Objective: This study examined anti transgender legislative trends impact on high school youth reported violence and suicide-related behaviors. Design: This retrospective analysis collected data from 2010-2019 by the Human Rights Campaign; Legislation Affecting LGBTQ Rights Across the Country; and the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance survey. Methods: Violence and suicide outcomes were matched to legislation counts, with frequency distribution summarized by state. Chi-square and Fisher exact tests assessed the association between state responses and number of state passed bills using SAS. Results: One hundred, ninety-two anti-transgender bills were tallied. Twelve bills passed during the study period. As the number of anti-transgender bills passed increased, youth respondents were more likely to report experiencing/engaging in 13 of 17 violence-associated behaviors: (carrying a weapon (p<0.0001), gun (p=0.0009), been threatened/injured by a weapon (p<0.0001), physical fight (p=0.383), bullied at school (p=0.0058) or suicide (serious considerations (p<0.0001), attempt (p=0.0004), treatment after attempt (p=0.0465)). Transgender youth were more likely to report suicide (considerations, planning, attempting, or treatment after an attempt (all with p<0.0001)). Conclusion: Transgender and non-transgender youth reported experiencing more violence and suicidality as more anti-transgender legislation passed. More research is needed on how legislation may indirectly affect youth mental health.

The authors have declared no competing interest.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Equality from State to State (available for 2004-2013) State Equality Index(9) (available for 2014-2018) reports by Human Rights Campaign Legislation Affecting LGBTQ Rights Across the Country tracker (available for 2018-2022)(10) maintained by the ACLU Youth Risk Behavior Surveillance Survey from the Centers for Disease Control and Prevention

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors. Requests for publicly accessible data can be sent to the organizations listed above.