Unpacking the +: An Inclusive Framework for a Complex, Select-All-That-Apply Gender Identity Survey Item on a Large Public Health Survey

Effective efforts to promote equity require survey measurement that accurately captures youth’s experiences of gender. The present study aimed to identify multiple categorization options and examine differences in rates of gender-based bullying and past-year suicidal ideation by those options. Data come from the 2022 Minnesota Student Survey, specifically 8th, 9th, and 11th grade students (N = 98,682). Students (age range: 12–19 years, M = 14.8, SD = 1.3) had nine response options for gender, with 96.1% selecting one, 3.0% selecting two, 0.6% selecting three, and 0.9% selecting four or more. Responses were coded four ways (15-, 9-, or two 4-category options). Important between-group differences were lost when combining responses into larger groups. For example, the prevalence of gender-based bullying was 39.3% for genderfluid+ youth and 52.2% for nonbinary youth (p <.05) in the 15-category option. Using the 9-category variable that combines nonbinary, nonbinary+, genderfluid, and genderfluid+ into one group, the prevalence of gender-based bullying was 49.8%, which masks significant differences seen with the 15-category variable. The findings fromthis study support further research with expanded, select-all-that-apply gender identity response options in large adolescent epidemiologic surveys and inform survey creation and analytic approaches.