Experts Release New Report Highlighting the Lack of Population-Based Data about Transgender People and Other Gender Minorities

Experts Release New Report Highlighting the Lack of Population-Based Data about Transgender People and Other Gender Minorities

Current survey practices fail to identify transgender and other gender minority respondents

Los Angeles—A new report released today by the Gender Identity in U.S. Surveillance (GenIUSS) group highlights the lack of survey measures to identify transgender and other gender minority respondents in most federally-supported population-based surveys. This groundbreaking report, entitled Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys, examines current practices in population-based surveys to see which surveys currently include measures to identify transgender and other gender minority respondents and offers expert recommendations for including sex and gender-related measures in population-based surveys.

The 2011 Institute of Medicine report on LGBT health specifically identified transgender health research as being a high priority.  However, without adequate measures to differentiate between trans and cis people such research would be very difficult to conduct.

The report offers best practices for identifying transgender and other gender minority respondents in population-based surveys. Among the best practices delineated in the report, the most effective is the “two-step” approach. This practice includes measures of self-reported assigned sex at birth (the birth recorded on one’s original birth certificate) and gender identity at the time of the survey. There are also recommendations on the best way to place and integrate sex and gender-related measures into population-based surveys in this report.

Among the federally supported population-based surveys that currently do not include measures to identify gender minority respondents are the American Community Survey, the Current Population Survey, and the National Health Interview Survey, and others.

The proposed guidelines are an important step in working toward the the development and inclusion of transgender health within national health studies.

The full report is available here: http://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf

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The Gender Identity in U.S. Surveillance (GenIUSS) Group is a multi-disciplinary and multi-institutional group of experts convened by the Williams Institute to increase population-based data about transgender people and other gender minorities by advancing the development of gender-related measures for population-based surveys, with a particular consideration for publicly-funded data collection efforts.

National Lesbian, Gay, Bisexual, Transgender, and Intersex Health Research Conference to be Held at Baldwin Wallace University

Research concerning the health issues of lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals has been very limited and more work is needed to better understand the health needs of LGBTI populations. This was the finding of an Institute of Medicine (IOM) 2011 report written at the request of the National Institutes of Health (NIH). Since then, academics, researchers, and government officials have been working to improve the state of LGBTI health research.

(Link: http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx)

With this in mind, representatives from Baldwin Wallace University, Cleveland State University, and MetroHealth Medical Center have organized a conference to provide people (students, researchers, and community members) an opportunity to learn more about LGBTI health research. Speakers from across the United States will discuss their work. The conference will be able to provide students, researchers, and community members with opportunities to learn more about LGBTI health research, to network with existing researchers, and learn of opportunities for training in LGBTI health research.

The conference will be held August 7-9, 2014 at Baldwin Wallace University (Center for Innovation & Growth (CIG), 340 Front Street, Berea, OH 44017). The conference is free and open to students, researchers, academics, and community members.

Registration:

https://www.eventbrite.com/e/conference-on-current-issues-in-lesbian-gay-bisexual-transgender-and-intersex-lgbti-health-research-registration-11575064329

Contact:

Emilia Lombardi, PhD

elombard@bw.edu

Teaching R to Undergraduates Part 1, Why R and How to Install it

Teaching R to Undergraduates Part 1, Why R and How to Install it (work in progress)

 # This will be a rough draft of what I hope to provide for students in my research class in the fall.  Suggestions/questions welcome.

 First, what is R and why are we using it?

 ·        R is a free software environment for statistical computing and graphics.

·        Have I mentioned that its free and can be used on multiple platforms (windows, mac, linux)

 So it’s free, but is it any good?

 ·        R is used by many academics, and companies around the world.  Google and Health Canada both use R for example.   http://www.revolutionanalytics.com/companies-using-r

·        It is a living program, in that it has a community constantly building and adapting the program.  

·        It can provide very powerful tools for analyses and graphics. 

·        It is considered to be as useful if not better than SPSS or SAS

 Why don’t we just use SPSS or SAS since the University provides it for free on its computers?

 ·        If you just plan on using University computers for the rest of your life than that can work.  But what if you want to use your own computer or if you are working/interning somewhere that won’t let you move their data off of their computer, what will you use then?

·        SPSS and SAS are expensive programs and require yearly patches to continue working after its initial purchase.  You don’t really buy the software as rent it from year to year.  SPSS has a special student price, but you can’t use it after you graduate.

·        If you are working for a nonprofit or other small organization, expecting them to spend thousands of dollars on software per year may not be very sustainable.  That same amount could be used to provide direct services or develop other goods. 

 So how do I install it?

·        The first step is to download the latest version.  Case Western Reserve hosts a depository that you can access it and other needed packages (more on that later).

o   GO to http://cran.case.edu/ and click on the version for your system (window, mac, or linux) and install it onto your system using the direction provided.

o   Once installed, run the program you should see this.

 ·        Next, make sure that you have java installed on your computer, if you don’t have it or don’t know got to http://www.java.com and find the right version for your system.  If you have a 64 bit computer, make sure you have the 64 bit version of java.  This program will be needed to run the Graphic User Interface (GUI) that we will be using.

 ·        We will be using the Deducer GUI to work with R.  It’s not necessary, but it will be easier to work with for beginners.

 o   At the top of the R program you should see an option for Packages, click on that.

o   You should see an option for Install package(s), click on that.  You should be given a list of cran mirrors.  Scroll down and look for USA (OH) option.  Click on that and hit OK.

o   Next, you should see a list of Packages.  Scroll down and look for Deducer.  Click on that and hit OK.

o   That will install Deducer and any related package.

o   Once finished, go pack to Packages and look for Load package(s) and then click on it.  You will be given a list of packages available.  Look for Deducer and click on it, and then click OK.  The program will attach itself and you will see additional options available on the tool bar after Help on the right.  You should see Deducer, Data, Analysis, and Plots.  If you do that means that its installed and ready to go. 

 The next part will cover inputing data and simple statistics.

Faculty/Student Collaboration Examining the Affordable Care Act

A student (Jesper Zuber) and I at Baldwin Wallace University are conducting a study examining the Affordable Care Act.

Understanding People’s Beliefs and Experiences with Health Insurance and The Affordable Care Act

If you are over the age of 18 and live in Ohio, we would like to know how you feel about the Affordable Care Act and how it is affecting your life. Please take a moment to answer the survey, all responses will be confidential. You can access the survey from any computer, tablet, or smartphone using this link: https://bwresearch.typeform.com/to/CtqyTO

We are especially interested to hear from those between the ages of 18-26.

For your participation you will be given an opportunity to enter your email into a drawing to win a $50 gift card to Amazon.com (three prizes will be awarded). Your email will not be linked with your survey responses in any way. If you have any questions please contact:  Emilia Lombardi, PhD at (440) 826-2243 or elombard@bw.edu.

Transgender Day of Remembrance

Yesterday was the Transgender Day of Remembrance (TDOR).   Its purpose is to highlight the violence experienced by transgender people this past year.  There has been 238 transgender, transsexual, and gender nonconforming (trans) people on this years TDOR list, but we will never know the exact number of people killed.  What is crucial is to acknowledge that most of the people on this list (and of every list since the Day of Remembrance first started) are trans women of color, many also poor, and many very young (the youngest being 13 years of age).  What is also significant is the amount of violence these young people experienced:  Multiple gunshots, multiple stabbings, multiple physical blows, and even beheadings.  There perpetrators doing vast amounts of damage as if to literally remove any trace of these people from this world.  Can you imagine hating someone that much?  Can you imagine being on the receiving end of that hate.

One of the first activities I was involved with once I came out as transgender in 1994 was volunteer to help with GenderPAC’s transgender violence study.  At the time no one was interested in doing transgender related research.  This was also before people noticed that many trans people (especially young trans women of color) were being infected with HIV and dying.  I volunteered to do data entry, analysis, and to write up the results of the many surveys sent to me.  Over 400 surveys were delivered to my door roughly from 1995 to 1996.  Many were pretty easy to deal with if not aggravating (experiences of discrimination, verbal harassment), but there were always a few that talked about the extreme violence they’ve experienced by strangers or by supposed loved ones as well.  I never knew about the one’s who were never given the chance to fill out one of our surveys.

1998 was important in that people decided that the trans people who had their lives taken needed to be honored.  That was the start of the Transgender Day of Remembrance.  I think I’ve been to a ceremony every year (mostly), I’ve even organized a few.  Many things have changed.  More jurisdictions have established anti-discrimination and hate crimes legislation, even at the federal level there have been some changes that is beneficial to many transgender people.  But there are still too many names added to the Day of Remembrance list.  There are also those who after failing to turn the tide against same-gender marriage are now turning on the most vulnerable group within the trans community; young trans people.  Cristan Williams from the Transadvocate has been very busy detailing the lies and the harassment being done to young trans people (especially young trans women).  The issue is whether young trans people will be given the social space to express their identities safely.

This Day of Remembrance I want to remember those who were taken away through such horrendous violence because somebody (or somebodies) did not believe that they deserved to live.  I also want to remember those who are still with us but also facing hate and ignorance that may make life unbearable.  To both groups, you are in my thoughts.

 

Testing Gender Identity and Expression Measures in a Trans and Cis Sample

These are the results to the study my colleagues and I conducted last year for the Williams Institute as part of their Gender Identity in U.S. Surveillance (GenIUSS) Project.  A PDF copy is available.

Abstract

Health research examining the disparities faced by gender minorities (transgender, transsexual, and other gender nonconforming individuals) has reached a stage where population based studies are needed in order to expand upon what smaller, community based studies have identified within the population.  One of the issues hindering the inclusion of measures needed to identify gender minority populations is the lack of measures that can effectively identify gender minority populations but can be understood by gender majority populations and provide data usable by researchers.  This study examined measures that can identify gender identity/gender transition and gender expression by conducting cognitive interviews with 50 people (25 gender minority, 25 gender majority).  The interviews asked people to read and answer the questions; afterwards they were interviewed about why they answered the way they did.  The gender identity/gender transition question was found to be understood by all participants and only requires small changes to improve its usage.  The researchers found gender minority and majority participants to have problems answering the gender expression questions.  The results show that the gender expression measures may not be effective when used in a population based study.    Researchers conclude that the gender identity/gender transition questions would be effective in quantitative studies and be useful in identifying health disparities among gender minority populations.

Examination of Gender Identity and Expression Measures within a Mid – West Sample: Report to the Williams Institute

#GLMA13 Poster Abstract: Questions to Identify Gender Diversity

Questions to Identify Gender Diversity

Emilia Lombardi, PhD; Swagata Banik, PhD; Jesper Zuber; and Katherine Mitchell
Baldwin Wallace University, Berea, Ohio

The study was supported with a grant by the Williams Institute, UCLA School of Law as part of the Gender Identity in U.S. Surveillance (GenIUSS) Project

Background

Transgender has been defined generally as not conforming to societal norms of gender, or specifically to having a gender identity and/or expression that is contrary to one’s assigned sex at birth.  The term is used to refer to a broad range of identities and expressions within the United States and other English speaking countries.  There are efforts to identify study measures that are able to identify transgender populations, but little is known about how cisgender men and women will respond to those questions

Methods

The study interviewed 25 cisgender and transgender men and women to cognitively test how individuals respond to questions about transition status, gender nonconformity, and birth-sex assignment (the two-step and gender nonconformity measures).  The results will help assess the utility and understanding of quantitative measures designed to people’s transition status and gender nonconformity.

Results

Factors discussed include the understandability of the questions and participants ability to accurately identify people’s transition status and gender nonconformity in a manner that has high reliability and validity within quantitative analysis.  Generally, participants were able to easily answer questions relating to transition status but had more difficulty regarding gender expression

Discussion/Conclusion

Results will show that measures to identify transgender populations can be effectively used on cisgender populations, while still being able to identify transgender populations.

Lombardi GLMA poster

Trans veterans study finds high rate of suicide related events

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

 

The paper is very unique in that the authors are utilizing a database that allowed them to examine trans people along side a cis sample within the Veterans Health Administration database  They identified their trans sample based on those who were given CD-9 diagnosis codes for Gender Identity Disorder (GID) from 2000-2011 (They did not utilize self-identification for their study).  They identified 3177 unique trans people within the time period (the vast majority were military personnel and not dependents).  They report two interesting findings.

The first was the increase in the prevalence of people being given GID diagnoses from 13/100,000 in 2002 to 23/100,000 in 2011.  There measure of prevalence was much higher than estimates made for general populations.  The implication being either that military populations have a greater percentage of trans people then general populations (i.e. Flight into hypermasculinity).  They do not identify the difference between those assigned male and those assigned female, but identify that 95% of the VHA data were assigned male.  This is one issue I have with this study.  Another possibility is that general population estimates under represent trans populations.  This may be true as the number of people given a GID diagnosis have been increasing overtime within the VHA dataset.

The second part of the study was to examine rates of suicide related measures among this population.  They found their sample to have a very high rate of suicide related events, much higher than rates found within general populations (of cis people).  They can’t say if rates are different from non-veteran trans people.

While the study is not perfect it is an important step in the study of the health issues of trans populations.  We need to include population based studies of trans people along with community based convenience samples.  This is the reason why measures are needed to effectively identify trans samples within larger populations, so that studies like this one can be done.  There are those who would question this considering the small number of trans people found within general populations studies, and the percentage of trans people within the VA study itself represented .02%% of the total VA data-set.  However, its important because while trans people represent a small population, they are likely to experience higher levels of social and health disparities that require some sort of intervention.

 

 

 

The Beginning of a Transgender Sociologist

1994 was the start of two of the most significant things to happen in my life.  One was the start of my PhD program, and the other was coming out as transgender.  In a way, both were tied very closely to each other.  I began to use what I was learning in my PhD program to help me learn more about what it means to be transgender, so using my new skills searching for information at my University’s library.  Unfortunately, there wasn’t much sociological literature on the subject.

Psychology and psychiatry had a long history of writings on the subject, but they were focused on transsexualism as an illness and there was very little I found useful.  I had classes on the sociology of mental illness and read the literature on stigma and saw what was written as being representative of the way society seeks to control and minimize any form of gender nonconformity.  This was not the way I was viewing myself and trans issues; I was hoping more for a critical perspective.

Fortunately 1994 was the year of two significant (for me) publications.  The first was Kate Bornstein’s book “Gender Outlaw” (I still have it and managed to get her to autograph later), and the other was an essay by Susan Stryker called “My Words to Victor Frankenstein Above the Village of Chamounix:  Performing Transgender Rage”.   Both articulated a critical response to the experiences faced by transgender people.  These, along with Sandy Stone’s Essay “The Empire Strikes Back: a Posttranssexual Manifesto”, were very important in that they were other woman who are thinking the same things I was thinking.  That being trans wasn’t an illness and that trans people face numerous problems in their daily lives.  I would think that sociology would be very interested in investigating the inequities faced by trans people, but that’s not what I found.

One of the few articles I found at the time was “The process of deviance designation: The case of the homosexual transvestite” (Authors: LM Fournet, CJ Forsyth, CT Schramm) that was published in the Free Inquiry in Creative Sociology in 1988.  A very hard to find article, but one that represents the general view within sociology, that trans people represents a form of deviancy.   However, another article surprised me the most. “The socio-medical construction of transsexualism: An interpretation and critique” (Authors:  D. B. Billings and T. Urban) Published in the journal Social Problems.  In this case the social problem in question was being a transsexual, and individuals such as myself are just confused.   I wasn’t finding anything within the discipline that I felt that was actually dealt with the actual lives of transgender people.  So I felt it was important that I work to change that.

In 1996 I began to be more active as trans professionally.  I even chaired a session at the American Sociological Association meeting in New York City inviting local activists to talk about transgender issues.  I also recall a presentation on an HIV program in Rio de Janeiro targeting transgender women involved in sex work.  The topic of HIV and Transgender issues being very important to me and I was hoping to get some valuable information.  Unfortunately the talk was peppered with photos of topless trans women.  When this was brought up the answer that was given was that they consented and this is what they did to find clients.   Still a graduate student, I didn’t know how to react to the actions of a senior sociologist.   Unfortunately this also the beginning of my disenchantment with discipline of sociology, I eventually finished my program and started a post-doc in Los Angeles.  Shortly after that I legally and medically transitioned (thanks to the resources and support available in LA), but what I didn’t know at the time was that it also was the beginning of my transition from sociology to public health.

Project Summary: Finding Measures to Identify Gender Minority Populations

Research examining health disparities among gender minorities (transgender, transsexual, and other gender nonconforming individuals) has reached a stage where population based studies are needed in order to expand upon what smaller, community based studies have found.

However, the diversity of terminology and operationalization of various gender minority groups has made it difficult to identify a measure that can be used globally.

At the same time, it will be necessary to create a measure that can be understood by gender majority populations and correctly differentiate between gender majority and minority populations.

One concept that stands out is gender identity/gender transition.  Gender identity/gender transition is defined by people’s answers to two questions, one asking about one’s sex assigned at birth and another about their current sex or gender.  This “two-step” question is being advocated by the Center of Excellence for Transgender Health.

A preliminary study utilizing the National Transgender Discrimination Survey (NTDS) conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force examined the relationship between gender identity/gender transition and discrimination.  A dichotomous measure was based on two questions:

What sex were you assigned at birth
What is your primary gender identity Male      Female
Male/Man No          Yes
Female/Woman Yes         No
Part-time No          No
Other No          No

The measure identified those whose primary gender identity was consistently different from their sex assigned at birth (yes versus no).

Another concept is that of gender nonconformity.  Gender nonconformity was measured by a single question “People can tell I’m transgender/gender non-conforming even if I don’t tell them?”.  The variable ranged from zero (never) to four (always).

Plotting these two variables against people’s experiences with discrimination resulted in the following:

http://emilia-lombardi.com/wp-admin/images/discbygi.jpg

Those who were identified as having a gender different from their assigned sex were found to report more experiences of discrimination; even at higher levels of gender nonconformity.

The above data was found to show that a two-step gender identity question could be useful in identifying those likely to experience greater social disparities among transgender populations.  The next step was to examine whether gender majority individuals can understand and answer these questions in a way that represents their gender majority status.

Another study (funded by the Williams Institute, UCLA) examined gender identity/gender transition measures by conducting cognitive interviews with 50 people (25 gender minority, 25 gender majority).  The interviews asked people to read and answer the questions; afterwards they were interviewed about why they answered the way they did.

The study utilized these questions:

1. What is your sex or gender? (Check ALL that apply)
  • Male
  • Female
  • Other: Please specify: _____________________
 2. What sex were you assigned at birth? (Check one)
  • Male
  • Female
  • Unknown or Question Not Asked
  • Decline to State

The results show that individuals within the gender majority group consistently answered these questions in a manner that identified their gender majority status.  If they answered male (or female) in the first question, they also answered male (or female) for the second; whereas, individuals within the gender minority group had different answers for both questions, and a small number used the “other” option for the first question.

Overall, the two-step question was effective and easily understood by both groups.

  • Individuals within the gender majority group were able to answer the question about sex assigned at birth even though they never heard the phrase before.  They knew what it was referring too.
  • Most people in both groups see gender as an identity
  • People generally felt these two questions were easy to answer.
  • Gender minority group generally saw a difference between the terms sex and gender, but the gender majority group tended to see the terms to be the same.

The next step is to utilize these measures in a quantitative study with gender majority and minority populations to see how effective they are in the field.