Research

"Because I Got to Pick My Gender:" A Qualitative Analysis of Gender Identity Measures in a Gender Diverse Sample of 5-8-Year-Olds"

Authorship order: Catherine Schaefer, MS, Mary O’Brien McAdaragh, MSW, Transforming Families MN, Niko Blando, Arthi Jegraj, Toli Reigada, Dianne Berg, PhD, LP,* Nic Rider, PhD, LP*

*These authors are co-senior authors

Current pediatric gender identity measures in research and clinical use may be developmentally inappropriate, use language unfamiliar to children, or be non-inclusive of nonbinary identities. Increasingly, children are sharing that their genders are different from those assigned to them at birth, therefore it is important to have accurate, inclusive measures of gender identity that children are able to understand in order to self-report their own identity.

This community-engaged qualitative study seeks to characterize how children self-report their gender identities and perceive a common set of gender identity measures. The ultimate goal is to use this information to guide development of inclusive and appropriate measures for young children relevant for clinical, research, and demographic use.

This study shows the importance of including children themselves in the research process and honoring the wisdom that young children bring to the understanding of measures. Children provide a unique perspective on how to construct measures that will work best for them. In general, preliminary findings seem to indicate that open-ended or expanded child-friendly gender response options, even with young children, are unlikely to limit a child’s ability to self-identify.

The Compulsive Sexual Behavior (CSB) Lab at the Eli Coleman Institute for Sexual and Gender Health aims to inform assessment, diagnosis, and treatment. We are a team of faculty at ISGH and national collaborators who conduct research with large online surveys, diagnostic interviews, and clinical data. We hope to identify factors that may underlie CSB; clarify CSB diagnostic criteria; and test our integrated biopsychosocial and sex-positive model of CSB. We actively publish in peer-reviewed journals and present our research at national and international associations. Our recent and current projects include:

• Developing and testing a structured clinical interview for the ICD-11 Compulsive Sexual Behavior Disorder.
• Assessing other mental health concerns that co-occur with CSB.
• Identifying coping strategies and types of social support important to individuals in treatment for CSB concerns, including ineffective (for example, self-blame) and effective ways of coping.
• Exploring relationships between emotion dysregulation, attachment styles, and CSB.
• Probing how sexual functioning, sexual satisfaction, and relationship satisfaction are associated with CSB.
• Clarifying relationships between religiosity, moral disapproval of sexual behaviors, and CSB
• Discovering how CSB relates to authenticity, impression management, and social anxiety.
• Assessing how people describe their CSB concerns and unintended outcomes of CSB through qualitative research.
•  Validating CSB measures to help assess concerns for people seeking treatment.
   

This 5-year NIH-funded R01 takes place in Tanzania, Africa in collaboration with MUHAS University. It is a randomized controlled trial (RCT) to examine the efficacy of providing training to future physicians, nurses, and midwives in their ability to provide sexual and reproductive health education for people with disabilities in Tanzania. Dr. Kristen Mark is the mPI on this project with a robust team of Tanzanian colleagues.  

Tanzania has among the most significant adverse reproductive health statistics of any country and high rates of persons with disabilities who are invisible in reproductive healthcare, yet health professionals receive no training in how to address reproductive health concerns in persons with disabilities. To address multiple, intersecting, sex-related epidemics, and to train the professionals who do everything from staffing clinics to writing national policies, we need effective, evidence-based, culturally tailored, reproductive health curriculum. This study will conduct the formative research needed to develop the strongest reproductive health curriculum for healthcare providers treating Tanzanian people with disabilities, revise and pilot test it, and conduct a randomized controlled trial of the intervention against a waitlist control, on health worker ability to effectively address reproductive health concerns for people with disabilities.
 

In collaboration with a team of physicians, medical students, and graduate students, Dr. Kristen Mark is the PI of this study that has collected demographically representative data from 1446 adults on their experience of sexual health education, attitudes toward abortion, religiosity, sexual shame, sexual pleasure, and several other healthcare access, educational background, and psychosocial health variables. A real strength of this dataset is that we have data from people across the political spectrum, across the attitudes toward abortion and attitudes toward sex spectrum, and the data mirrors the demographics of the United States population.

Using in-depth interviews of 41 women who have experienced sexual trauma but are now in healthy pleasure-filled relationships, this study goes in depth to understand the ways in which women navigate the pursuit of sexual pleasure after experiencing sexual trauma. Dr. Kristen Mark and colleaugues have published several papers from this and continue to work on disseminating these findings.

Physicians are often the first stop for people who have questions about their sexual health and don't know where else to turn. Unfortunately, there is a dearth of sexual and gender health information taught to medical students across the country. University of Minnesota Medical School has been a leader in this regard for over 50 years, with a dedicated course for sexual and gender health required for all students in their first year of medical school. The medical school curriculum at University of Minnesota is undergoing a large restructure, resulting in this course being distributed throughout separate portions of the curriculum. This study aims to collect pre-post data from a cohort of medical students in legacy curriculum before and after their dedicated required first year sexual and gender health course and to collect pre-post data from a cohort of medical students in the new curriculum before and after their coursework. We assess knowledge, attitudes, and skills in sexual and gender health and this will help to identify strengths and gaps in our curriculum related to sexual and gender health and allow us to ensure we maintain the level of expertise we have come to expect from graduates of the University of Minnesota Medical School in sexual and gender health. 

This project, lead by Dr. Michael Miner, is part of a collaborative effort with scientists at the Université de Montréal, the Centre for Addiction and Mental Health (Toronto), Saint Mary's University (Canada), and the University of Saskatchewan. It is designed to develop an empirically based psychotherapy intervention to prevent reoffending in men who have perpetrated child sexual abuse and an assessment battery to measure the outcomes, impacts, and other important factors for understanding the efficacy of this intervention. This study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, is a feasibility study to determine whether the intervention, assessment battery, subject recruitment, group assignment, and study retention procedures can be implemented in a correctional setting, the Minnesota Department of Corrections. It will identify the issues and barriers to implementation of each element of a random clinical trial and provide preliminary data, which will inform future studies of the efficacy and effectiveness of our innovative sexual abuse tertiary prevention intervention.
 

The University of Minnesota community strives to meet the highest ethical standards in the planning and conduct of research.

The University holds each individual involved in research with human participants accountable for adherence to these standards. Essential to the research enterprise is preserving the trust of research participants. Each researcher has a duty to maintain that trust and to protect participant well-being. Individuals who make the gift of consenting to volunteer as research participants trust us to protect them from harm and to respect their freely given, informed consent to participate in research. Research participants retain the right to decline to continue participation in a research study for any reason, including as new data, side effects, or unexpected circumstances occur during the course of the study. We bear special responsibilities toward those persons whose capacity to consent to research is impaired or fluctuates during participation in a study.

All involved in conducting research must ensure that research is conducted ethically and in compliance with University policies and procedures. Any action that violates the trust of potential or enrolled research participants harms the entire research enterprise.

University leaders and all involved in research with human participants have the responsibility to:

• Ensure that all faculty, staff, and others who oversee and/or conduct University research on human beings have taken the appropriate ethics training;
• Protect and promote the rights and interests of all research participants, including those who are vulnerable, who may be susceptible to coerced consent, or who lack (or may come to lack) the capacity to consent to or decline continued participation in research;
• Comply with the letter and be committed to the spirit of the laws, regulations, and policies that pertain to the treatment of patients and of participants who are enrolled in research studies;
• Be transparent and accountable in all research activities. Anyone who observes a breach of the ethical rules, laws or regulations that govern the conduct of research involving human participants should report his or her observations. Individuals can report without fear of retaliation and with confidence that their concerns will be promptly considered and fully addressed;
• Ensure that identified individual and institutional conflicts of interest that potentially undermine the well-being of research participants will be effectively managed;
• Sustain a culture of respect and engagement at the U of M that recognizes the importance of integrity in University-based research. Sustaining that commitment requires respect for participants, their families, and community, as well as regard for cultural diversity, and attention to the societal implications of research;
• Effectively engage in a dialogue with the broader community which has a stake in benefitting from research involving human participants and an interest in protecting loved ones who may participate in these studies.