Majority of young people are willing to answer questions about their sexual orientation and gender identity

Measuring sexual orientation, gender identity, and gender expression (SOGIE) in adolescent health surveys is necessary to influence legislation, monitor health disparities, and advocate for government funding of resources and health interventions that address these inequalities.

Despite the importance of these data, some clinicians and researchers are hesitant to include SOGIE questions in their youth assessments or data collection because they fear that youth may be unwilling or unable to share this information.

But a new study from the School of Public Health and Boston Children’s Hospital (BCH) has found that the vast majority of LGBTQ+ youth have no problem answering questions about their sexual orientation and gender identity in health surveys.

Published in Psychological methodsa journal of the American Psychological Association, the study examined the prevalence and sociodemographic patterns of “missingness”—survey questions that adolescents did not answer—related to SOGIE and sexual fluidity (changes in one’s identity or inclinations). Results showed that more than 95 percent of adolescent participants answered all questions on these topics.

As hundreds of proposed and passed state-level bills continue to threaten and harm the health of LGBTQ+ people, especially youth, it is necessary to capture the breadth of these identities and identity trajectories in order to respond to these discriminatory legislative measures and advocate for the dignity and fundamental rights of this population.

“Fortunately, our results are consistent with what we know about adults—just as we believe that including questions about sexual orientation and gender identity generally strengthens adult health surveys, we believe researchers can safely include these questions in youth surveys as well,” says lead study author Allegra Gordon, assistant professor of Community Health Sciences (CHS). She adds that the questions and response options should be reviewed to ensure they are valid for each specific study population. “Our results overwhelmingly suggest that youth are very willing to answer these questions.”

The study is the first to examine missing response patterns in adolescents’ responses to a range of SOGIE-related survey questions, and it is the first study to assess these patterns for questions about sexual fluidity across all age groups.

For the analysis, Gordon and colleagues at SPH and BCH examined survey data from 4,245 adolescent participants between the ages of 14 and 25 in the United States who answered brief questions about their sexual orientation, sexual attraction, gender identity, and sex assigned at birth and reported whether they had experienced some flexibility in their sexual orientation.

The team found that only 0.4 percent of teens skipped the question about sexual orientation and only 0.2 percent did not answer the question about gender identity. Notably, these overall numbers were similar to the missing-report results for other demographic questions in the survey, including 0.5 percent of teens skipping the questions about race/ethnicity and 0.1 percent not providing information about their zip code. Teens also overwhelmingly reported 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 participants reported identifying as heterosexual and cisgender, suggesting that both LGBTQ+ and non-LGBTQ+ youth can comfortably answer SOGIE questions.

These findings also have important implications for clinical care, Gordon says, as research shows that LGBTQ+ youth are more likely to have positive health care experiences and better health outcomes when cared for by a supportive provider.

“This support may include healthcare providers offering opportunities for youth to share their sexual orientation and gender identity in a confidential and supportive setting, such as on clinical intake forms or during a social history,” Gordon says. “Given how common sexual fluidity is among youth, it is also important to ask these questions at multiple time points so providers can ensure they have an accurate picture of a patient’s social identity and can ask about strengths and needed resources during each clinical encounter.”

And as language and identities evolve, it’s also important to adapt the way young people are asked these questions, she says.

“As public health researchers, it is our job to keep engaging with youth so we can figure out how best to revisit these questions over time. We need these questions to accurately capture the full range of young people’s experiences of sexual and gender diversity so that clinicians can provide high-quality care and researchers can collect population data that effectively support our work to identify and eliminate health inequalities.”

The study’s lead author is Sabra Katz-Wise, associate professor of adolescent and young adult services at BCH, of pediatrics at Harvard Medical School, and of social and behavioral sciences at Harvard TH Chan School of Public Health. At SPH, co-authors of the study included Lynsie Ranker, assistant professor at CHS, Kimberly Nelson, associate professor at CHS, and Ziming Xuan, professor at CHS, and SPH alumna Jennifer Conti (SPH’18). Also co-authoring the study was R. “Kork” Korkodilos, clinical research assistant in the Division of Adolescent and Young Adult Services at BCH.