Creating Valid Sexual Orientation and Gender Identity Items for Adolescents: Lessons from Cognitive Interviews and Survey Field Test

Understanding the relative risk lesbian, gay, bisexual, and transgender (LGBT) youth face is a critical gap in the prevention science field. Although sexual orientation measures have slowly been incorporated into existing surveillance surveys, such as the Youth Risk Behavior Surveillance Survey (YRBS), concerns remain as to the validity of these items given large patterns of missing responses. Such efforts have also been generally limited to older youth and have not yet included items assessing gender identity. The present project leveraged demands to add sexual orientation and gender identity measures to a school climate survey administered in 30 middle and high schools in an urban city. This project consisted of three phases. First, available measures for both adult and adolescent populations were reviewed during an expert panel meeting, from which a series of new items were developed to measure sexual identity, sexual attraction, biological sex, and gender identity. Second, a series of 20 cognitive interviews were conducted with a diverse sample of urban youth ages 13-17 (50% Black, 65% Female), probing on whether youth understood the items and whether they would feel comfortable answering the items in a survey setting. Finally, the revised items were field tested as part of a school climate survey on which ~7500 students in grades 7-12 participated. Response patterns for each of the piloted items were analyzed and compared as an indicator of how well the items worked to assess sexual orientation and gender identity. The resulting measures provide new opportunity to understand how experiences of LGBT youth differ from those of their straight peers. Concerns about privacy and mischievous respondents, or those who purposefully misreport their demographic information, will also be discussed.