Methodological developments

Background: The child functioning module (CFM) is the internationally recommended way to measure disabilities. It consists of 11 items on core functions needed to execute daily activities and participation and is offered as an optional package. In some reports, these 11 items have been combined to provide estimates of broader disabilities, which brings to question the need for asking 11 items instead of only a few. 

Objective(s): To investigate the reliability of the 11 items of the CFM with a CFM short form from a national representative sample. 

Method: Data were collected from the 2022 HBSC Kazakhstan survey where the long CFM items were towards the beginning of the questionnaire, and the short form at the end. Items were dichotomised into the recommended cut-points (i.e. none/some vs a lot/cannot do) and compared with comparable short version items (i.e. each item on concentration, remembering, learning were compared to a combined short version on concentration, remembering and learning difficulties). Kappa statistics were used to determine the intra-rater reliability of the items. 

Results: There were 9.5% of children (n = 704/7485) with at least one functional difficulty, where they had a lot or could not do the function (disability). All items had slight (Kappa = .164) to fair (Kappa = .217) stability levels. 

Conclusions: The short version was tested in a novel way. However, the stability of the items was interpreted to be slight to fair. Further work is needed to understand the stability of the CFM.

Background: There has been progress in population-based adolescent health surveys becoming more inclusive in asking about gender identity, but measures vary, and it is unclear which measures of birth-registered sex and gender identity would be most suitable for young people around the world. 

Objective(s): To understand how gender diverse young people answer birth-registered sex and gender identity questions, and to determine preferred measures among young people living in Canada, Ireland, Spain and the United Kingdom. 

Methods: An online survey was conducted in English, French, and Spanish from July to December 2021, among 13 to 18-year-old adolescents recruited from local LGBTQ+ community organisations [N=626]. A majority of youth reported being assigned female at birth (77.7%). The survey included questions that asked about birth-registered sex and gender identity in different ways, including the current HBSC question with binary boy or girl response options. Crosstabulations were computed between birth-registered sex and gender identity questions.

Results: More than 10% of youth did not answer the HBSC question, Are you a boy or girl? Of those who did answer that question, 17% reported a birth-registered sex different from gender. More gender identity options were preferred: In a question with seven response options, among participants who were registered female at birth, 10.1% chose “transgender, female to male,” 8.2% as “transgender, do not identify as only male or female, and 18.0% as “non-binary,” and 12% “not sure.” 

Conclusions: Binary gender identity options may not resonate with how youth choose themselves, and may misclassify gender diverse young people.

Background: Extensive literature exists about sexual orientation identities, but among adolescents, it is unclear which dimensions of sexual orientation are relevant to measure and which labels currently resonate best, especially as gender identities become less binary. 

Objective(s): To investigate youth understanding and preferences for various measures of sexual orientation in Canada, Ireland, Spain and the UK. 

Methods: An online survey was conducted in English, French, and Spanish from July to December 2021 among 13 to 18-year-old adolescents recruited from local LGBTQ+ community organisations [N=626]. A majority reported being assigned female at birth (77.7%). Five different sexual orientation questions were included. Crosstabs between different questions, asking about sexual orientation identity, were computed. 

Results: In this sample of LGBTQ+ youth, 73% had never had sex, 27% had never been in love, and 25% do not fantasize about sex. Fewer than 5% did not have sexual attractions, and less than 1% said they did not understand the questions. When offered a write-in option, 20% of young people did so, with many different nuanced terms, although the most common were asexual, pansexual, and omnisexual. Questions which offered response options that were not solely binary gender, and included open-ended options, were less likely to exclude or misclassify youth. 

Conclusions: Questions about sexual orientation should focus on attraction rather than sexual or romantic relationships, and when asking youth about sexual orientation identity, might consider offering open-ended options due to evolving labels. Young people are able to understand and appear to identify with more gender-inclusive response options.