Monitoring the health of transgender and other gender minority populations: Validity of natal sex and gender identity survey items in a U.S. national cohort of young adults

Abstract

BackgroundA barrier to monitoring the health of gender minority (transgender) populations is the lack of brief, validated tools with which to identify participants in surveillance systems.MethodsWe used the Growing Up Today Study (GUTS), a prospective cohort study of U.S. young adults (mean age = 20.7 years in 2005), to assess the validity of self-report measures and implement a two-step method to measure gender minority status (step 1: assigned sex at birth, step 2: current gender identity). A mixed-methods study was conducted in 2013. Construct validity was evaluated in secondary data analysis of the 2010 wave (n = 7,831). Cognitive testing interviews of close-ended measures were conducted with a subsample of participants (n = 39).ResultsCompared to cisgender (non-transgender) participants, transgender participants had higher levels of recalled childhood gender nonconformity age < 11 years and current socially assigned gender nonconformity and were more likely to have ever identified as not completely heterosexual (p < 0.001). No problems with item comprehension were found for cisgender or gender minority participants. Assigned sex at birth was interpreted as sex designated on a birth certificate; transgender was understood to be a difference between a person’s natal sex and gender identity. Participants were correctly classified as male, female, or transgender.ConclusionsThe survey items performed well in this sample and are recommended for further evaluation in languages other than English and with diverse samples in terms of age, race/ethnicity, and socioeconomic status.

Using a Two-Step Method to Measure Transgender Identity in Latin America/the Caribbean, Portugal, and Spain

“…Additional studies are needed using mixed methods to formally validate the survey items to measure natal sex/gender identity status using a two-step method. Cognitive testing of the modified survey items (Reisner et al, 2013; Sudman, Bradburn, & Schwarz, 1996) is recommended in different languages, and geographic contexts, using diverse samples. This would ideally include confirming accurate classification of transgender cases (i.e., that people checking cross-sex, transgender, or other gender are being classified correctly as transgender).…”

“…It has been suggested that a two-step approach offers a method of measuring transgender identity in the U.S. (Sausa et al, 2009; Tate et al, 2013). We view the two-step cross-classification procedure as a method to categorize the construct of natal sex/gender identity status in health research (Reisner et al, 2013a). The current study extended previous work by offering conceptual precision of the construct being measured, bringing the two-step method into a global context, and offering Spanish and Portuguese translations of two survey items for health research.…”

“…Natal sex/gender identity status refers to the biological and social cross-classification of participants based on assigned sex at birth and current gender identity; it is neither sex nor gender, but a third construct obtained from cross-classifying the two (sex and gender) (Reisner, Conron, Tardiff, Jarvi, Gordon, & Austin, 2013). It is termed a status because statuses can change over time and people’s identities can shift over the lifecourse.…”

“…(e.g., Sausa, Sevelius, Keatley, Iñiguez, & Reyes, 2009; Tate, Ledbetter, & Youssef, 2013; for a history of this method, see GenIUSS, 2013). The specific survey questions used to implement the two-step method differ across recommendations, including the item stem and response options, as does the order in which the sex and gender identity questions are sometimes asked (Reisner et al, 2013; Sausa et al, 2009; Tate et al, 2013). However, the procedure always uses two steps: assigned sex at birth and current gender identity.…”

Substance use and treatment of substance use disorders in a community sample of transgender adults

“…Gender was assessed using a two-step method asking two items: (1) assigned sex at birth (female, male) and (2) current gender identity (man, woman, female-to-male (FTM)/trans man, male-to-female (MTF)/trans woman, genderqueer, gender variant, gender-nonconforming, other; Reisner et al, 2014b, 2014c). The two items were cross-tabulated to categorize participants as female-to-male (FTM) spectrum or male-to-female (MTF) spectrum according to their natal sex and current gender identity.…”