Majority of Youth Are Willing to Answer Questions About Their Sexual Orientation, Gender Identity.
Majority of Youth Are Willing to Answer Questions About Their Sexual Orientation, Gender Identity
A new study has found that most youth are comfortable answering questions about sexual orientation and gender identity in health surveys, dispelling concerns that youth do not want to provide this information.
Assessing sexual orientation, gender identity, and gender expression (SOGIE) in youth health surveys is necessary to inform legislation, monitor health inequities, and advocate for government funding for resources and health interventions that address these inequities.
Despite the importance of this data, some clinicians and researchers are hesitant to include SOGIE questions in their youth assessments or data collection because of concern that adolescents do not want to, or are not able to, share this information.
But a new study led by the School of Public Health and Boston Children’s Hospital (BCH) has found that the vast majority of LGBTQ+ youth are comfortable answering questions about sexual orientation and gender identity on health surveys.
Published in Psychological Methods, a journal of the American Psychological Association, the study examined the prevalence and sociodemographic patterns of “missingness”—that is, survey questions that youth did not answer—related to SOGIE and sexual fluidity (changes in one’s identity or attractions). The findings showed that more than 95 percent of youth participants answered all questions related to these topics.
As hundreds of proposed and enacted state legislative bills continue to threaten and undermine the health of LGBTQ+ people—particularly youth—capturing the breadth of these identities and identity trajectories is necessary to respond to this discriminatory legislative action and advocate to preserve the dignity and fundamental rights of this population.
“Happily, our findings are consistent with what we know about adults—just as we are confident that including questions about sexual orientation and gender identity typically strengthens population health surveys among adult populations, we believe researchers can be confident in adding these questions to youth surveys,” says study senior author Allegra Gordon, assistant professor of community health sciences (CHS), adding that the question and response options should be reviewed to make sure they are valid for each specific study population. “Our findings overwhelmingly suggest that youth are very willing to answer these questions.”
The study is the first to explore missingness patterns in youth responses across a range of SOGIE-related survey questions, as well as the first study to assess these patterns for questions on sexual fluidity among any age group.
For the analysis, Gordon and colleagues from SPH and BCH examined survey data from 4,245 US youth participants ages 14-25 years old, who answered brief survey questions about their sexual orientation identity, sexual attractions, gender identity, and sex assigned at birth, and shared whether they had experienced fluidity in their sexual orientation.
The team found that only 0.4 percent of youth skipped the question about sexual orientation, and only 0.2 percent of youth did not answer the question about gender identity. Notably, these totals were similar to missingness results of other demographic questions in the survey, including 0.5 percent of youth who skipped the questions about race/ethnicity, and 0.1 percent who did not provide information about their zip code. Youth also overwhelmingly provided information on sexual fluidity; only 1.2 percent did not answer questions about changes in their identity, and 0.8 percent did not share information about their changes in attraction.
About 70 percent of the participants reported that they identified as heterosexual and cisgender, suggesting that both LGBTQ+ and non-LGBTQ+ youth are comfortable answering SOGIE questions.
These findings also lend important implications for clinical care, Gordon says, as research shows that LGBTQ+ youth are more likely to have positive healthcare experiences and better health outcomes when they receive care from a supportive provider.
“This support can include healthcare providers offering youth the opportunity to share their sexual orientation and gender identity if they wish in a confidential and supportive setting, for example on clinical intake forms or during a social history,” Gordon says. “Given how common sexual fluidity is among youth, it is also relevant to ask these questions at multiple time points, so that providers can make sure they have an accurate picture of a patient’s social identities and can inquire about strengths and needed resources during each clinical encounter.”
And as language and identities evolve, it is also important to adjust the way these questions are posed to youth, she says.
“As public health researchers, it is our job to keep checking in with youth so that we can figure out the best ways to revise these questions over time. We need these questions to accurately capture the full range of sexual and gender diversity youth experience so that clinicians can provide high-quality care and researchers can capture population data that effectively informs our work identifying and addressing health inequities.”
The study’s lead author is Sabra Katz-Wise, associate professor of adolescent/young adult medicine at BCH, of pediatrics at Harvard Medical School, and of social and behavioral sciences at Harvard T.H. Chan School of Public Health. At SPH, the study was coauthored by Lynsie Ranker, assistant professor of CHS; Kimberly Nelson, associate professor of CHS; and Ziming Xuan, professor of CHS; as well as SPH alum Jennifer Conti (SPH’18). The study was also coauthored by R. “Kork” Korkodilos, clinical research assistant in the Division of Adolescent & Young Adult Medicine at BCH.