Post on 13-Jan-2016
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
Do you think of yourself as…
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.
Sexual Identity Men Women All
Heterosexual or straight 95.4% 93.2% 94.3%
Homosexual or gay/lesbian 2.3 1.5 1.9
Bisexual 1.3 3.3 2.3
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
Do you think of yourself as…
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
Sexual Identity Men Women All
Heterosexual 95.7% 93.7% 94.7%
Homosexual 1.7 1.1 1.4
Bisexual 1.1 3.5 2.3
Missing 1.5 1.7 1.6
100 100 100
Weighted N in thousands
55,556 56,032 111,588
Note. Missing data= something else, refused, and don’t know responses
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
Note. Missing data= something else, refused, and don’t know responses
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
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
Do you think of yourself as…
Lesbian or gay
Straight, that is, not lesbian or gay
Bisexual
Something Else
Don’t Know
Revised sexual identity question
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?
_____________________________________
Revised sexual identity question
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….