GENDER IDENTITY AND SEXUAL ORIENTATION IN RURAL CONTEXTS: IMPLICATIONS FOR PARENTING, YOUTH DEVELOPMENT, AND SERVICE PROVIDERS

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1016924
• Project Start Date: Oct 1, 2018
• Project End Date: Sep 30, 2021
• Program Code: [(N/A)]- (N/A)

Recipient Organization
UNIV OF MINNESOTA
(N/A)
ST PAUL,MN 55108

Performing Department
Family Social Science

Non Technical Summary
There has been rapid cultural shift across the United States and in Minnesota in factors relevant for sexual and gender minority persons, those whose sexual orientation and/ or gender identity or expression fall outside heterosexual or cisgender societal norms. This cultural shift has taken hold first in urban areas, and is enacted with less consistency throughout rural America.This project will address the weakness in the current research by improving the knowledge base about LGBT youth well-being and LGBT parenting practices in rural America, as well as create infrastructure to improve supports for this population.

Animal Health Component

50%

Research Effort Categories

Basic

0%

Applied

50%

Developmental

50%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
802	6099	3070	100%

Knowledge Area
802 - Human Development and Family Well-Being;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3070 - Psychology;

Keywords

lgbt

sgm

well-being

parenting

Goals / Objectives
Identify factors associated with LGBT youth well-being specifically within rural contexts. 1a. Analyze and write manuscripts from the rural data using quantitative secondary databases on school based LGBT youth in rural schools (Minnesota School Survey, GLSEN).1b. Utilize other qualitative and quantitative national secondary data sources (USTS, Translifeline, etc.) to examine well-being and sources of support and resilience for LGBT (specifically trans) persons with a contextual analyses of rural environments and the unique contributions to risk and resilience.Research how parenting practices in rural environments influence well-being specifically for children in LGBT headed households and provide outreach for LGBT parent education. 2a. Finalize research and program development on same sex divorce and develop modules for inclusion in Parents Forever curriculum.2b. Implement and evaluate educational materials geared at same sex parents.2c. Continue outreach with parenting groups and extension parent education programs via Parents Forever, North Central Regional Parent education Collaboration, and existing Extension parenting contacts.Create infrastructure to provide service supports for providers of sexual orientation and gender based care to improve access to care in rural environments. 3a. Continue ongoing research on gender identity development and assessment of gender related care needs in University of Minnesota clinic and continue establishment of research protocols in three other clinics with processes in development (Nationwide Children's (Ohio), Children's National (DC), Pacific University(Oregon)).3b. Continue outreach to rural communities via factsheets, direct consultations, workshops, podcasts and electronic platforms to improve access to gender care in rural environments. .

Project Methods
Methods of Procedure (approach)Identify factors associated with LGBT youth well-being specifically within rural contexts. 1a. Analyze and write manuscripts from the rural data using secondary data bases on school based LGBT youth in rural schools both from Minnesota and US datasets. .1b. Utilize other secondary mostly national data sources (USTS, Translifeline, etc.) to examine well-being and sources of support and resilience for LGBT (specifically trans) persons with a contextual analyses of rural environments and the unique contributions to risk and resilience.Several secondary data sets exist and are available with indicators of rurality and LGBT status. Our ongoing survey research work with collaborators has made use of several of these data sets for other papers and this project will extend that work to focus specifically on rural issues for SGM youth. During each of the three years, we will make a concerted effort to submit at least one manuscript from national or Minnesota Sate secondary data (by myself or someone on my team) that attends to well-being of LGBT youth. This year a team member is analyzing data from the Generations project focused on school experiences over time. Some of those experiences are specific to rural environments, and can be explored more fully within the manuscript. Data from GSLEN school climate survey will be available to us in the coming months and has a zipcode indicator of rurality, and includes 22,000 LGBT students from around the country. Likewise the MSS survey has indicators of the rurality of each district and items of sexual orientation and gender identity. Additional data sets we have access to have indicators of rurality, but are less focused on youth or school experiences such as the Translifeline hotline data, the USTS survey data or the ongoing analyses of Trans Youth Study interview data. Our goal will be a total of three non-school specific manuscripts over the three years. Work on the multi-state collaboration has been funded separately through AES as part of NCERA 229, and the AES funding of graduate research assistant. I also apply for other sources fo funding to support this work.Research how parenting practices in rural environments influence well-being specifically for children in LGBT headed households and provide outreach for LGBT parent education. 2a. Finalize research and program development on same sex divorce and develop modules for inclusion in Parents Forever curriculum.2b. Implement and evaluate educational materials geared at same sex parents.2c. Continue outreach with parenting groups and extension parent education programs.Interview data from 13 parents and 3 stakeholders have been collected, transcribed and analyzed. We are writing papers and presenting at conferences. During year one we will develop a supplemental module, focused on identity salience and social support, during years two and three we will evaluate and refine that process. We also engage in outreach with parenting groups through training in transgender well-being, Military families learning network, Transfamilies network, Parents Forever, etc. This work is largely funded through Extension and supported by my time (Via AES) and somewhat with support from a graduate research assistant. Outreach exists through statewide efforts as well as in the online programming and in the regional multi-state coparent education group.Create infrastructure to provide service supports for providers of sexual orientation and gender based care to improve access to care in rural environments. 3a. Continue ongoing research on gender identity development and assessment of gender related care needs in clinics.3b. Continue outreach to rural communities via factsheets, direct consultations, workshops, podcasts and electronic platforms to improve access to gender care in rural environments. .This objective includes continued workshop, consultation and visitation to rural environments, as well as enhanced electronic capability to provide usable tools. These tools will come of the form of translated products designed for parents and kids, as well as products useful for clinicians such as the new measurement protocols we are developing. We have engaged in significant assessment of these tools in Minnesota at the UMN clinic as well as nationally in online surveys with SGM persons. Some of these efforts are funded in collaboration with Extension or with the UMN National Center for Gender Spectrum Health, others will be funded through AES time and work with a research assistant.We present a multidimensional assessment created through a partnership with gender diverse individuals and adapted from the most sensitive available instruments in order to capture the full range of gender experiences and needs in TGNC youth and young adults. This is important because it provides an assessment framework for treatment that is focused on individual needs rather than a direct pathway towards a unitary treatment option: binary transition. This GAP is designed to 1) assess the full spectrum of gender identities, including non-binary and fluid as well as binary transgender identities, 2) use gender neutral language so that the same measure can be given to all people longitudinally regardless of whether the gender identity of a person (MTF, FTM or a non-binary identity) shifts over time with part of social or medical transition, and 3) span critical developmental periods (into the young adult years), instead of restricting assessment to the adolescent or adult years separately. The four modules of the GAP build on existing measures or established developmental assessment approaches using novel item sets. The four modules address: gender development (new item set: gender signs before puberty reported retrospectively, as compared to current gender signs and based on both youth and parent report); body image (existing item set adapted and updated: comfort/discomfort ratings over an inventory of parts of the body; original measure: Lindgren and Pauley, 1975); gender dysphoria (existing item set adapted and updated: physical, social, and cognitive experiences of gender dysphoria; original measure: Cohen-Kettenis & van Goozen, 1997); and genderqueer identity (new item set: capturing multi-dimensional components of identity-driven gender including fluidity, challenging the binary, social constructionism and theoretical awareness).TimelineYearTasks1Secondary data analyses (Objective 1), Disseminate parenting materials (Objective 2) Resubmit assessment grant (Objective 3)2Manuscript publication (Objective 1) Program evaluation (Objectives 2-3)3Grant submissions (Objectives 1, 2, 3) data analysis, dissemination, and development of future directions (Objectives 2-3)

Progress 10/01/18 to 09/30/21

Outputs
Target Audience:There has been rapid cultural shift across the United States and in Minnesota in factors relevant for sexual and gender minority persons, those whose sexual orientation and/ or gender identity or expression fall outside heterosexual or cisgender societal norms. This cultural shift has taken hold first in urban areas, and is enacted with less consistency throughout rural America. Rural communities in the U.S. have less infrastructure to support SGM needs than do urban communities and struggle with employment. Thus rurality can be stressful for all, requiring strong familial interdependence and contributing to risk of out-migration and poverty. Minority stress is exacerbated for SGM rural residents due to stigma of SGM status (Meyer, 2003). Health disparities have been found among SGM populations compared to their heterosexual peers, and rural populations compared to urban ones. My involvement has altered the form of assessment for many transgender people in clinics in the United States and around the globe. Because the assessments are freely available, and have been translated to a number of languages (Spanish French, Dutch, Russian, Greek) they can be used in rural contexts in a way that was not previously possible or accessible. Changes/Problems:Covid reduced our ability to engage in community based outreach and research in person. However our virtual presence, through webinars and measures distribution was enhanced. What opportunities for training and professional development has the project provided?I regularly (1-2 per quarter) provide webinars the UMN Extension Center for Family Development. The focus of these webinars is on transgender youth and families, family support for LGBTQ youth, and rural families dealing with ambiguous loss (not necessarily LGBTQ related). I also participate in an AES multistate project that provides training for extension educators in a different state each year. We have completed trainings in Minnesota, Hawaii, and Illinois. How have the results been disseminated to communities of interest?The publicly available measures we have developed have been used in countries around the world, and are translated for research and clinical use in multiple countries. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Care for gender diverse persons is one form of care that currently requires travel to urban centers, especially for children and adolescents with needs for puberty suppression or consideration for gender affirming hormone treatments. There is a critical need for the development and testing of assessment approaches that measure the full spectrum of gender diversity and can be used by a broader spectrum of the healthcare community. This project sought in part to support the development of conceptual and measurement work that allows for rural areas to have greater access to specialized gender care support. In my collaboration with gender clinics it was clear new clinical assessment measures were needed. The clinical measures in place at that time violated some of the assumptions of longitudinal analyses, especially in the case of gender transition. The measures also included assumptions of binary identity, which was not a fit for at least one third of transgender identified youth in my community study. The first two measures development projects include new instruments I wrote in consultation with the CEGD: The Genderqueer Identity Scale (GQI; McGuire, Berg, Catalpa, & Steensma, 2019), and The Family Gender Environment Scale (FGE; McGuire, Fish, Okrey Anderson, Berg, Spencer, anticipated 2020 submission). In my collaborations with the National Center for Gender Spectrum Health (NCGSH) at UMN and with support from the CEGD, I have also led the revision of two longstanding gender instruments which previously required separate versions based on assigned birth sex to now address the full gender spectrum (i.e., non-binary): Utrecht Gender Dysphoria Scale (UGDS-GS; McGuire, Rider, Catalpa, Steensma, Cohen-Kettenis, & Berg, 2019) and the Body Image Scale (BIS-GS; McGuire et al., in prep). The GQI and the UGDS-GS are published in the Handbook of Sexuality Related Measures (2019), and are both now published in peer reviewed articles as well. All four scales I have led development efforts for are available online for free at: (https://www.sexualhealth.umn.edu/ncgsh/measures). The decision to make these free and unscored creates an important link to accessibility; many clinical assessment measures cost money to administer or score. Since going live in December of 2017, over 103 entities have signed collaborative agreements to download and use the measures and 45 have indicated desire for data sharing. The collaborators include nine community clinics and hospitals, 25 clinicians in private practice, and 10 university based gender clinical research programs. Thus far, we have clinical data in the NCGSH from 180 intake patients. Three gender clinics, an Autism coordination care group and a Differences of Sex Development (DSD) resource group have also begun to coordinate in grant proposals to use these measures as part of a multi-site validation effort to improve screening for gender dysphoria among youth with Autism and DSD.

Publications

• Type: Journal Articles Status: Published Year Published: 2021 Citation: McGuire, J. K., Okrey-Anderson, S. 1, & Michaels, C. M. 2 (2021). I dont think you belong in here: The impact of gender segregated bathrooms on the safety, health, and equality of transgender people. Journal of Gay and Lesbian Social Services. https://doi.org/10.1080/10538720.2021.1920539
• Type: Journal Articles Status: Awaiting Publication Year Published: 2022 Citation: Callahan, C., & McGuire, J.K. (2022) Interaction of sexual orientation and gender identity development. Culture, Health, and Sexuality.
• Type: Journal Articles Status: Under Review Year Published: 2022 Citation: Allen, S. H., Fish, J. N., McGuire, J. K., & Leslie, L. A. (under review). Beyond the (family) binary: Family environment heterogeneity and associations with health outcomes among transgender adults. Journal of Marriage & Family.
• Type: Journal Articles Status: Published Year Published: 2021 Citation: Okrey Anderson, Sloan & McGuire, Jenifer K. (2021). "I feel like god doesn't like me": Faith and ambiguous loss among transgender youth. Family Relations: An Interdisciplinary Journal of Applied Family Studies, No Pagination Specified. https://doi.org/10.1111/fare.12536
• Type: Journal Articles Status: Published Year Published: 2020 Citation: McGuire, J. K., & Reilly, A. (2020). Aesthetic Identity Development Among Trans Adolescents and Young Adults. CLOTHING AND TEXTILES RESEARCH JOURNAL. doi: 10.1177/0887302X20975382
• Type: Journal Articles Status: Published Year Published: 2020 Citation: Powell, S. 2, Cronin, S., 1 McCann, E. 2, McGuire, J., Becher, E.H. 2, & Hall, E. 1 (2020). Parent well-being in divorce education. Journal of Family Strengths, 20:1(2) 1-1. : https://digitalcommons.library.tmc.edu/jfs/vol20/iss1/2
• Type: Journal Articles Status: Awaiting Publication Year Published: 2022 Citation: Strang, J. F., Knauss, M., van der Miesen, A. I. R., McGuire, J. K, Kenworthy, L., Caplan, R., Freeman, A. J., Sadikova, E., Zacks, Z., Pervez, N., Balleur, A., Rowlands, D. W., Sibarium, E., Willing, L., McCool, M. A., Ehrbar, R. D., Wyss, S. E., Wimms, H., Tobing, J., Thomas, J., Austen, J., Pine, E., Griffin, A. D., Janssen, A., Gomez-Lobo, A., Brandt, A., Morgan, C., Meagher, H., Gohari, D., Kirby, L., Russell, L., Powers, M., & Anthony, L. G. (in press). A clinical program for transgender and gender-diverse autistic/ neurodiverse adolescents developed through community-based participatory design. Journal of Clinical Child and Adolescent Psychology. https//doi.org/10.1080/15374416.2020.1731817, PMID Pending.
• Type: Journal Articles Status: Published Year Published: 2020 Citation: *McGuire, J.K., Berg, D.R., Catalpa, J.M.1, Morrow, Q.J. 1, Fish, J.N., Rider, G.N., Steensma, T. D., Cohen-Kettenis, P. T., & Spencer, K. (2020 online awaiting print queue). Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples, International Journal of Transgender Health. https//doi.org/10.1080/26895269.2020.1723460
• Type: Journal Articles Status: Published Year Published: 2020 Citation: Hunt, Q. A.1, Weiler, L. M., Mendenhall, T. S., McGuire, J., Kobak, R., & Diamond, G. (2020). Testing basic assumptions of the Interpersonal Needs Questionnaire-15 in a sample of clinically depressed and suicidal youth. Suicide and Life-Threatening Behavior, 50(2), 372-386. https//doi.org/10.1111/sltb.12594
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Kuvalanka, K. A., Bellis, C.2, Goldberg, A., & McGuire, J. K. (2019). An exploratory study of custody challenges experienced by affirming mothers of transgender and gender non-conforming children: Custody challenges involving trans children. Family Court Review, 57, 54-71.
• Type: Journal Articles Status: Published Year Published: 2019 Citation: *Catalpa, J. M.1, McGuire, J. K., Berg, D. R., Fish, J. N., Rider, G. N., & Bradford, N. J. 1 (2019). Predictive validity of the Genderqueer Identity Scale (GQI): Differences between genderqueer, transgender and cisgender sexual minority individuals. International Journal of Transgenderism, 20(2-3), 305-314. https//doi.org/10.1080/15532739.2018.1528196
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Becher, E. H. 2, Kim, H. 1, Cronin, S. E. 1, Deenanath, V. 1, McGuire, J. K., McCann, E. 2, & Powell, S2. (2019). Positive parenting and parental conflict: Contributions to resilient coparenting during divorce. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 68(1), 15-164. https//doi.org/10.1111/fare.12349
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Daley, T., Grossoehme, D.2; McGuire, J. K., Corathers, S, Conard, L., & Lipstien, E. (2019). "I couldn't see a downside": Decision-making about gender-affirming hormone therapy. Journal of Adolescent Health, 65(2), 274-279. https//doi.org/10.1016/j.jadohealth.2019.02.018
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Okrey-Anderson, S.1, & McGuire, J. K. (2019). Personal faith and professional ethics: Best practice with families of sexual and gender minority youth. Social Work, 64(4), 365-372. https//doi.org/10.1093/sw/swz030
• Type: Journal Articles Status: Published Year Published: 2020 Citation: Hunt, Q. A. 1. Morrow, Q. J. 1, & McGuire, J. K., (2020). Experiences of suicide in trans-identified youth: A qualitative community based study. Archives of Suicide Research, 24, S340-S355. https://doi.org/10.1080/13811118.2019.1610677

Progress 10/01/19 to 09/30/20

Outputs
Target Audience:The target audience during this year includes: Extension educators in Hawaii and in Minnesota, Professionals in youth services, Clinicians who provide gender care services, Consumers of research, and primary and secondary school educators. My target audiences have included providers who care for transgender persons, extension educators, researchers focused on LGBTQ youth and families, counselors and social workers and parents. Over the past year, my work has specficallyfocused on ways that health care can be accessed across a broad spectrum of environments through making appropriate measures available. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?I completed a training with Extension Educators in Hawaii in February when there as paret of NCERA 218, health well-being and economic opportunity for rural LGBTQ individuals annual meeting. I advise five doctoral students. I presented a webinar for service providers during the summer 2020. How have the results been disseminated to communities of interest?An article in MN Parent magazine highlighted my research and gender nonconformity among kids. Peer reviewed journal articles, free public access to website, podcasts, webinars and extension outreach workshops. What do you plan to do during the next reporting period to accomplish the goals?Resubmit unfunded grants. Finalize remaining manuscripts.

Impacts
What was accomplished under these goals? Goal 1. Identify factors associated with LGBT youth well-being specifically within rural contexts. Continuing analyses yielded acceptance at a conference that was cancelled but resubmitted for analyses of data on LGBTQ youth in Minnesota. Ongoing manuscripts are in review (1) or in press (2) that examine links between service access and well-being, or developmental approaches to body image and aesthetic identity among transgender identified youth (early 2021 publication date). Goal 2. Research how parenting practices in rural environments influence well-being specifically for children in LGBT headed households and provide outreach for LGBT parent education. Continuing work on manuscript development and program redevelopment has occurred.. One manuscript is slated for early 2021 publication, one was published in 2020. An interview in a popular parenting magazine was published (Minnesota parent). Interviews and focus groups with parents of transgender youth and service providers regarding service access has occured. Goal 3. Create infrastructure to provide service supports for providers of sexual orientation and gender based care to improve access to care in rural environments. Two NIH grants were submitted with multi-state collaboration to further defvelop and refine measures. Ongoing measurement use and rtechnical assistance occurs through collaboration with the National Center for gender Spectrum health.

Publications

• Type: Book Chapters Status: Published Year Published: 2020 Citation: McGuire, J. K., & Morrow, Q. J.1 (2020). Pathways of gender development. In G van Schalwyk, J. Turban, & M. Forcier (Eds.), Pediatric gender identity: Psychiatric comorbidities (pp. 33-46). Springer.
• Type: Journal Articles Status: Published Year Published: 2020 Citation: McCann, E. 2, Powell, S. 2, McGuire, J. K., & Becher, E. H. 2 (2020). Reinvisioning coparent curriculum: Meeting the needs of a changing population. Adult Learning. https//doi.org/1045159519892681

Progress 10/01/18 to 09/30/19

Outputs
Target Audience:My target audiences have included providers whocare for transgender persons, extension educators, researchers focused on LGBTQ youth and families, counselors and social workers and parents. Over the past year, my work has specfically focused on ways that health care can be accessed across a broad spectrum of environments through making appropriate measures available. Changes/Problems:No problems or changes. What opportunities for training and professional development has the project provided?I conducted workshops with extension educators in Hawaii as well as in Illinois in conjunction with my multi-state AES (NCERA-218) project. I also completed a podcast. The measures of gender I am developing and validating are publicly maintained on a website through the National Center on Gender Spectrum Health. How have the results been disseminated to communities of interest?Peer reviewed journal articles, free public access to website, podcasts, webinars and extension outreach workshops. What do you plan to do during the next reporting period to accomplish the goals?Same approaches.

Impacts
What was accomplished under these goals? Goal one- One publication from MSS data was published on excercise and eating habits of transgender youth in Minnesota. Another conference proposal was submitted and accepted (then the conference was cancelled) from MSS data. Data analyses from Translifeline has continued and collaborative work with the organization has begun to submit a grant proposal to American Foundation For Suicide Prevention this November. Goal two- Three papers with extension educators were completed and published or submitted last year on Parents Forever. The final paper on same sex parenting is almost ready for submission. Program module content is planned and in development. I have worked with parenting educators to support parent education outrach via extension educators. Goal three - Measures for genderqueer identity and gender dysphoria were published in the Handbook of Sexuality Related Measures, and peer reviewed journals. Two grants to refine validation of these measures in gender clinics were submitted to the National Institutes of Health. I completed two extensions webinars and a podcast (Mom Enough), and retained the webpage where over 100 clinics ahve downloaded the measures for use.

Publications

• Type: Journal Articles Status: Accepted Year Published: 2020 Citation: Bishop, A., Reicks, M., McGuire, J. (in press, 2019) Food and exercise among TGNC youth. Journal of Adolescent health.
• Type: Journal Articles Status: Submitted Year Published: 2019 Citation: Powell, S. 2, Cronin, S., 1 McCann, E. 2, McGuire, J., Becher, E.H. 2, & Hall, E. 1 Parent well-being in divorce education. (under review). Journal of Family Strengths.
• Type: Journal Articles Status: Published Year Published: 2019 Citation: McCann, E., Powell, S., McGuire, J.K., & Becher, E.H. (in press, 2019). Reinvisioning Coparent Curriculum: Meeting the Needs of a Changing Population. Adult Learning. Manuscript accepted for publication
• Type: Journal Articles Status: Published Year Published: 2019 Citation: Reilly, A, Catalpa, J. M. 1, & McGuire, J. K . (2019). Clothing fit issues for trans people. Fashion Studies, 2, pp. 1-15.