Three Approaches to Make Sex Ed Evaluations More LGBTQ+ Inclusive

Understandably, most parents want to be involved in their adolescents’ health-related decisions so they can guide them toward healthy choices and protect them from harm. As such, most research involving minors requires study teams to receive both parental consent and youth assent to participate, to protect children and adolescents from harm or discomfort.

In evaluations involving LGBTQ+ minors, however, this current standard practice can be problematic for reasons of participants’ safety and the study’s rigor. Obtaining parental consent for evaluations of LGBTQ+ inclusive sex ed programs could risk outing LGBTQ+ youth, which can be difficult and even harmful for some. Many families of LGBTQ+ youth are supportive of their child’s identity, but some are unsupportive or even hostile. Coming out (or being outed) to unsupportive parents can have devastating consequences for adolescents, including parental abuse, negative mental health outcomes including suicide, and homelessness. In such cases, researchers’ responsibility to protect adolescents from harm should include protecting them from non-consensual outing.

Requiring parental consent may also diminish an evaluation’s rigor. Youth who come from less supportive environments may be uncomfortable asking their parents for permission to participate in an LGBTQ+-focused evaluation study, which could lead to an unwanted identity disclosure and reduce the young person’s willingness to participate. The opposite may be true, too: LGBTQ+ youth who’ve come out to their parents or have supportive parents may be more likely to participate if parental consent is required. Both possibilities would undermine the evaluation’s scientific validity by contributing to selection bias. To enhance studies’ internal validity, researchers should include a more representative sample of LGBTQ+ youth (e.g., youth who are out and not, those with supportive parents and without).

In developing the SafeSpace study, we involved the Child Trends Institutional Review Board (IRB)[2] to ensure a safe and ethical design for adolescents. The IRB reviewed our eligibility, consent, and enrollment processes and our survey, assessing them for medical accuracy, age-appropriateness, and trauma-informed practices. We also followed evidence regarding parental consent from other social science research and observed precedent set by other sex ed evaluations in requesting a waiver of parental consent from the IRB. After its thorough review, the IRB determined that our study was safe for young people, and that it was ethical and important to allow adolescents to consent to their own participation without parental involvement. Not only did this demonstrate a respect for young people’s autonomy as it applies to their bodies, relationships, and sexual health, but it protected them from harms and enhanced our study’s rigor.

Thoughtful and culturally responsive participant surveys improve the quality of data that evaluators collect and validate and respect participants’ experiences. For example, if an evaluator needs to ask about a participant’s sex assigned at birth, they can include language in the survey that explains why the question is being asked and states that one’s sex assigned at birth may not represent their full identity. This helps affirm the experiences of transgender and gender-expansive people and works to avoid stigmatizing language (see our article for sample survey questions).

To measure the effects of sex ed programs, evaluation surveys usually include questions about consensual sexual behaviors, including penile-vaginal (PV) sex, oral sex, and anal sex. While some LGBTQ+ youth engage in PV sex, they also engage in many other types (e.g., sexual touching, genital rubbing, sexting, and sex with sex toys) that may not be included in surveys. However, these additional measures not only better represent LGBTQ+ peoples’ sexual experiences throughout adolescence and their life course, but are relevant to key sexual health outcomes that sex ed programs address, such as STIs. Furthermore, sexual activities other than PV sex are relevant to all youth who participate in sex ed programs, not just LGBTQ+ youth. Our pilot evaluation of SafeSpace indicates that cisgender-straight and LGBTQ+ adolescents engage in these sexual behaviors at about the same rates. By using these measures, we affirm and capture a more accurate picture of all youth’s sexual experiences.

Furthermore, survey questions about sex and sexuality can be sensitive. And because LGBTQ+ adolescents are more likely to experience unwanted sexual contact, building in additional protections increased the sensitivity and inclusivity of our study. To protect youth from the potential discomfort of participating in the sex ed program or the evaluation, the SafeSpace consent form acknowledged the risk and affirmed participants’ right to skip any educational content or survey questions they want (see quote box). Within the survey, too, we prefaced the series of sexual behavior questions with the following: “Please only answer these questions about sexual experiences you chose for yourself. We recognize that people can have sexual experiences they have not chosen. Such experiences are not their fault.” One cognitive interview participant was grateful to read this statement, calling it “very affirming.”

Building an inclusive study team can help ensure inclusive evaluations, especially when those involved in developing the evaluation share the identities of the study participants. For example, researchers should work with an LGBTQ+ expert during planning and writing. Experts with lived experience are shown to be beneficial across many fields and can further provide insights relevant to LGBTQ+ youth. The SafeSpace team is staffed with researchers who are experienced in working with LGBTQ+ youth and we involved two additional experts on adolescent sexual and gender identity—each of whom identify as LGBTQ+—in developing and refining our evaluation survey questions. These researchers brought their lived experience to developing evaluation measures, leading cognitive interviews with LGBTQ+ teens, and providing key suggestions regarding the relevance of sexual behavior survey questions and language.

LGBTQ+ youth can also play roles in programming and evaluations—for example, by sitting on an advisory board to review survey questions and ensure understandable, clear, and relevant study procedures. The SafeSpace team engaged LGBTQ+ adolescents in cognitive interviews to assess drafted survey questions, receiving insightful feedback. One young person pointed out that one of the survey questions was written in a way that would not be inclusive of asexual participants, and as such, would isolate them. The team adapted its language as a result.

Conclusion

Implementing these strategies to increase LGBTQ+ inclusion in evaluations of adolescent sex ed programs can improve study rigor by reducing bias in sampling and improving the relevance and clarity of survey questions. More inclusive and tailored evaluations may also reduce instances in which LGBTQ+ young people feel isolated and rejected, and instead uphold their autonomy and increase their sense of self-worth. Rigorous, inclusive evaluations are critical for identifying high-quality, evidence-based programming for LGBTQ+ youth, which will help them and their non-LGBTQ+ peers thrive.

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Footnotes

[1] Lesbian, gay, bisexual, transgender, and queer/questioning, as well as other non-heterosexual and cisgender identities.

[2] The Institutional Review Board is an administrative body established to protect the rights and welfare of human research subjects who directly or indirectly participate in research activities conducted by Child Trends.