JMIR Publications

ABSTRACT

Background:

Compared to heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers’ ability to conduct meaningful survey research to understand these disparities. Many national health surveys only offer respondents three substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual) despite the prevalence of additional identities, which could lead to measurement error via misreporting and item non-response.

Objective:

This study compared the traditional three-option approach to measuring sexual identity with an expanded approach that offered respondents five additional options.

Methods:

An online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1,258 young adults (ages 18-21) to answer either the three-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item non-response.

Results:

The expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item non-response. Twelve percent of participants answering the expanded version of the question selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2% vs.7%). Females and Non-Hispanic whites were slightly more likely to skip the shorter item (1% vs. 0%). Five percent of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared to respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (Odds Ratio 9.57, 95% CI 1.21-75.73, P=.03).

Conclusions:

Results favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities.