SOGI Questions Justification

Justification for including the following questions on sexual orientation and gender identity on the 2021 NYTS:

Sexual Orientation:

2021 Proposed Question (NYTS)	OMB Question
Which of the following best describes you? Heterosexual (straight) Gay or Lesbian Bisexual Not Sure	Which of the following best represents how you think of yourself? Do you think of yourself as: Gay / lesbian or gay Straight, that is, not [gay / lesbian or gay] Bisexual Something else I don’t know the answer

The proposed question to assess sexual orientation for the 2021 NYTS was previously approved and subsequently used on the 2020 NYTS survey. This question wording came directly from the Youth Risk Behavior Survey (YRBS), which has assessed sexual orientation using this question since 2015 and most recently fielded it in 2019.^1,2 This question was cognitively tested by CDC among a sample of youth prior to fielding the survey. CDC would prefer to maintain this question as is to allow greater comparability in this measure across NYTS survey years (2020-2021) and to allow comparability between these youth-focused surveys (NYTS and YRBS).

Gender Identity:

2021 Proposed Question (NYTS)	OMB Question
Some people describe themselves as transgender when their sex at birth does not match the way they think or feel about their gender. Are you transgender? No, I am not transgender Yes, I am transgender I am not sure if I am transgender I do not know what this question is asking	What sex were you assigned at birth, on your original birth certificate? Male Female Refused I don’t know Do you currently describe yourself as male, female, or transgender? Male Female Transgender None of these

The proposed 2021 NYTS question wording is taken directly from the Youth Risk Behavior Survey (YRBS), a survey of U.S. high school students administered by CDC. CDC worked with partners and researchers for several cycles to develop a credible question to identify transgender students. The question recommended by CDC was successfully piloted by 11 states and 10 large urban school districts during the 2016/2017 YRBS cycle. This yielded meaningful results suggesting that in some states, transgender youth have a disproportionate burden of tobacco use related behaviors.³ This question is included in the 2019 YRBS Optional Question list for any interested state or large urban school district to use when modifying the standard YRBS questionnaire. CDC proposes to maintain the originally proposed transgender question on the 2021 NYTS in lieu of the questions provided by OMB. It is possible that some youth may not know what transgender means. Thus, the 2021 proposed question includes a brief description of what it means to be transgender before asking youth if they are transgender. Moreover, a single question as opposed to multiple questions may pose less of a mental strain and burden upon youth respondents. Cognitive interviews conducted in March of 2018 by CDC indicated that the single question functioned well among youth. The NYTS also includes a question on sex (“What is your sex?” with response options male and female). As with all questions on the NYTS, participation is voluntary, and respondents may skip any question(s) they do not wish to answer.

References

1. Kann L, Olsen EO, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, Lowry R, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12 - United States and Selected Sites, 2015. MMWR Surveill Summ. 2016;65(9):1-202. doi: 10.15585/mmwr.ss6509a1. PubMed PMID: 27513843.

2. Creamer MR, Everett Jones S, Gentzke AS, Jamal A, King BA. Tobacco Product Use Among High School Students – Youth Risk Behavior Survey, United States, 2019. MMWR Suppl 2020;69(1). (publication info forthcoming).

3. Jallah N. Youth Transgender Status Pilot Test: Measuring Tobacco Use Prevalence by Transgender Identity on the Maryland 2016 YRBS/YTS. Abstract presented at the 2019 National Conference on Tobacco or Health (NCTOH), 2019. Minneapolis, MN.