An Experimental Evaluation of How Survey Measurement of Sexual Identity Affects Population Estimates of Identity-Based Differences in the Prevalence of Adverse Health Outcomes

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ABSTRACT A large body of research has presented evidence of significant differences among subgroups of individuals defined by sexual identity in terms of the prevalence of adverse health outcomes, where subgroups of individuals who identify as sexual minorities (e.g., lesbian, gay, bisexual) have been shown to be at higher risk of substance use disorders, mental health disorders, suicidality, discrimination, and risky sexual behaviors. This research has led to the implementation of public health policies designed to understand and reduce these differences at the local, state and national levels. The majority of this research has utilized secondary analyses of large national survey data sets that collect measures of both sexual identity and the various health behaviors, so the validity of the estimated differences reported in these studies therefore relies heavily on high- quality measurement of the construct of sexual identity. Despite a large amount of recent qualitative work on methods for improving this measurement, much of our existing knowledge about these differences is based on surveys that collected relatively simple closed-ended measures of this construct. This practice introduces a risk of survey respondents being misclassified in terms of their sexual identity, especially if respondents do not perceive that the small number of sexual identity options provided apply to them. This misclassification will ultimately attenuate population estimates of the associations between sexual identity and health outcomes, potentially understating differences or providing misleading estimates of the directions of the differences. The proposed PI and co-I recently published a demonstration of this significant problem at the national level in a preliminary study using novel experimental data from the NICHD-funded National Survey of Family Growth (NSFG). This proposed secondary analysis project aims to build on this preliminary work, consistent with the purpose and scope of Notice of Special Interest NOT-HD-20-022. By conducting secondary analyses of data collected from five years of the NSFG (2015-2019), where two large national half-samples were randomly assigned to receive different versions of a question about sexual identity, and also conducting parallel analyses of identical data from the National Survey of Drug Use and Health (2015-2019) for replication purposes, this project will evaluate the possibility of attenuation in estimates of the differences between sexual identity subgroups in the distributions of additional health outcomes of interest to NICHD, and extend the study of the attenuation problem to socio-demographic subgroups and the potential moderation of these differences by state-level policies related to the protection of sexual minorities. Results from the proposed work will inform existing policies and motivate future experimental research further evaluating improved tools for the measurement of sexual identity in national surveys.