June 19, 2019 — A new study shows that transgender and gender-nonbinary teens face a greater risk of sexual assault in schools that prevent them from using bathrooms or locker rooms consistent with their gender identity. In this week’s episode we speak with the study’s author, Gabe Murchison, a doctoral student at Harvard T.H. Chan School of Public Health. Murchison explains why restrooms and locker room policies are so critical and outlines steps that schools, parents, and physicians can take to create more inclusive environments for transgender and gender-nonbinary adolescents.

You can subscribe to Harvard Chan: This Week in Health by visiting iTunes or Google Play and you can listen to it by following us on Soundcloud, and stream it on the Stitcher app or on Spotify. If you’re a fan, we’d appreciate you leaving a rating and review wherever you listen.

Full Transcript

NOAH LEAVITT: Coming up on Harvard Chan: This Week in Health…

How can schools create a more inclusive environment for transgender and gender-nonbinary students?

GABE MURCHISON: So, if you’re in a school where adults are saying, ‘We affirm and support your gender identity,’ peers may take their cue from that and think, ‘We’re not going to get away with targeting that young person.’ But if you’re in a school and community where adults are really pushing back against the young person expressing their gender identity, there may be more opportunities for bullying and harassment.

NOAH LEAVITT: In this week’s episode, we speak with the author of a new study that showed how school policies around restrooms and locker rooms can affect the risk of sexual assault among transgender and gender-nonbinary teens.

[MUSIC]

NOAH LEAVITT: Hello and welcome to Harvard Chan: This Week in Health…I’m Noah Leavitt.

AMIE MONTEMURRO: And I’m Amie Montemurro.

NOAH LEAVITT: In this week’s episode we’re speaking to the author of a new study that found transgender and gender-nonbinary teens face a greater risk of sexual assault in schools that prevent them from using bathrooms or locker rooms consistent with their gender identity.

AMIE MONTEMURRO: The study was led by Gabe Murchison, a doctoral student at the Harvard Chan School.

Murchison and co-authors looked at data from a survey of nearly 3,700 U.S. teens aged 13-17 and found that 36-percent transgender or gender-nonbinary students with restricted bathroom or locker room access reported being sexually assaulted in the previous 12 months.

NOAH LEAVITT: Of all students surveyed—one quarter reported being a victim of sexual assault in the past year.

I recently sat down with Murchison to talk about the study, and why restrooms and locker room policies are so critical. We also discussed broad steps that schools, parents, and physicians can take to create more inclusive environments for transgender and gender non-binary adolescents.

Take a listen.

NOAH LEAVITT: For this study, you looked at transgender and gender non-binary teens. So to start, can you just explain what each of those terms mean?

GABE MURCHISON: Absolutely. So transgender usually refers to someone whose gender identity doesn’t match what was expected for the sex they were assigned at birth. So for instance, you might have someone who was born and everyone took a look at them and said, OK, that’s a boy, but then when they got a little older, they said, actually, really, I don’t feel like a boy. I feel more like a girl.

Or they might say, I don’t feel like a boy or a girl. I feel like a combination of the two, or somewhere in between, or something totally different. So if that person says, I feel more like a girl, then we’d refer to them as a transgender girl, or if they were an adult, a transgender woman. But if they said, I don’t feel like either a boy or a girl, or a mix of the two, or something like that, then we might use the term non-binary. So most non-binary people also identify as transgender, but not all transgender people are non-binary. They might just be a boy or man or a girl or a woman who’s transgender.

NOAH LEAVITT: So before we dive into this study in particular, I do want to kind of start a little broadly. I think one of the things you note in this study is that kind of for teens who fall into these groups, they already face a lot of what you term peer victimization. So can you describe a little bit about what that is and what forms does that take?

GABE MURCHISON: Sure. So I think the classic example, and probably what’s gotten the most attention and research, would be bullying. So verbal negative comments, exclusion by peers, and even physical harassment.

Something that’s maybe gotten a little less attention, but I think it’s really important to understand, is that oftentimes, that bullying takes the form of sexual harassment. So those negative comments might be sexualized, or there might be unwanted physical contact that’s done in a sexual way. So there’s really a lot of overlap between bullying and sexual harassment, but the sexual dimensions of it haven’t always gotten as much attention. And then sexual harassment, of course, is a spectrum where it can be verbal, or can be something that takes place online, but it can also involve unwanted physical contact, and that’s a form of sexual assault.

NOAH LEAVITT: And are we seeing any trend in terms of like, is this– are these levels of sexual harassment overall increasing, are they being reported more? What are some of the trends there with regards to harassment?

GABE MURCHISON: I think it’s a little bit tough to know, because sexual harassment typically hasn’t been measured well in research. So it’s a little hard to know what’s happened over time, because we haven’t had good ways of looking at it back into the past. In terms of whether trans and non-binary youth are experiencing more or less harassment than they used to, it may depend a lot on where you look.

So there certainly are more trans and non-binary young people who are coming out at younger ages. So probably, the overall levels that are happening have gone up because there are simply more kids who have the potential to have this experience. At the same time, we have seen bullying and harassment and sexual harassment based on someone’s gender expression, so how masculine or feminine they look or act.

And that’s been going on for a long time. So those aren’t necessarily kids who grew up to be transgender or non-binary, but the idea that people are being harassed in K12 schools based on how other kids perceive their gender is not at all new. That’s been going on for decades.

NOAH LEAVITT: And you touched on it just a second ago with more kind of adolescent who might be coming out younger. Is there something unique about that kind of K through 12 period– that’s obviously a long period of time– that makes kind of those teens kind of uniquely vulnerable during that period?

GABE MURCHISON: With transgender and non-binary, if there is no particular age that people come out. So people can begin to understand that their gender is different from what was expected of them even in early childhood. Really, that people can have this realization at any age.

What’s unique about the middle and high school years is really the fact that kids are spending more time with their peers not supervised by adults. So for instance, in middle or high school, kids may start to use locker rooms to change for physical education and sports, and that’s often a time that’s unsupervised. That’s why we see so much harassment in that space. Also, kids are much more likely to be hanging out with their peers after school without an adult around. So it’s more that there are more opportunities for kids to engage in really serious harassment behaviors when there’s not an adult paying attention.

NOAH LEAVITT: And so for this specific study, you looked at the effect of policies around restroom and locker room usage for these teens. So why did you choose to study this? I think you just alluded to it right there a little bit. And then what policies in particular were you looking at?

GABE MURCHISON: So I think there’s a few reasons why it’s important to take a closer look at restroom and locker room policies. One is that for all youth, restrooms and locker rooms at school tend to be an unsupervised space, and so they’re a space where harassment may take place. And another is that this has become– when it comes to trans and non-binary kids, restrooms and locker rooms have become a very politicized hot button issue.

And because they’ve become so politically symbolic in terms of whether we respect transgender and non-binary youth or whether we are trying to put pressure on them to not express their gender identity in schools and communities, we felt it was a policy where other youth in the community might take cues from what the adults are saying in terms of how they should be treating their peers. So if you’re in a school where adults are saying we affirm and support your gender identity, then peers may take the cue from that and figure they’re not going to get away with targeting this young person. But if you’re in a school and community where adults are really pushing back against the young person expressing their gender identity, there may be more opportunities for bullying and harassment. So peers are really taking– we think peers are taking cues from adults. And because restrooms and locker rooms in particular are so politicized, that may be a major cue that young people are looking to in terms of how they should be treating their peers.

NOAH LEAVITT: That’s really interesting. So in a sense, restrooms and locker rooms can kind of be a bellwether for acceptance, but also younger teens might kind of view this as it’s almost OK to bully because these particular policies are in place. And so what did you find then with regards to the relationship between these policies and the risk of sexual assault among the teens that you studied?

GABE MURCHISON: So overall, what we found is that transgender and non-binary youth who were in a school where a teacher or a school staff member had told them they weren’t allowed to use the restroom or locker room associated with their gender identity were more likely to have been sexually assaulted in the past year. So we looked overall at youth who were in middle or high school, so youth who were between the ages of 13 and 17. We didn’t break the results down by age group there.

We did break the results down in terms of both kids’ gender identity, so being a boy or girl or non-binary, as well as the sex they were assigned at birth, which would be either male or female. And when we looked separately at those groups, we found clear evidence for an association between rest room and locker room policies and sexual assault risk in three out of the four categories we looked at, so transgender girls, transgender boys, and non-binary youth who were assigned a female sex at birth. We didn’t find evidence for that association specifically in non-binary youth assigned a male sex at birth, but our sample size for that group was really small, so it was hard for us to say anything conclusive about them.

NOAH LEAVITT: Is the next step kind of trying to run another study maybe with a larger sample size to kind of– or maybe even over a larger kind of age group span?

GABE MURCHISON: Probably our next step will be to look more closely at what’s actually going on. So we know that in this sample, there was an association between these policies and sexual assault. We didn’t have as much ability to say why or what to do about it.

So some important next steps might be looking, for instance, at lower level sexual harassment behaviors. In our data set, other forms of sexual harassment, so verbal behaviors, unwanted touching that didn’t fall into our definition of sexual assault in this case seemed to statistically explain the association between the policies and sexual assault. So one thing we may look at next is whether doing something about sexual harassment behaviors can actually reduce the risk of sexual assault.

NOAH LEAVITT: You mentioned earlier this idea that harassment is this continuum. Would one of the ideas be that if you can intervene when you see maybe what you would call lower levels of harassment, that it could prevent escalation into more severe forms or sexual assault?

GABE MURCHISON: Yeah, I think that’s a great way of thinking about it. So obviously, one takeaway is that we should be very concerned about restrictive policies with respect to restrooms and locker rooms. But just getting rid of those restrictive policies is probably not going to solve the problem.

We should also be looking at other ways that teachers and school staff set the tone for how to treat transgender and non-binary youth. And from previous work with LGBTQ youth in general, so including youth who are lesbian, gay, bisexual, pansexual, and so on, is that whether teachers specifically intervene to stop anti-LGBTQ bullying seems to have a really important effect. So one potential takeaway is can we be doing– can we be training teachers to intervene specifically in those types of bullying as well as other identity-based bullying, such as racial and ethnic bullying, religious bullying, and so on, and can we extend that to also specifically addressed sexual harassment behaviors?

NOAH LEAVITT: And so on the flip side was something like schools where there are all gender restrooms, for example, is there any data yet on the benefits having all gender restrooms can reduce these types of bullying? So what’s the flipside there mean among schools or buildings that have more policies that are focused on acceptance.

GABE MURCHISON: There’s good qualitative data on youth whose schools have affirmative policies, and particularly for all gender restrooms. So youth say what’s really beneficial is having an all gender restroom. So that doesn’t mean making all restrooms in the school available regardless of gender, it means having one or more restrooms that can be used by anyone, regardless of gender, and youth say that’s really beneficial.

And when it’s most beneficial is when that’s a restroom that all students not only are able to use, but that all students actually use. So what youth say is a real problem is any kind of restroom or locker room situation that singles out transgender and non-binary students. So some transgender and non-binary students have been told by their school that they have to use a single person unisex restroom that’s really intended for staff, or it’s really intended to be used by the nurse’s office, and they’re the only student who’s using that restroom. And youth say that that singles them out and causes a lot of problems, even though the space itself is private.

So when schools create all gender restrooms, it’s doing two things. First of all, it’s creating a space that those youth can use without singling them out because other students can also use it. And second of all, if it’s done well, it’s making a statement that the school staff accept and support transgender and non-binary youth and really want to meet their needs. And so that in itself can be a very powerful signal.

There are other things that schools can do in that respect too. So for instance, having a strong gender sexuality alliance club we know can be really beneficial, training teachers to intervene in identity-based bullying, including LGBTQ lessons, so historical figures, for instance, LGBTQ identity in the curriculum. There are lots of things that schools can do. But youth do say that all gender restrooms can be an especially important step to take.

NOAH LEAVITT: It’s interesting. Kind of what you’re saying is that in order them to be effective, they actually have to be inclusive spaces that everyone is using.

GABE MURCHISON: That’s exactly right. So really, the thing that comes out in the qualitative research that others have done previously on this issue is the importance of not singling out transgender and non-binary youth, that they want to be able to use the same facilities that their peers are using and to not have what we’ve been calling unwanted negative attention drawn to them based on the facilities that they are or are not able to use.

NOAH LEAVITT: And you spoke a few minutes ago about kind of the importance of, for example, teachers intervening in bullying. Are there other– I don’t know if authority figures is the right word, to kind of play a key role, whether it’s doctors who can be talking to young adults. Who are, I guess, some of the other kind of key people who can play a role in either intervening, or kind of being an important person for teens to talk to?

GABE MURCHISON: Yeah, so adults are really huge here. So adults, first of all, at school really set the tone. So not only teachers, but school counselors, administrators. It’s really important that trans and non-binary youth have a trusted adult that they can turn to at school for any problems that they’re having.

And then beyond school, parents are extremely important. So we know for youth in general, having a close and supportive relationship with your parents means that you’re less likely to experience sexual assault. There may be various reasons for that, but, in general close and supportive relationships with parents are really important for adolescents.

And as well as pediatricians. So pediatricians, one important role that they can play is being an advocate with schools. So if schools are not providing appropriate restrooms and locker room access, pediatricians can write a letter, they can call the school and they can say, look, it’s really important that students have x, y, and z. So they can play a very important role as well.

NOAH LEAVITT: And what are some of the biggest barriers to putting some of these more inclusive policies in place, whether it’s something like an all gender restroom, or more student alliances? What are some of the barriers that exist there? And are there other strategies for overcoming those?

GABE MURCHISON: So I think the situation in a lot of school districts is that parents of non-transgender students are hearing misinformation about what it means for a school to have supportive policies for trans and non-binary youth. And they also know, maybe from their own middle and high school experiences, that restrooms and locker rooms can be very fraught spaces. They’re often not well supervised.

They’re often a place where bullying and harassment takes place. And their own child may have experienced bullying and harassment in locker rooms. So the combination of that misinformation and their own knowledge about these are really tough spaces in middle and high school may lead them to, for instance, call school administrators, call the school board and identify transgender and non-binary students and policies about them as the problem, when in fact, that’s not actually the problem, right?

The problem may be that restrooms and locker rooms are not being well supervised. Staff aren’t being adequately trained to address bullying and harassment. So what school boards and school administrators may be hearing is from these parents who have a real concern, they are confused about the source of that concern. And it may be that the vast majority– in many cases, the vast majority of parents and the community understand the issue, understand why trans and non-binary youth need to be supported, but those parents aren’t the ones picking up the phone and calling.

So I think that schools and school boards need to be prepared to articulate what they’re doing about problems in restrooms and locker rooms and to make those spaces safer when parents call with concerns. They need to feel confident about talking to parents who wonder about trans and non-binary youth in their child’s school. And they also need to understand that most people in their community may be very supportive of what they do to protect trans and non-binary youth. So that’s somewhere where supportive community members can call in. So if you are a parent of a child who’s in school who’s not transgender and non-binary, making clear to your child’s school and your child’s school district that you support what they’re doing or what they should be doing to protect trans and binary youth, that’s a place where you can make a real difference.

NOAH LEAVITT: So it’s interesting, Sari Reisner, who was one of your co-authors, I heard him speak a couple of years ago, and this was actually around the time of the North Carolina– the bathroom bill and the controversy around that. And Sari had made the point that really, in public health, there has been– historically, there just hasn’t been much research into transgender and non-binary teens, and mental health issues around sexual harassment, sexual assault. Do you see that is changing?

Is there more research kind of happening in this area? And what more needs to be done? Because it seems like, as you were saying, there’s still so many unanswered questions. So are we seeing that trend change as more research in these areas? Is there positive progress in that area?

GABE MURCHISON: Absolutely. So I think there’s been more research addressing health disparities for LGBTQ people in general, and transgender and non-binary people in particular. And I think another thing that we’re seeing is there are issues that people who work on the ground, so clinicians who work directly with youth, people who work in schools understand very well, but we haven’t necessarily had the hard data to back them up.

So I think as people have learned more and more about how do we collect data about the experiences of transgender and non-binary youth, how do we identify transgender and non-binary youth in surveys, what are the right questions to be asking, we are able to follow up that on-the-ground knowledge with some quantitative findings. So I doubt that anyone who works closely with transgender and non-binary youth was surprised by what we found about restrooms and locker rooms and sexual violence. But now that we have these numbers, it broadens the conversation, and I think helps us to make– helps us to impress on people who don’t work in this field every day how big of a problem this is.