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Pages 113-136

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From page 113...
... For example, the GSS changed the placement of the two-step measure between its 2018 and 2020 waves and, as noted above, item nonresponse declined in 2020, when the questions were asked with other demographic items midway through the survey.10 In the Household Pulse Survey, sex assigned at birth and gender identity are included as the sixth and seventh questions overall (between questions about education and marital status and questions about sexual orientation and household size) .11 These developments in overall survey placement, along with consistently low item nonresponse, underscore both the feasibility and acceptability of implementing a two-step gender measure in the United States.
From page 114...
... However, the panel recognizes that the same could be said for many demographic items already in regular use, and we do not believe it is appropriate to hold questions about sex assigned at birth or gender identity to higher testing and performance standards than have been used for other items before their widespread adoption. We conclude that there is sufficient evidence in the United States to support using a two-step approach to measuring gender for general population enumeration and research among English-speaking adults, as well as in health contexts, including medical settings, clinical trials, and public health surveillance.
From page 115...
... Overall, measurement recommendations across these countries are quite similar. They all are either testing or actively using a two-step gender measure that references sex assigned at birth and gender identity, and they all affirm the importance of providing inclusive counts of both cisgender and transgender people in national statistics.
From page 116...
... ." In settings where it is important to identify transgender people but where privacy protections are deemed inadequate for collecting data on sex assigned at birth, New Zealand endorses asking "Do you consider yourself to be transgender? " in addition to a gender identity question that offers the answer options of female, male, and a free-text field for another gender.
From page 117...
... RECOMMENDATION 4: The panel recommends that the National Institutes of Health use the following pair of questions assessing sex assigned at birth and gender identity: Q1: What sex were you assigned at birth, on your original birth certificate? ● Female ● Male (Don't know)
From page 118...
... and people with other nonbinary gender identities who report any sex at birth and select either Two-Spirit or "I use a different term"15 to write in a different gender identity. In analyzing the responses to the two-step measure, we advise that data from the two-step measure not be collapsed to report counts of females, males, and transgender people (leaving the cisgender categories unmarked)
From page 119...
... Thus, the panel's recommendation follows the question ordering with sex assigned at birth first and gender identity second because it has been used successfully in both general population surveys and health contexts; however, further research on this point is warranted. Several general population surveys, including the NCVS and the Household Pulse Survey, follow the two-step measure with a confirmation question to reduce false positive responses.
From page 120...
... • Recommended by the Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys (2016) What is ● Female Conceptual Fit • Clearly distinguishes between sex assigned at birth and current gender, which allows for your current ● Male enumerating the broadest definition of the transgender population gender?
From page 121...
... nonresponse • Demonstrated test-retest reliability (Saperstein 2022) Adjustments • Female-first response list corresponds with both alphabetical and population size to previously ordering tested item • Removes "none of these" response and replaced with "I use a different term" followed included in by a free-text field recommended • Includes Two-Spirit category in automated data collection where racial identity is measure collected and AIAN is indicated Weaknesses and • Format for current gender question is forced choice but response options are not Challenges necessarily mutually exclusive • Write-in gender identity field will have to be cleaned and coded for reporting; newer terms not listed (e.g., nonbinary)
From page 122...
... 122 MEASURING SEX, GENDER IDENTITY, AND SEXUAL ORIENTATION Our recommended question includes a reference to "your original birth certificate" in the question stem. This wording is not universal across general population surveys that have asked questions on sex assigned at birth and is not used in the All of Us Program, in particular.
From page 123...
... , and helps to convey that the response can change over time.  Other surveys specify gender identity in the question stem (the National Intimate Partner and Sexual Violence Survey) or offer additional text noting that "gender is how you feel inside" (High School Longitudinal Study of 2009)
From page 124...
... The panel also weighed concerns that using subjective language, such as "consider yourself to be," might inadvertently minimize gender identity by implying it is less factual than sex assigned at birth. This concern, combined with the goal of limiting both questionnaire space and cognitive burden, made the simple and straightforward wording of "What is your current gender?
From page 125...
... Finally, as with sexual orientation, the panel's recommendation includes the Two-Spirit category in general population surveys, provided they collect racial identification data prior to gender identity and can be automated to ensure that this response option is available only to AIAN respondents. When this is not possible, respondents who want to identify explicitly as Two-Spirit can write in that response. We note that the Indian Health Service recommends using a two-step measure with the inclusion of a Two-Spirit response option, as well as a write-in gender response option in its strategic plan for gender-affirming care (NPAIHB 2020)
From page 126...
... . In addition to the issues already noted above, these include the following concerns: • whether the sex assigned at birth component should be replaced with a question about transgender identity in nonresearch and nonhealth administrative settings; • whether the current gender question should be measured as "mark all that apply"; • the need to reevaluate and expand answer options over time, par ticularly with regard to nonbinary responses; and • the need for further assessment of item performance across all sur vey modes, including proxy reporting, in languages other than Eng lish, for all major U.S.
From page 127...
... In these circumstances, it may be inappropriate to ask transgender people to disclose their sex assigned at birth, but still important to distinguish between transgender and cisgender people in order to ensure access to appropriate services and to monitor disparate treatment. As noted above, the New Zealand statistical standards recommend a modified two-step measure that first asks about gender identity broadly (with the answer options "male"; "female"; and "another gender, please state")
From page 128...
... As noted above, the transgender populations identified using different measurement approaches cannot be assumed to be identical or directly comparable: people who might be classified as transgender using the panel's recommended two-step method may not endorse a transgender identity on an alternative measure. Considerations of when to use different approaches require assessment of the relative importance of generating more complete counts of the transgender population and respect for individual privacy around either sex assigned at birth or transgender experience.
From page 129...
... . In addition, "nonbinary" and other similar terms include a range of identities that can reflect resistance to binary gender identities rather than endorsing a transgender identity per se, and thus these terms may be used by people who are or are not transgender (see, e.g., Wilson and Meyer, 2021; Thorne et al., 2019; Streed, McCarthy, and Haas, 2018)
From page 130...
... More research is needed using pilot tests, methods panels, and other small-scale quantitative experiments to understand the measurement error properties and best practices for collecting both sexual orientation and gender identity by proxy.
From page 131...
... and the lowest rates among Bengali and Haitian Creole speakers (0% on either item) ; Spanish speakers fell somewhere in between (1.7% for gender identity and 0.8% for sex assigned at birth)
From page 132...
... When explicitly justified, this was noted as being determined by the age of majority or when someone was legally considered an adult for the purposes of consent and was similar to age minimums for asking about sexual orientation. In the United States, some studies have asked gender identity questions of younger children.
From page 133...
... • Periodic reevaluation of write-in gender identity responses and how they change over time and may vary in different settings (e.g., among LGBTQI+ samples in comparison with general population samples and in clinical settings in comparison with surveys) , as well as periodic reevaluation of listed response options.
From page 134...
... ● None of these gender identity? ■ Transgender (Check all that ■ Another term apply)
From page 135...
... Cenwere you rently describe sus Pulse Survey ● Female ● Female assigned at yourself as...? birth, on ● Transgender your original ● None of these birth certificate?
From page 136...
... gender identity? [If needed: We ● Male-to-female What sex have to know your transgender were you sex in order to (MTF)


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