Iowa HHS abandons critical adolescent mental health data collection

The Iowa Department of Health and Human Services announced last month it will no longer conduct a planned 2023 survey on adolescent health in Iowa. In the midst of a youth mental health crisis, HHS is abandoning its only source of nationally comparable data on the mental-health experiences of Iowa high school students — and of the health experiences of LGBTQ+ students.

For 25 years, findings from the Iowa Youth Risk Behavior Survey (YRBS) guided planning and practice across public health programs, schools and youth-serving organizations. The survey captured data on adolescent health topics including obesity, alcohol use, tobacco, violence, and, critically, mental health and suicide.

Per a February 9 letter from State Medical Director Robert Kruse, the department is jettisoning the YRBS to focus on its other adolescent health survey, the Iowa Youth Survey.

The Iowa Youth Survey is a useful instrument, but it has limitations. It does not capture the experiences of all high school grades and excludes many health topics included in the YRBS. Although it started asking about sexual orientation in 2021, it does not ask about gender identity and, thus, cannot describe the experiences of transgender and nonbinary students.

Survey shows the degree of suffering among LGBTQ+ youth

Unlike the Iowa Youth Survey, the YRBS — conducted in almost all states in conjunction with the Centers on Disease Control and Prevention — allows us to compare the health experiences of straight and cisgender students to LGBTQ+ students. Iowa first included a demographic question on sexual orientation to its YRBS questionnaire in 2017 and added a demographic question on gender identity in 2021.

Data from the 2021 Iowa YRBS, which was released last month, shows we are in the midst of an adolescent mental health crisis that is especially alarming for LGBTQ+ youth:

• 74% of LGBTQ+ Iowa high school students reported feeling so sad or hopeless they could not engage in their regular activities for at least two weeks during the previous year, compared with 31% of straight, cisgender students.

• Fully one-quarter of Iowa LGBTQ+ students attempted suicide in the previous year, compared with 7% of straight, cisgender students.

Once we no longer get this critical data from the YRBS, how will we know if the mental-health needs facing LGBTQ+ students are persisting, improving or deepening? 

End of YRBS connects to broader anti-trans agenda

Whatever the stated rationale, it’s difficult to interpret HHS’s decision as anything a contribution to the broader anti-trans agenda at the Iowa Capitol. Iowa legislators continue to advance an alarming slate of bills that would:

• force schools to “out” students without regard for their safety and well-being

• ban any mentions of sexual orientation or gender identity in the classroom

• keep trans youth from using restrooms aligned with their gender identity

• ensure that teachers and staff can misgender students without consequences

• ban gender affirming care for youth

These bills aim to erase the experiences of trans students and adults from curriculum, classrooms, libraries and public life. Astonishingly, HHS leaders are so eager to erase the health experiences of trans students that they are willing to abandon their best source of all adolescent health data to do so.

The Iowa survey decision mirrors similar moves in red states across the country. In April 2022, Florida governor Ron DeSantis pulled his state out of the YRBS, also in the midst of a flurry of anti-LGBTQ+ legislation.

The February 9 Iowa announcement followed the cancellation without explanation of two meetings of HHS’s YRBS Advisory Group — comprised of researchers, program administrators and advocates, including Common Good Iowa — which were to include updates on 2023 survey administration. A meeting scheduled for November 30, 2022, was canceled on November 22, and a meeting scheduled for January 13, 2023, was canceled on January 11.