HHS Releases Findings On How to Ask LGB on Surveys

Scout, Ph.D.

Director, Network for LGBT Health Equity

A Project of The Fenway Institute

Old Friends & Great Science

Sometimes things just work out fortuitously. For me, it’s always been great that a friend of mine from way back, Dr. Kristen Miller, ended up running the HHS Question Design Lab. Yes, that’s the place where they research how to ask different questions on surveys. Since I’ve had a strong interest in LGBT surveillance, and have long been one of the many loud voices calling for it, you can imagine, Kristen and I have hashed some of these issues around for years. Many years ago we’d planned to work together when CDC commissioned testing of gender identity questions, but somehow (under a different administration) that plan got derailed and shelved. A few years ago, when the Network embarked on testing a gender identity inclusive question for the folk in Minnesota, she nicely brought me in and updated me on all the latest methods before we started. Now, we’ve been in close communication as HHS finally agreed to test and add questions to the National Health Interview Survey.

Well, Dr. Miller just released the first part of their testing on these issues, the results of their extensive cognitive testing on how to ask about sexual orientation, which they are relabeling to be sexual identity (for convenience sake and custom, I’m still using sexual orientation here). Sexual orientation questions on large surveys have largely started to settle into some close variation of similar questions. Which is good because they’ve been getting more acceptance, being added to more and more state surveys. But there were still a few twitchy points in the most common question design, which created measurement error, which is really bad when you’re trying to measure a rare population. Only a little bit of measurement error of the mainstream people can really affect the data for our small subgroup. This HHS testing has given us a stronger measure of sexual orientation, one I hope will be widely adopted on surveys at many levels. Great job Kristen and everyone else over there at National Center for Health Statistics!

As always, our profound thanks to the many organizations and advocates who also took up the banner of “data collection”, the many internal HHS advocates who toiled hard to make it real, the agencies like SAMHSA who helped fund this testing, and of course, Secty. Sebelius for committing to add LGBT data collection to the largest federal health survey, National Health Interview Survey.

Findings: English Speaking Heterosexuals Don’t Know They Are Heterosexual

I remember when we were doing our own cognitive testing, as one apparently straight woman barked at me, “Well, I know I’m not HETEROSEXUAL!” I tried not to smile… but it showed clearly, people are often confused by the so similar and so long words “heterosexual” and “homosexual”. In surveys, confusion is your enemy, so these words had to go. Kristen’s work found the same issue, so one of her biggest changes is to get these words off.

But that’s only in English, in Spanish, they use the word “heterosexual” and there’s not equivalent for “straight”. So in a Spanish language question, that word helps.

Findings: Most People Are “Not Gay”

What you knew this? No, let’s talk in full population survey terms. Another finding Kristen had was that most straight people don’t think about positively constructing their sexual identity as much as to realize they are “not gay”. So, they also recommend changing the phrasing of that answer to be “Straight, that is, not gay.”

Drumroll Please… The Question

Do you think of yourself as:

[For men: ] Gay                                          [For women:]  Lesbian or gay

[For men: ] Straight, that is, not gay      [For women:]  Straight, that is, not lesbian or gay

Bisexual

Something Else (Go to A)

Don’t Know (Go to B)

A. [If ‘something else’ is selected]  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, transsexual or gender variant
• You have not figured out your sexuality or are in the process of figuring it out
• You do not think of yourself as having sexuality
• You do not use labels to identify yourself
• You made a mistake and did not mean to pick this answer
• You mean something else (Go to C)

B.  [If ‘don’t know’ is selected] You did not enter an answer for the question. That is because you:

• You don’t understand the words
• You understand the words, but you have not figured out your sexuality or are in the process of figuring it out
• You mean something else (Go to C)

C.  [If ‘you mean something else’ is selected]

• What do you mean by something else?  Please type in your answer __________________________________

I encourage everyone who is actually adding measures to surveys to read the full report, we’ve put it up in our library here.

What About Transgender?

Many of you know, we long ago tested a measure that allowed multiple options for checking sexual orientation and gender identity in a setup that is really multiple questions, but looks like a single one. This measure did test well, and is still a viable option if you have the most limited type of survey real estate.

But the feds nicely are able to have more flexibility than just adding a single measure, so they’re continuing by having a second listening session with community experts, then they’ll move forward with deciding how gender identity will be measured on the National Health Interview survey. It always puts a lump in my throat to see LGB measures move without T added, so I’m one of many who’ll be watching closely to make sure that process keeps moving forward. So the short answer on transgender is… coming soon.

Postscript from comments

After testing some similar questions myself, I know that for many transgender folk, stating a sexual orientation is challenging. The concept of being identified by the gender of partners gets muddy when your own gender changes, or isn’t clearly M/F at all. So it’s not uncommon for people to want to clarify that they’re transgender as one way of showing they can’t really answer this question clearly. So, don’t fear, the researchers didn’t put ‘transgender’ as an option under A because they think it’s synonymous, it was likely put there because some trans respondents really wanted this option.