Tweak in survey language identifies more gender-diverse youth in Appalachia

A survey of students in the Appalachian region of the United States found more gender diversity than previously identified, according to a research letter published in JAMA Pediatrics.

A prior study by UCLA’s Williams Institute found that roughly 1% of youth in the Appalachian state of West Virginia identified as transgender, but the researchers did not collect data from the youth themselves, the authors of the new study noted.

Kacie M. Kidd, MD, MS, medical director of the gender and sexual development clinic at West Virginia University Medicine Children’s Hospital, told Healio that the new study was inspired by the results of a similar study in Pittsburgh.

“We were surprised at the number of gender-diverse youth in that sample, as it was higher than previous studies,” Kidd said. “There is very little known about gender-diverse young people in rural areas, and we wanted to see if using more inclusive questions led to similar results.”

As part of the study, 7th through 12th grade students in 16 schools across the Appalachian region completed an anonymous online survey, which included a two‐step gender identity question that asked about gender identity and sex assigned at birth separately.

Prior studies asked young people if they identify as “transgender,” but Kidd said many young people do not identify with that word and might answer “no,” even if their gender identity does not align with their sex assigned at birth. Thus, the researchers used the term “gender diverse” for any student whose gender identity and sex assigned at birth did not fully align.

A total of 2,921 students completed the survey, and 2,822 of the participants answered questions that addressed both gender identity and sex assigned at birth. According to those answers, 202 participants (7.2%) identified as gender diverse, including 46 (22.8%) who expressed an exclusively binary identity and 128 (63.3%) who expressed an exclusively nonbinary identity. The remaining 28 (13.9%) expressed both binary and nonbinary identities.

According to Kidd and colleagues, the results are important because there are “few resources available for [gender-diverse youth] and their families in rural Appalachia, especially for racial and ethnic minority Appalachians, who are often further marginalized through invisibility and assumed racial homogeneity.”

Kidd said she was hopeful that organizations conducting national surveys of youth populations may consider adding “the more inclusive two‐step gender identity question in order to better understand the prevalence of gender-diverse young people in other areas.”

“All young people benefit from feeling seen and supported by their families, schools, and communities,” Kidd said. “Gender affirmation is part of feeling seen and supported for gender-diverse youth. Many of the young people in this study will not need additional support from medical or mental health providers, but some will. It is important that resources such as trained medical and mental health providers are available for them.”