Abstract

Most research about gender-diverse adolescents is with clinical samples, skewing population estimates of health and risk. With trans youth estimated at around 0.5% of the population and no reliable measures, school health surveys have not asked gender diversity items. In 2018, the British Columbia Adolescent Health Survey (BCAHS) in Canada trialled measures to differentiate cisgender, trans, and non-binary youth, to capture a representative picture of health for gender-diverse young people.

The 2018 BCAHS is a stratified random survey of 2,175 classrooms of grades 7-12 (ages 12-19) in 58/60 school districts province-wide (N = 38,015). Two measures asked about sex assigned at birth and current gender identity, combined to identify cisgender boys and girls, trans boys, trans girls, non-binary and questioning youth. We examined patterns of missingness by demographics.

Overall, nearly 99% of youth responded to both items, with very low missing (0.5% for sex, 0.8% gender identity) with no differences by school or district, or by age. Missing responses were higher among international students and English language learners but still low (1.1%). Youth living in foster care or with a disability or chronic condition also had higher odds of skipping both items, but the highest missing was only 3.7% among youth with FASD. Overall, 48.9% identified as cis girls, 48.6% as cis boys, 0.13% as trans girls, 0.33% trans boys, 0.75% non-binary, and 1.28% as not sure (479 trans/non-binary, and 484 unsure). Preliminary analyses show positive assets also support gender diverse youth well-being.

A two-step measure of gender identity is feasible for adolescents as young as 12 years old in large scale school surveys, with very low missing responses in western Canada. Although <1% identified as trans, in large samples stable estimates for population comparisons are possible. Future studies should pilot gender identity measures in other nations/languages.