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Calzo JP, Blashill AJ. Child Sexual Orientation and Gender Identity in the Adolescent Brain Cognitive Development Cohort Study. JAMA Pediatr. 2018;172(11):1090–1092. doi:10.1001/jamapediatrics.2018.2496
Sexual and gender minorities (ie, individuals who do not identify as heterosexual and those whose gender identities differ from their birth sex) experience significantly elevated physical and mental health morbidities compared with heterosexual and cisgender individuals.1 By collecting sexual orientation and gender identity (SOGI) data in a US representative cohort of 9- to 10-year-old children, the recently released Adolescent Brain Cognitive Development (ABCD) Study2 provides an opportunity to understand the development of health disparities and resilience by SOGI at earlier ages than previous research. Both children and parental figures reported SOGI data, bolstering measurement rigor. Baseline analysis of ABCD Study SOGI data can contextualize the opportunities afforded by the data set for epidemiologic surveillance.
The ABCD Study currently provides 2 SOGI-related measures, self-identification and identity-related stress. Baseline data collection began September 1, 2016; the present study used ABCD annual release data from February 12, 2018. Children self-reported whether they self-identify as gay or bisexual and whether they identify as transgender (Table 1 displays question and response options) via researcher-administered computer-assisted interviews. A response of yes or maybe for each question, indicating probable sexual or gender minority identity, triggered follow-up questions about identity-related stress (Table 2 displays question and response options). A parental figure reported on the child’s identity and stress with similar questions. Parents also reported on their child’s potential gender minority identity via a 2-step process based on the child’s sex assigned at birth and current gender identity. The ABCD Study used complex sampling to recruit youth representative of 9- to 10-year old children in the United States (eg, regarding race/ethnicity, income, and family relationships).2 Thus, results display raw observations and population-weighted estimates.
The institutional review board at the University of California, San Diego, approved the overall ABCD Study protocol. Approval of secondary analysis of SOGI data was obtained from the institutional review board of San Diego State University. Parents and children participated after providing informed consent/assent, and were reimbursed for their participation.
Coding yes and maybe responses as probable minority SOGI identities, approximately 0.86% (raw, n = 43; weighted, n = 70 952) of children self-identified as gay or bisexual. Nearly a quarter of children (raw, n = 23.8%; weighted, n = 23.7%) indicated that they did not understand the sexual orientation question. By contrast, 6.7% of parents (raw, n = 332; weighted, n = 554 674) indicated their child might be gay. For gender identity, 0.4% (raw, n = 23; weighted, n = 33 575) of children self-identified as transgender; 40.2% did not understand the question (raw, n = 1729; weighted, n = 3 298 558). A total of 1.2% (raw, n = 51; weighted, n = 98 732) of parents indicated that their child might identify as transgender. The 2-step gender identification method identified 0.15% of youth (raw, n = 8; weighted, n = 12 501) whose current gender identity differs from their birth sex.
Most children reported that their minority sexual orientation and/or gender identity was not a source of problems with family or school. Parents reported slightly more variance, with 7.0% reporting some problems related to sexual orientation (raw, n = 21; weighted, n = 39 083), and 15.3% reporting some problems with gender identity (raw, n = 7; weighted, n = 15 089). Neither children nor parents reported a lot of problems related to SOGI.
The ABCD Study data indicate that less than 1% of US youth report minority sexual orientation or gender identities at age 9 to 10 years; youth and parent reports of SOGI information were generally discordant. A substantial number of youth indicated not understanding the SOGI questions, which may be attributed to measurement design1,3 or youth’s age and developmental stage.3-5 The study does not yet include other dimensions of SOGI (eg, same-gender attraction; gender expression) or other sexual orientation identities that youth may report (eg, pansexual)6; future inclusion or availability of such assessments may enhance identification of sexual and gender minority youth. Identifying as a sexual minority typically occurs in midadolescence4,5; thus, more youth in the ABCD Study cohort will likely identify as sexual minorities as the cohort ages. Contrary to prior research on minority stress,5 parents and youth indicated that minority sexual orientation and gender identity were not sources of substantial familial and school stress. However, this study did not examine SOGI indicators in association with health indicators. Future researchers should analyze the rich data available in the ABCD Study to understand how minority SOGI development is associated with health and resilience across adolescence.
Accepted for Publication: June 7, 2018.
Corresponding Author: Jerel P. Calzo, PhD, MPH, Division of Health Promotion & Behavioral Science, School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 (email@example.com).
Published Online: September 10, 2018. doi:10.1001/jamapediatrics.2018.2496
Author Contributions: Dr Calzo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Calzo.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Both authors.
Administrative, technical, or material support: Both authors.
Conflict of Interest Disclosures: None reported.
Funding/Support: Dr Calzo was supported by grant K01DA034753 from the National Institute on Drug Abuse.
Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: This article reflects the views of the authors and may not reflect the opinions or views of the National Institutes of Health or the Adolescent Brain Cognitive Development (ABCD) Study consortium investigators.
Additional Information: Data used in the preparation of this article were obtained from the ABCD Study (https://abcdstudy.org), held in the National Institute of Mental Health Data Archive. This is a multisite, longitudinal study designed to recruit more than 10 000 children aged 9 to 10 years and follow them over 10 years into early adulthood. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A full list of supporters is available at https://abcdstudy.org/federal-partners.html. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html. The ABCD Study consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in analysis, writing, or submission of this report. The ABCD Study data repository grows and changes over time. The ABCD Study data used in this report came from doi:10.15154/1412097; dois can be found at https://ndar.nih.gov/study.html?id=500.