Soon there will be the first nationwide population based study on the health of transgender populations in the US. The study is a collaboration between the Williams Institute at UCLA, Fenway Institute, and Columbia University, and will examine the healthcare needs of trans people. The study will also provide a better estimate of the size of transgender populations within the US.
I interviewed two of the study’s investigators a year ago. We talked about the the study’s purpose and goals.
Jody Herman, PhD., Scholar of Public Policy, Williams Institute at UCLA School of Law, University of California, Los Angeles
Sari L. Reisner, Sc.D., Affiliated Research Scientist at The Fenway Institute, Fenway Health, Harvard University and The Fenway Institute, Fenway Health
For more information about Trans-Pop can go to their website.
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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
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.
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.
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.
Emilia Lombardi, PhD
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.
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
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.
That makes two NIH grants submitted this summer.
R21 The impact of discrimination and social support upon the health of transgender men and women.
R13 Current Issues in Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Research. My colleagues and I are hoping to do a LGBT health conference just prior to the Gay Games being held in Cleveland next year. Both events would work wonderfully together.
I should hear about both early in 2014.