measuring sexual identity in nchs surveys jennifer madans, ph.d. u.s. department of health and human...

MEASURING SEXUAL IDENTITY IN NCHS SURVEYS

Jennifer Madans, Ph.D.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

NCHS Staff

NSFG Anjani

Chandra Casey Copen Bill MosherCatlainn

Sionean

NHIS Marcie Cynamon Jim DahlhamerBeth Taylor

QDRL Heather Ridolfo Kristen Miller Aaron MaitlandMike Ryan

Background

Need to better understand health of sexual minority groups

Some evidence of health disparities

Challenges to Researching Sexual Minority Health

Definition of Construct

Sexual Orientation: Generic term, catch-all

Sexual Behavior: Same-sex vs. opposite-sex behavior Not necessarily consistent with self-conception or presentation of self Design problem: what counts as “sex” varies across sub-groups

Sexual Attraction: Same vs. opposite sex/gender desire Not necessarily consistent with self-conception or presentation of self Latent and elusive phenomena, not tangible, not observable Design problem: Variation in conceptualization, particularly in what

respondents consider and actually report

Sexual Identity Conscious understanding and identification of self Similar to racial identity Represents individuals’ relationship to social world Design problem: complex and fluctuating

Patterns of Interpretation/Construct Equivalence

Non-Minority Patterns LGBT Patterns

Lack of salient sexual identity

Highly salient

No concept of sexual identity but rather dis-identification

Identity rooted in complex process of negotiating and forming a

sexual identity

“not me,” “I’m normal,” “soy mujer,” “I don’t know”

Shifting sexual identity

For transgender respondents, intersection of gender

and sexuality

Provided response categories: Interpretation of ‘heterosexual’ as gay; ‘bisexual’ as heterosexual

Provided response categories: Use of non-traditional

identity categories

Results Thus Far

National Survey of Family Growth (NSFG)

National Health and Nutrition Examination Survey (NHANES)

Questionnaire Design Research Laboratory (QDRL)

NSFG Cycle 6 (2002)

Do you think of yourself as…

HeterosexualHomosexualBisexualor Something else

NSFG Cycle 6 (2002)

Table 1. Sexual identity by gender.

Sexual Identity Men Women All

Heterosexual 90.2% 90.3% 90.3%

Homosexual 2.3 1.3 1.8

Bisexual 1.8 2.8 2.3

Missing 5.7 5.6 5.6

100 100 100

Weighted N in thousands

55,399 55,742 111,141

Note. Missing data= something else, refused, and don’t know responses

NHANES 2002-2008


Heterosexual or straight (attracted to men/women)Homosexual or lesbian/gay (attracted to

women/men)Bisexual (attracted to men and women)Something elseNot sure

NHANES 2002-2008

Table 2. Sexual identity by gender.


Heterosexual or straight 95.4% 93.2% 94.3%

Homosexual or gay/lesbian 2.3 1.5 1.9


Missing 1.1 2.0 1.6

100 100 100

n (3697) (4201) (7898)

Note: Missing data = something else, not sure, don’t know, refused and don’t know responses

NHANES 2002-2008

Table 3. Distribution of missing data by education

Men Women

Missing data <HS HS >HS <HS HS >HS

Yes 3.4% 0.8% 0.4% 5.7% 2.1% 1.1%

No 96.7 99.2 99.6 94.3 98.0 99.0

100 100 100 100 100 100

n (976) (995) (1724) (976) (918) (2306)

Chi-square = 42.34, p<.0001 Chi-square = 50.29, p<.0001

NHANES 2002-2008

Table 4. Distribution of missing data by gender and ethnicity.

Men Women

Missing data

Hispanic Non-Hispanic

Hispanic Non-Hispanic

Yes 3.4% 0.6% 5.8% 1.3%

No 96.6 99.4 94.2 98.7

100 100 100 100

n (1103) (2594) (1247) (2954)

Chi-square = 42.10, p<.0001 Chi-square = 46.06, p<.0001

Note. Missing data = something else, not sure, refused, and don’t know responses

NHANES 2004-2008

Table 5. Distribution of missing data by language and ethnicity (for women only).

Missing data Hispanic Hispanic Non-Hispanic

English interview

Spanish interview

English interview

Yes 3.3% 9.9% 1.4%

No 96.7 90.1 98.6

100 100 100

n (496) (426) (2169)

Note. Chi-square = 43.85, p<.0001

Results

High rates of missing data in comparison to the target group (something else, not sure, don’t know, and refused responses)

Unevenly distributed across population Higher among low education Higher among minority population

NSFG 2006-2008


Heterosexual or straightHomosexual or gay/lesbianBisexualor Something else

When you say “something else” what do you mean? Please type in your answer

NSFG 2006-2008

Table 6. Sexual identity by gender. United States, aged 18-44, 2006-2008


Heterosexual 95.7% 93.7% 94.7%

Homosexual 1.7 1.1 1.4


Missing 1.5 1.7 1.6

100 100 100

Weighted N in thousands

55,556 56,032 111,588


NSFG 2002 and 2006-2008

Table 7. Percent missing data for sexual identity by selected characteristics: United States, aged 18-44, 2002 and 2006-2008

Men Women

2002 2006-08 2002 2006-08

Ethnicity

Hispanic 10.8 4.5 10.2 4.8

NH White 3.0 0.5 3.5 0.9

NH Black 10.7 0.4 8.5 2.2

Language

ACASI -English 5.4 0.9 5.1 1.2

ACASI-Spanish 12.0 8.5 12.6 9.2

Note. Missing data= something else, refused and don’t know responses

NSFG 2002 and 2006-2008

Table 7 Continued. Percent missing data for sexual identity by selected characteristics: United States, aged 18-44, 2002 and 2006-2008

Men Women

2002 2006-08 2002 2006-08

Education

Less than HS 12.7 3.9 15.1 4.2

HS 8.7 1.5 8.4 1.1

Some college 1.7 0.8 2.5 1.1

Bachelor’s degree or higher

1.3 0.7 1.5 1.0


NSFG Results

2006-2008 NSFGSignificantly improved question wordingLower rates of missing dataStill high rates of missing in some populations

Lowest educational level Spanish speaking, especially women

Women: BMI by ‘Sexual Orientation’

2002 NSFG

HETEROSEXUAL HOMOSEXUAL BISEXUALNormal 49.7 30.5 48.5

Overweight 25.6 35.3 29.6

Obese 24.7 34.2 22.0

2006 NSFG

STRAIGHT OR HETEROSEXUAL

GAY OR LESBIAN OR HOMOSEXUAL BISEXUAL

Normal 40.7 38.2 36.5

Overweight 26.5 33.0 19.5Obese 32.8 28.8 44.0

Preparing to Add Questions to the NHIS

What’s different about the NHIS? Multipurpose General Population Survey Interviewer Conducted Interview

Areas Needing Development Audio Computer Assisted Self Interview

(ACASI)Development Question Development

Sources Informing NHIS Question Development

Quantitative Studies 2001-2008 National Health and Nutrition Examination

Survey (NHANES) 2002 -2003 National Survey of Family Growth (NSFG) 2006-2008 NSFG

Qualitative Studies 7 cognitive testing study results This project 139 interview Total 377 cognitive interviews

139 Cognitive Interviews conducted

Design for New Question

Goals for New Question:1. Reduce misclassification, especially for non-minorities2. Reduce “something else” and “don’t knows” 3. Sort non-minority from minority cases

Revision Based on Principles:1. Use labels that respondents use to refer to themselves2. Do not use labels that respondents do not understand-

especially if not required by any respondents3. Use follow-up questions to meaningfully categorize

‘something else’ and ‘don’t know’

Revised sexual identity question


Lesbian or gay

Straight, that is, not lesbian or gay

Bisexual

Something Else

Don’t Know


By something else, do you mean that…

You are not straight, but identify with another label such as queer, trisexual, omnisexual or pan-sexual

You are transgender or transexual

You have not or are in the process of figuring out your sexuality

You do not think of yourself as having a sexuality

You personally reject all labels of yourself

You made a mistake and did not mean to pick this answer

You mean something else

Please type in your answer

What do you mean by something else?

_____________________________________


By Don’t Know, do you mean that…

You don’t understand the words

You understand the words, but you have not or are in the process of figuring out your sexuality

You mean something else

Please type in your answer

What do you mean by something else?

_____________________________________

Additional work

Limitations: Washington DC metro region Different vocabulary can vary (particularly true for

Spanish)

Question still being evaluated/may change with: Field interview debriefings Analysis of field test data

NHISTHREE PHASE TEST

The National Health Interview Survey

Since 1957General health surveyNoninstitutionalized populationIn person interviews by Census

interviewersn = 40,000 households, national sampleData on households, adults, and childrenAnnual , one time, and periodic contentOne hourAdvance letter/informed consent

Phase 1: Bridging Field and Lab Techniques

n = 50Maryland, Virginia, and Pennsylvania6 interviewersAdapting QDRL procedures to Census

field requirementsContext of NHISTransition from standard CAPI to

ACASI

Phase 2: Testing Technical Procedures

n = 500Several regionsFull NHIS with ACASI at the endTests procedures for

Using headphones Delivering instructions Respondent concerns Input and output

Phase 3: The Pilot

N = 5,000Split BallotACASI compared to CAPIAdditional issues and experimentation

SpanishQuestion wording, orderVoice qualities (human or text to

speech; sex; speed)Placement

Evaluation Criteria

Break off ratesNonresponseDon’t know and refused responsesImpact on other survey dataInterviewer debriefingObserver debriefingComparisons to other surveys

Timeline

NHIS Pretest

Stay tuned….

measuring sexual identity in nchs surveys jennifer madans, ph.d. u.s. department of health and human...

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