In this blog, PhD student, Sophie Borgia based at DECIPHer, Cardiff University, explains how her research is uncovering health and well-being inequalities using SHRN data, and how she will be exploring what schools can do to better support transgender and gender diverse (TGD) learners in mainstream secondary schools in Wales.
Hello, I’m Sophie Borgia, a PhD student at DECIPHer, Cardiff University. I’m using SHRN’s 2021 Student Health and Well‑being Survey data to explore health inequalities experienced by transgender and gender diverse (TGD) young people in Wales. My study also looks at how school policies, practices, and everyday environments shape these outcomes. To do this, I’m combining large‑scale quantitative analysis with qualitative research involving school staff, TGD learners, and decision makers.
Why This Research Matters
Transgender and gender diverse[1] (TGD) young people can face health inequalities compared to their cisgender[2] peers. While mental health disparities are well documented, much less is known about other health outcomes, such as physical activity, substance use, and healthy eating, and the role schools play in shaping these. My research begins to address these gaps by using SHRN’s 2021 data to explore potential inequalities across a broader range of health and well-being outcomes. It also examines how secondary school contexts influence these outcomes. My work aims to provide evidence that can help schools create more inclusive and supportive environments.
What Evidence Tells Us
Evidence suggests that transgender and gender diverse (TGD) young people experience significantly poorer mental health than cisgender young people (Wittlin, Kuper & Olson 2023; White et al. 2023; White, Trinh & Reynolds 2023). There is also research suggesting that TGD young people’s experience at school is related to their mental health (Horton 2023; Kelley et al. 2022; Johns et al. 2021).
However, there is limited research investigating whether TGD young people experience inequalities in other outcomes related to health and well-being, and how schools influence these.
Using SHRN Data for New Insights
Building on this evidence, my PhD study uses SHRN’s 2021 Student Health and Well-being Survey data to examine health-related inequalities experienced by TGD young people. I’m exploring whether these inequalities go beyond mental health to areas such as physical activity, substance use, and healthy eating. Alongside this, I’ll explore how secondary school policies and practices influence TGD learners’ health by speaking with school staff, TGD young people, and partners involved in health and education. The aim is to generate evidence that can help schools create more inclusive environments and reduce health inequalities. Together, this will help build a fuller picture of where inequalities exist and why.
It can be challenging for researchers to understand whether TGD young people experience differences in health-related outcomes compared to their cisgender peers. One reason is that studies often struggle to recruit a large and diverse enough sample of young people with different gender identities.
This is where SHRN data makes a difference. SHRN surveys thousands of young people across Wales every two years, and asks questions about a wide range of health and well-being outcomes. Young people can also choose to share their gender identity, which means SHRN data provides a unique opportunity to study differences in health-related outcomes between gender identity groups.
My PhD focuses on five key areas:
- Mental health
- Well-being
- Substance use
- Physical activity
- Healthy eating
Using SHRN’s 2021 Student Health and Well-being Survey data, I’ve been able to compare these outcomes across young people with different gender identities.
Early findings suggest that TGD young people report reduced physical activity and poorer mental health and well-being compared to cisgender peers. I’m continuing the analysis and will share detailed results in an upcoming research paper.
How Secondary Schools can Get Involved
These patterns raise important questions: How do school environments influence health behaviours and outcomes? And what can schools do- practically and sustainably- to support TGD learners’ health and well‑being?
To answer these, I’m inviting secondary schools andpeople working in health and education to take part in the next stage of my PhD. I’ll be working with four secondary schools across Wales to recruit staff and learners.
My research will use:
- Focus groups with school staff (including senior leadership, teaching and pastoral roles)
- Creative focus groups with transgender, nonbinary, and gender diverse young people
- Interviews with people working in education and health (e.g. Welsh government and local authority education roles, health and well-being promoting schools co-ordinators, and other public health roles related to secondary education settings)
The goal is to provide practical insights for school staff and policymakers to create more inclusive and supportive school environments for TGD learners, and to identify what’s working and what needs to change.
Looking Ahead: How Schools Can Make a Difference
SHRN’s 2021 data has given us a clearer picture of the health and well-being challenges faced by TGD young people. Next, I’ll examine how school policies and everyday practices contribute to these outcomes , and which inclusive approaches can make a measurable difference. TGD young people deserve school environments where they feel safe, seen, and supported and your insight can genuinely help make that happen.
The next stage of my PhD relies on the lived experience and professional expertise of people working directly in secondary education and health. By taking part, you’ll be helping to shape practical, realistic recommendations that schools across Wales can use to improve the health and well-being of TGD learners.
I’m looking to work with four secondary schools from across Wales to assist with recruiting staff and learners to take part.
If you work or know someone who works in a Welsh secondary school which could help with this, I’d love to hear from you. I would also be keen to speak to people working in education and health (such as Welsh government and local authority education roles, health and well-being promoting schools co-ordinators, and other public health roles related to secondary education settings)
Your perspectives and experiences are essential; they can directly influence how we understand these challenges and how we build more inclusive approaches that truly make a difference for TGD young people.
Interested in taking part? Contact me at schoolhealth_phd@cardiff.ac.uk
[1] TGD: Transgender and gender diverse. This term is used to describe people whose gender identity is not the same as the sex they were assigned at birth.
[2] Cisgender: Describes people whose gender identity is the same as the sex they were assigned at birth.