(Reuters Health) - Teenagers who identify as transgender or gender nonconforming may be worse off on several health measures than their non-transgender classmates, suggests a new study from Minnesota.

Compared to their classmates, transgender and gender nonconforming teens were more likely to engage in risky behavior and less likely to have traits that would protect them from poor health outcomes, researchers found.

“One of our most surprising findings was that the prevalence of a trans identity was almost identical in the metropolitan area and the non-metro parts of the state, showing that support for these teens is needed in all areas,” said lead author Marla Eisenberg, of the University of Minnesota in Minneapolis.

People who are transgender or gender nonconforming have a gender and sex that do not align at birth. People are called cisgender if their sex and gender do align at birth.

As reported in the Journal of Adolescent Health, Eisenberg and colleagues analyzed data that had been collected regularly through a survey of high school students in Minnesota. In 2016, the survey started asking about gender identities.

Overall, of the 81,885 students in grades 9 and 11 who responded to the survey in 2016, 2.7 percent identified as transgender or gender nonconforming.

Students were more likely to identify with that group if they were assigned female at birth, faced severe economic hardship or were American Indian, Pacific Islander or multiracial.

About 61 percent of transgender and gender nonconforming students reported suicidal thoughts, compared to 20 percent their cisgender peers, researchers found.

Similarly, 31 percent of transgender and gender nonconforming students reported attempting suicide, compared to about 7 percent of their classmates.

Transgender and gender nonconforming students were also less likely to report traits that may protect against poor outcomes.

Cisgender students reported higher levels of family connectedness than transgender and gender non-conforming students, for example.

The study’s findings regarding suicidal thoughts and attempts are similar to what’s been found in other research, Eisenberg told Reuters Health by email.

“Other findings, however, did not show the substantial differences we have seen elsewhere,” she added. “For example, we did find significant disparities in substance use, but not as great as in prior studies with adults.”

The researchers conclude that people who work with and on behalf of youth should recognize the special needs of this population and work as their allies.

“They need and deserve support, respect, safety and love just like all other young people,” said Eisenberg.

SOURCE: bit.ly/2u34xVf Journal of Adolescent Health, online July 20, 2017.