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

摘要 大量研究已经提供了个体亚群之间显著差异的证据 根据不良健康后果的流行率由性别认同定义，其中 自认为是性少数群体(如女同性恋者、男同性恋者、双性恋者)的人被证明有更高的风险 物质使用障碍、精神健康障碍、自杀、歧视和危险性行为。 这项研究导致了公共卫生政策的实施，旨在了解和减少这些 地方、州和国家层面的差异。这项研究的大部分都利用了二次分析 收集了大量的全国性调查数据集，这些数据集收集了性认同和各种健康状况的测量 因此，这些研究中报告的估计差异的有效性在很大程度上依赖于 性别认同结构的质量测量。尽管最近进行了大量的定性工作， 改进这种测量的方法，我们关于这些差异的大部分现有知识都是基于 收集了关于这一结构的相对简单的封闭式测量的调查。这种做法引入了一种风险 调查受访者在性别身份方面被错误分类的比例，特别是如果受访者没有 意识到所提供的为数不多的性身份选择适用于他们。这种错误的分类将 最终削弱了人们对性别认同和健康结果之间关系的估计， 可能低估了差异或对差异的方向提供了误导性的估计。这个 提议的PI和联合I最近在国家一级发表了一份关于这一重大问题的演示 使用NICHD资助的全国家庭成长调查的新实验数据的初步研究 (NSFG)。 拟议的二次分析项目旨在建立在这一初步工作的基础上，符合 特别利益通知的目的和范围NOT-HD-20-022。通过对数据进行二次分析 收集自NSFG的五年(2015-2019年)，其中随机抽取了两个大的国家半样本 被指派接收关于性别认同的问题的不同版本，并进行平行分析 来自全国药物使用和健康调查(2015-2019年)的相同数据，用于复制目的，这 该项目将评估性别身份差异估计中减弱的可能性 NICHD关心的其他健康结果的分布中的亚组，并扩大对 社会人口亚群的衰减问题以及这些差异的潜在缓和 与保护性少数群体有关的国家级政策。拟议工作的结果将通知 现有政策并激励未来的实验研究进一步评估改进的工具 在全国调查中衡量性别认同。

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.