Discussing the sensitive – and important – research areas on Questionnaire 6

“Why are you asking about medicinal marijuana?

I thought this study is about cancer; why are you asking about sexual orientation?

Why do you need to know about income?

How are these questions related to health?”

These are a few of the questions you have asked about the new research areas included on Questionnaire 6. Some of you have been very happy that these research areas were included, and others have been very upset. We know these are sensitive topics and can evoke a range of reactions. We sincerely care about your experience participating in this study, so we would like to provide additional information about these research areas with the hope that they will feel less polarizing.

Together, all of you—the 133,477 teachers and school administrators who joined this study over 20 years ago—comprise a diverse group of women representing a variety of ages, ethnicities, religious beliefs, and political ideologies throughout California and beyond. When the California Teachers Study researches sensitive topics, we want to ask questions in a way that is objective and non-judgmental and that allows you as participants to choose how you respond. Survey questions about any type of lifestyle or environmental factors, whether they are questions about diet and exercise or alcohol, tobacco, or marijuana use, does not suggest our approval or disapproval, but rather a scientific interest in whether those factors might affect health and risk of disease in our study population. If you have additional questions about any of the research questions we have asked, we encourage you to contact us at calteachersstudy@coh.org or 1-800-568-9471.

With that in mind, let’s take a look at the scientific reasons for these research topics:


There is a growing body of evidence that income level and financial stress affect health outcomes, including life expectancy. People with higher incomes may have lower rates of certain chronic diseases. There is also research to show that individuals with unpaid medical bills or without medical insurance may delay receiving necessary medical care. CTS researchers are asking questions about income and financial stress to study how they may relate to health outcomes among our study population.

Medicinal Marijuana

California legalized the personal use of medicinal cannabis and marijuana in 1996. Today, people use medicinal marijuana for many health conditions, including the side effects of cancer treatment such as nausea, vomiting, loss of appetite, and chronic pain. The overuse of medicinal cannabis can also have negative effects, such as the potential for increased risk of lung cancer, emphysema, and gastrointestinal conditions. CTS researchers are asking questions about the use of medicinal cannabis to better understand the health risks and benefits that may be associated with the use of cannabis for medical reasons.

Sexual Orientation and Gender Identity

Lesbian and bisexual women have higher rates of some cancers, including breast cancer.1 As a study originally founded to study the excess risk of breast cancer among California teachers, this makes the inclusion of questions about sexual orientation and gender identity all the more important for California Teachers Study researchers to accurately examine cancer risk. It also raises the bigger question of how sexual orientation and gender identity might affect other health outcomes.

Sexual orientation refers to one’s pattern of attraction to other people, based on their sex or gender. Gender identity refers to one’s internal experience of gender, which may or may not match the sex a person was assigned at birth. In California, about 95% of people identify as the same sex that was on their birth certificate and are attracted to people of the opposite gender. The 5% of the population who do not identify this way comprise this sexual and gender minority (SGM) population. Research suggests that in addition to higher rates of some cancers, SMG populations also experience health disparities; this means they experience preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health.

Our team is grateful for every question you take the time to answer on this questionnaire. Only through the participation of participants like you will we be able to continue studying the causes of cancer.

If you would like to learn more about medicinal marijuana or sexual orientation and gender identity, please feel free to look at the following resources: