Gender identity can be a fluid definition, especially for those who do not conform to conventional notions of male or female. In a Jan. 26 Center seminar, Matt Jans, California Health Interview Survey (CHIS) methodologist, discussed CHIS's cutting-edge research on sensitively asking gender identity questions so as to accurately represent transgender respondents.

In this brief interview, Jans talks about why so little data exist on this stigmatized and vulnerable group, how CHIS partnered with UCLA's Williams Institute to test an innovative way of asking about gender identity, as well as what the pilot study has found so far.

Q: What kind of data exists on transgender people in the United States and why is more needed?

Only a handful of large, population-based surveys have asked questions to estimate the size of the transgender population, and none have been conducted in California. While there is research (though not nearly enough) on this population in general, those studies often involve purposively-gathered samples that can be useful for studying small populations or groups of people with a rare characteristic (like being transgender), but likely don't represent the population as a whole.

For the broader population of transgender people, there is a need for more accurate and complete statistics to help evaluate their unique challenges in access to health care, and other related health and public policy uses. For example, better health data can support advocacy for gender-based rights policies, such as access to public facilities that have been historically sex-specific.

In 2014, the UCLA Williams Institute provided funding for testing gender identity questions in CHIS. We think this methodology provides an exciting new opportunity to understand, really for the first time, the health challenges facing transgender Americans within the broader population.

View the recent seminar on the CHIS transgender methodology.

At the same time, there seems to be momentum building in the state and federal statistical systems for more widespread measurement. The statistical arm of the US Office of Management and Budget (OMB), which sets statistical policy for the federal statistical system (and thus practice standards for many other surveys), has convened a working group on the measurement of sexual orientation and gender identity (SOGI) in federal surveys. CHIS has presented its pilot testing results and implementation plans to that group to aid in this important national effort.

Q: Asking a survey participant what gender they identify with seems like it could be tricky -- how do you make the question clear?

​This is why we ended up testing four different ways to ask about gender identity and transgender status. What we found is that people were most able to understand and respond accurately to a “two-step” question, in which the interviewer first 1) asked the respondent which sex they were assigned at birth, and then asked 2) what gender they currently identify with.

While at first it may seem more complicated to ask two questions instead of one, we actually found that respondents had an easier time answering the two-step version than the one-step version, and that it took less time to answer. This is probably because it asks two very simple questions and uses terms respondents already know. Whereas in one-step versions, we asked respondents to understand the definition of "transgender" in order to answer. For someone who is transitioning, or who perhaps already considers themselves a different gender, this can be tricky.

The two-step version was also 10 words shorter than the shortest one-step version, so it took less time for the interviewers to read. And the proof is in the pudding: we had a relatively low percentage of people who did not or would not answer the question and there were no “hang-ups,” in which a respondent is offended and hangs up on the interviewer.

Q: What did the pilot test indicate about the number of transgender people in California?

​In our pilot test, 9 of the 2,828 respondents interviewed (0.32%) identified as transgender or "gender non-conforming." As of September 2015, current CHIS data collection has identified 25 transgender respondents (or people with an alternative gender identity). This is 0.26% of the 9,528 respondents interviewed. Our official, weighted estimates will be released after the 2015-2016 cycle is complete. Because the population is expected to be so small, several years or cycles may need to be combined for meaningful, detailed analyses.