Transgender youth in Hawaii are significantly more likely to use tobacco, alcohol and other drugs than their non-transgender peers, resulting in greater health issues, a new state report shows.

They also deal with more mental health problems due to bullying and violence, which further exacerbates substance abuse and other risky behaviors, according to data released Monday by the state Health Department.

The Hawaii Sexual and Gender Minority Health Report 2018 found that 3 percent, or 1,260 public high school students, identify as transgender.

Half of transgender youth reported feeling sad or hopeless and attempted suicide in the past year, compared to 8 percent of their cisgender, or non-transgender, peers, according to the data collected from 12,000 public junior and high school students in 2017.

Forty percent of transgender youth reported being bullied at school or online versus 23 percent of youth overall.

Trans youth are more likely to sleep away from home and more likely to go hungry.

Only half reported sleeping at home during the prior month, compared to 94 percent of their peers, while 16 percent reported going hungry versus 6 percent of cisgender youth. Less than half received a physical exam or health checkup in the past year, compared to two-thirds of their counterparts.

“Part of it is is there’s not an acceptance. Half of them are not at home. That puts them in a crisis situation every day,” said Lola Irvin, administrator of DOH’s Chronic Disease Prevention and Health Promotion Division. “In terms of social acceptance, it’s been hard for people to find acceptance in terms of their gender identity. If they’re not finding it within the communities they’re from and especially within their homes, then it puts them at greater risk.”

The survey follows an earlier report that found the LGBT community was more likely to suffer health problems than heterosexuals, though there was not sufficient data on the transgender population.

In the latest report, a quarter of transgender children said they skipped school because of safety issues, compared with 7 percent of cisgender students, and nearly 50 percent admitted to purposely hurting themselves in the past year, compared to 17 percent of cisgender students.

A quarter of of the population said they had used an illegal drug before compared with only 1 percent of their peers, and more than 30 percent reported smoking cigarettes in the month before the survey, compared to only six percent of their peers. In addition, they were nearly three times more likely to report binge drinking in the past month compared with their peers, the report said. About 45 percent said they have an adult they can turn to versus three fourths of youth overall.

“We hope the findings will be used by our stakeholders to initiate and sustain efforts to address the health challenges faced by Hawaii’s transgender population,” said Irvin, adding that there needs to be more social services and outreach to the population. “We must work intentionally to improve the health of our at-risk and underserved populations to move the health of the state forward.”