford

Bongar

(2012). Effects of violence on transgender people. Professional Psychology: Research and Practice, 43, 452-459.

47.

Title IX of the Education Amendments (1972).

48.

Violence Against Women Reauthorization Act (2013). 113th Congress.

49.

Walters

Chen

Breiding

(2013). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 findings on victimization by sexual orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

50.

Winter

Diamond

Green

Karasic

Reed

Whittle

. . . Wylie

(2016). Transgender people: Health at the margins of society. The Lancet, 388, 390-400. doi:10.1016/S0140-6736(16)00683-8

51.

Worthen

(2013). An argument for separate analyses of attitudes toward lesbian, gay, bisexual men, bisexual women, MtF and FtM transgender individuals. Sex Roles, 68, 703-723.