Sabra Katz-Wise

• PhD
• Associate Professor at Boston Children's Hospital

Background In the United States, transgender, nonbinary, and gender diverse (TGD) young adults experience a higher risk of depression compared to their cisgender peers. Understanding factors associated with increased risk of depression within the TGD young adult population is important to guide clinical care as well as inform the development of int...

Understanding the frequency and patterns of experiencing changes in sexual orientation identity (SOI) is critical to the health of adolescents and young adults (AYA). Failure to measure and acknowledge change experiences may miss opportunities to tailor care, such as sexual and reproductive health care, accordingly. Much of the prior research among...

Transgender and nonbinary (TNB) emerging adults in the United States experience mistreatment inside and outside healthcare settings, which may contribute to known mental health and substance use inequities. The purpose of our study was to examine associations between provider and healthcare setting mistreatment with past 30-day severe psychological...

Objective To examine how having more than one trans person in a family facilitates investments in or divestments from cisnormativity. Background While there is now a robust body of literature on trans people's experiences with cisgender family members and vice versa, largely missing has been a focus on families where more than one person in the fa...

Transgender and gender-diverse young adults (TGDYA) report higher prevalence of substance use than cisgender peers, but little is known about how patterns of substance use may differ among TGDYA subgroups. Understanding the heterogeneity in substance use among TGDYA can inform tailored substance use disorder (SUD) prevention. This study described t...

Transgender (trans) and nonbinary youth (TNY) and, by extension, their family members, are currently facing widespread and virulent antitrans stigma and discrimination in the United States, which have been associated with negative impacts on health. While research focused on families of TNY has increased in recent years, siblings’ perspectives are...

Introduction Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on a...

Family support plays an important role in promoting resilience and health among transgender and/or nonbinary youth (TNBY), but family members often experience barriers to supporting their TNBY, including minority-adjacent stress stemming from exposure to structural stigma and antitransgender legislation. TNBY and their families need effective famil...

[This corrects the article DOI: 10.1371/journal.pone.0250500.].

Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure...

Some researchers and clinicians may feel hesitant to assess sexual orientation and gender-related characteristics in youth surveys because they are unsure if youth will respond to these questions or are concerned the questions will cause discomfort or offense. This can result in missed opportunities to identify LGBTQ+ youth and address health inequ...

While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health M...

While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory sec...

This study examined concordance of family members’ perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13–17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14–24 years) from 30 families from the U.S. New Englan...

Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SO...

LGBT individuals experience discrimination in health care settings and report difficulty accessing clinically competent healthcare. This study examined the self-assessed knowledge, clinical preparedness, LGBT health focused education received and attitudinal awareness of health care workers (HCW) (n = 215) toward LGBT patients at an urban hospital...

Background: Young adults who are transgender and/or nonbinary (TNB) experience discrimination, violence, and other social stressors as a result of cissexism, the system of power relations that marginalizes people whose genders diverge from sociocultural expectations for the sex they were assigned at birth. However, variation in TNB young adults' e...

Purpose: Gender-diverse youth (GDY) face significant health disparities, which can be mitigated by gender-affirming medical care. Understanding parents' experiences seeking care for their GDY can identify barriers to care and improve access. This study sought to understand parents' experiences accessing gender-affirming medical care with their GDY....

To provide optimal, equitable care to patients, hospital systems must have intentional efforts to advance health equity. We present both intentional and actionable steps that our senior executive leadership prioritized to improve the health equity of the children and families we serve and to create a more inclusive working and learning environment...

Objectives: To examine fluidity in sexual orientation identity and behavior among cisgender youth. Study design: Data were analyzed from five survey waves of the longitudinal US Growing Up with Media Study (2010-2019). Participants were 989 cisgender youth, aged 13-20 years at baseline, who completed online surveys assessing sexual orientation i...

Purpose: This study examined sociodemographic patterns of retrospective fluidity in sexual orientation identity (i.e., any change from one identity to another) and attractions (i.e., any change in attractions to one or more gender(s)) in a large sample of US youth. Methods: Participants were 4,087 youth (58% cisgender girls/women, 38% cisgender...

The aim of this study was to examine concordance and discordance in how different family members in families with transgender or nonbinary (TNB) youth described topics related to the TNB youth’s gender identity and its effects on the family. TNB youth, ages 7–18 years, and their caregivers (54 family members: 20 TNB youth, 34 caregivers) participat...

Sexual fluidity research (i.e., change over time in one or more sexual orientation dimensions) has grown exponentially, with advancements in conceptual models, measurement, and understanding of sexual orientation as a construct and developmental process that accommodates potential for change. Sexual fluidity research has also moved beyond samples o...

To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned fema...

This qualitative study explored how 249 transgender and non-binary (TNB) adolescents (ages 14–18) described salient supports in their lives, and ways in which key social-ecological contexts could better support TNB adolescents’ wellbeing. Participants were recruited through social media, and completed online surveys; all study procedures were appro...

OBJECTIVES Parents and caregivers’ responses to their child’s gender identity or expression play a pivotal role in their mental health. Despite increasing visibility of transgender and gender diverse (TGD) children, few scientific resources exist to advise their parents and caregivers. METHODS We used an online Delphi study to generate expert cons...

Problem: Sexual and gender minority (SGM) populations face numerous health disparities. Medical school curricula lack adequate educational content preparing students for serving SGM patients, and medical students typically do not experience welcoming, inclusive educational environments conducive to learning about SGM health care. Approach: In 20...

De mentale gezondheid en identiteitsontwikkeling van transgender en genderdiverse jongeren (TGD) worden beschermd door steun en acceptatie vanuit het gezin. Hoewel in sommige studies wel is gekeken naar de rol van steunende gezinsrelaties voor TGD-jongeren, is nog niet eerder diepgaand onderzocht hoe TGD-jongeren en hun verzorgers aankijken tegen d...

Background: Sexual minority women (SMW) are at increased risk of elevated body mass index (BMI) compared to heterosexual women, increasing their vulnerability to chronic diseases. Nonmonosexual SMW appear to be at additional risk for elevated BMI, likely due to unique sexual minority stressors. Methods: A total of 437 SMW and heterosexual women...

ProblemLGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula...

Introducing innovative health interventions into clinic settings requires a comprehensive and creative approach to multiple implementation challenges. To optimize implementation of a sexual and reproductive health intervention for young women with depression, we applied systems thinking and human-centered design thinking methods to develop tools an...

The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients,...

Sexual minority men (e.g., gay, bisexual, queer) are more likely than heterosexual men to be involved in an adolescent pregnancy, but little research has been done on the context surrounding this disparity. To address this gap, and as part of the larger Sexual Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) Study, semi-structured in...

Transgender and gender diverse youth (TGD) report high rates of mental health concerns. However, there is reason to expect that among TGD youth there is variation in mental health experiences related to specific aspects of gender identity. Furthermore, although certain school characteristics are related to improved mental health for sexual minority...

Objective To interview healthcare providers who serve adolescent populations to learn their perspectives on the factors that influence the continuum of sexual and gender minority (SGM) youth’s pregnancy expaeriences, including decision-making about sex, relationships, and pregnancy. Methods As part of the SexuaL Orientation, Gender Identity, and P...

Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexua...

Gender minority (GM) youth are more likely to engage in sexual behaviors that increase risk of exposure to sexually transmitted infections, including HIV. However, family functioning may be protective against sexual risk taking. We characterized longitudinal associations between family functioning (family communication and family satisfaction) and...

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current...

Parents/caregivers of transgender and/or nonbinary (TNB) youth (those who identify with a different gender than the gender typically associated with their assigned sex) may experience secondary stigma related to their child’s TNB identity. However, parent/caregiver support is critical for TNB youth’s mental health. This study explored attitudes and...

Background Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication...

Importance Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. Objective To examine mental health outcomes among TGD vs cisgen...

A positive LGBTQ+ (lesbian, gay, bisexual, transgender/nonbinary, queer) workplace climate is critical for healthcare employee satisfaction, productivity, and patient care. The current study assessed LGBTQ+ workplace climate among 791 employees from a large urban pediatric hospital. Several workplace climate domains were assessed in an online surve...

Purpose Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, de...

During and after the 2016 United States (U.S.) presidential election, discriminatory policies and stigmatizing rhetoric have been increasingly directed toward the transgender community at state and national levels. Transgender and/or nonbinary (TNB) adolescents, already at elevated risk for poorer health relative to their cisgender (nontransgender)...

Although most lesbian, gay, bisexual, transgender, and questioning youths are quite resilient and emerge from adolescence as healthy adults, the effects of stigma and heterosexism can contribute to health disparities. Part 2 of this first-of-its-kind 3-part series can help pediatric primary care providers become stronger allies for TGD patients and...

Introduction Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how...

Family support and acceptance are protective for transgender and gender diverse (TGD) youths’ mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships w...

Background Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities. Aims This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs. Metho...

Objectives Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and percei...

The current study used family and ecological systems approaches to understand transgender and/or nonbinary (TNB) youths' experiences of their gender identity within family and community contexts. A sample of 33 TNB youth, ages 13-17 years (M = 15.18, SD = 1.24), were recruited from community-based venues in the New England region of the United Stat...

Increased scientific understanding explains why transgender and gender nonconforming (TGNC) youth report more mental health concerns than their cisgender peers. However, the emotional processes of TGNC youth have not been assessed beyond mental health diagnoses. Our aim in this study was to investigate how TGNC youth understand, experience, and lab...

Study Objective This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes. Design We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcr...

Abstract: Sexual and/or gender minority (SGM) adolescents are at greater risk than their heterosexual, cisgender peers for adverse sexual and reproductive health outcomes, including teen pregnancy. SGM adolescents face a number of healthcare barriers (e.g., discrimination) that may contribute to teen pregnancy disparities. Previous research has no...

Purpose: Transgender adults may avoid medical settings due to concerns about discrimination or past experiences of maltreatment. Emerging evidence shows improved outcomes and psychosocial functioning when transgender adolescents receive gender-affirming care, but little is known about transgender adolescents' experiences in primary care. The objec...

Objectives: Our objective was to explore how mothers' attitudes and relationships with their daughters may impact the cervical cancer prevention behaviors of daughters with diverse sexual orientations. Methods: We examined 8,143 mother-daughter dyads from the Nurses' Health Study 2 and Growing Up Today Study. During the daughter's adolescence, e...

Study objective: Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors. Design: As a part of the SexuaL Orientation, Gender Identity, a...

This study examined associations between sexual fluidity in attractions and related beliefs and attitudes among sexual minority and heterosexual young adults. Two college and community-based samples who completed an online survey were combined to yield 421 young adults (224 women, 188 men, 7 transgender, and 2 another gender), ages 18–26 years. Two...

Objective: Sexual satisfaction has implications for well-being and may be related to gender norms. This study was conducted to understand the relationship between U.S. sexual minority (SM) individuals’ gender norm conformity and levels of sexual satisfaction, as well as examining the following potential mediators: sexual communication, internalized...

Bisexual individuals experience unique discrimination related to their sexual orientation, which may increase their risk of adverse health outcomes. The study goal was to investigate how bisexual and other non-monosexual individuals experience discrimination, understand how they perceive discrimination to affect their health, and examine the ways i...

Community-based participatory research (CBPR) involves community members collaborating with academic investigators in each step of the research process. CBPR may be especially useful for research involving marginalized populations with unique perspectives and needs. In this paper, we discuss successes and challenges of using a CBPR approach for the...

Despite an upward trend in research focused on trans youth, how trans youth cope with their gender identity remains relatively unknown. We aimed to gather in-depth information about how trans youth described the developmental process of coping with factors that arise when youth are exploring their gender identity, coming out to others, and navigati...

Purpose: To better understand links between depressive symptoms and high-risk sexual behavior in young women. Methods: We conducted semistructured interviews with young women from three primary care clinics who reported clinically significant depressive symptoms, had penile-vaginal sexual intercourse within the past 6 months, and met at least on...

Purpose: Gender-affirming medical interventions have been associated with mental health improvements among transgender individuals. However, little is known about optimal timing of these interventions as they relate to stress-sensitive behaviors such as smoking. Methods: We analyzed electronic health record data from transgender youth and young adu...

Objectives: Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual mino...

Gender-based analysis in public health is a systematic examination of how population health is shaped by systems of gender relations, involving policies and laws, programs and services, research priorities, social norms and practices, and public discourse. To address the paucity of critical gender-based analysis training in most public health, medi...

Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN yo...

Research has just begun to study associations between sexual fluidity and health among cisgender individuals; only 1 cross-sectional study examined these links among transgender individuals. The goals of the current study were to prospectively examine fluidity in sexual attractions and fluidity in sexual orientation identity, and associations with...

This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and...

Sexual minorities (mostly heterosexual, bisexual, lesbian/gay) are more likely than heterosexuals to have adverse mental health, which may be related to minority stress. We used longitudinal data from 1461 sexual minority women and men, aged 22–30 years, from Wave 2010 of the Growing Up Today Study, to examine associations between sexual minority s...

Introduction: Stigma against sexual minorities is well documented, but its long-term consequences for health-related quality of life (HRQL) are unknown. This study examined stigma-related predictors of sexual orientation disparities in HRQL and their contribution to young adult HRQL disparities. Methods: In 2013, participants (N=7,304, aged 18-3...

Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stre...

Background: A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using...

Previous theories of sexual orientation development and sexual fluidity are limited because they describe these processes separately and represent the experiences of only some sexual orientation subgroups. This study qualitatively examined sexual orientation development and sexual fluidity among 18 young adults, ages 18 to 26 years. Participants re...

Future perspectives of transgender youth and their caregivers may be shaped by knowledge of discrimination and adverse mental health among transgender adults. Qualitative data from the Trans Youth Family Study were analyzed to examine how transgender and gender nonconforming (TGN) youth and their caregivers imagine the youth’s future. A community-b...

In this article, we address theories of attachment and parental acceptance and rejection, and their implications for lesbian, gay, bisexual, and transgender (LGBT) youths’ identity and health. We also provide 2 clinical cases to illustrate the process of family acceptance of a transgender youth and a gender nonconforming youth who was neither a sex...

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men,...

Purpose: Disordered weight management behaviors are prevalent among youth; recent case reports suggested that these behaviors might also be common in transgender youth. We studied associations of gender identity with disordered weight management behaviors, nonprescription steroid use, and weight perception among transgender and cisgender (nontrans...

Theorists and researchers have noted an overlap between individuals who are bisexually-identified and queer-identified. Although early definitions of bisexuality may have been predominantly binary (i.e., attracted to women and men), in recent years there has been a move toward a more “queer” understanding of bisexuality (e.g., attraction to more th...

Purpose: This study investigates depression and anxiety in gender minority (i.e., transgender and/or gender nonconforming) compared with nongender minority (cisgender) young adults. Methods: Data were from the Growing Up Today Study, a national cohort of U.S. young adults. A two-step method (maternal-reported natal sex in 1996 cross-classified w...

This research examined endorsement and timing of sexual orientation developmental milestones. Participants were 1,235 females and 398 males from the Growing Up Today Study, ages 22 to 29 years, who endorsed a sexual minority orientation (lesbian/gay, bisexual, mostly heterosexual) or reported same-gender sexual behavior (heterosexual with same-gend...