The Sexual Continuum

Discussing all things related to Lesbian, Gay, Bisexual, and Transgender (LGBT) health

Do You Know What “Straight” Means?

How do you measure sexual identity?

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Surveys of the health and health related behaviors of Americans play a critical role planning for population health. For example, if a health issue is on the rise in a particular geographic area or demographic group, this knowledge can help inform targeted health intervention that can curb the rise. Recently, there has been increased attention to health issues experienced by the lesbian, gay, bisexual, and transgender (LGBT) community. To help understand the magnitude and causes of these issues, the federal government has begun a process of collecting information on LGBT health problems. So how do you measure them?

It may seem obvious that if you want to know someone's sexual orientation you could simply ask them, "are you gay?" But in reality, it is much more complicated than that. Recently, the National Center for Health Statistics issued a report on how to ask these questions for the National Health Interview Survey, which is one of our primary sources of information about the health of various American communities.

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For this health interview, the primary aspect of sexual orientation they are interested in studying is sexual identity. The report authors define this as "a concept of self that is formed within a social context and defines for individuals their relationship to other individuals, groups, and sociopolitical institutions within that context (Rust, 1993)." What they mean by this is that rather than focusing on who people are sexually attracted to or who they have sex with, their primary interest is in identity aspects (i.e. "do you identify as lesbian?"). Their rational is that, "In the context of health, sexual identity is informative in understanding respondents' access to health care and, subsequently, the quality of care they are provided. It is also informative in understanding risk factors such as diet, exercise, stress and smoking patterns as these factors are closely linked to community as well as self-conception. It is important to note that although individuals may conceptualize their identity within a framework of who they have sex with or who they are attracted to, behavior and attraction in and of themselves do not constitute identity. It is the meaning-specifically the interpretations that the individuals assign those behaviors and experiences-that defines how they ultimately conceptualize their identity (Plummer, 1981; 1995)." Their perspective is that identity is the most important dimension for studying health disparities, although they acknowledge that other dimensions like sexual behavior may be more important for specific health issues (i.e. sexually transmitted infections).

The report acknowledges that measuring sexual identity presents challenges because it is complex concept that is rooted in social and political contexts and can change across the live course. The report highlights that while sexual identity is an important construct for LGBT individuals, many non-minority individuals do not hold salient identities. According to the report, "Instead, these respondents (who for all intents and purposes would be categorized as being heterosexual), often dis-identify from a gay identity, possessing what is referred to as a 'not-me' identity (McCall, 2003)."  In other words, they are more likely to identify as "not gay" than as "heterosexual." Perhaps reflecting limited consideration of sexual orientation among those in the majority, previous cognitive interviewing studies found that respondents can confuse the words "homosexual" and "heterosexual," believing that "heterosexual" means being gay and that "homosexual" means being straight.

There are also issues with measuring sexual identity amongst the "LGBT" population, which I have grappled with for much of my career in studying "LGBT" youth. According to the report, "previous cognitive interviewing studies found that respondents can confuse the words 'homosexual' and 'heterosexual,' believing that 'heterosexual' is the equivalent of being gay and that 'homosexual' is the equivalent of being straight."

Somewhat to my surprise, the researchers found that the word "straight" is not well understood among English-speakers and is instead often interpreted to mean "straight-laced."   

After considering these issues, the report outlines a set of design principles to inform the selection of questions recommended for the next National Health Interview Survey. These included using common, everyday labels that people use to refer to themselves (i.e. "gay" rather than "homosexual"), avoiding labels that people do not understand (i.e. "heterosexual), and using follow-up questions to break down vague answers.

So what did the researchers settle on for their measure of sexual identity? 

Do you think of yourself as:

[For women] Lesbian or Gay
[For women] Straight, that is, not lesbian or gay
[For men] Gay
[For men] Straight, that is, not gay
Bisexual
Something else (Go to A)
Don't know (Go to B)

If a respondent selects something else they are then asked the following,

A.     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)

If a respondent selects they "don't know," then they are asked the follow,

 

B.     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.     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

Keep in mind that this measure is designed for general surveys of the American population, and may not be ideal for more targeted surveys of the LGBT population. I probably wouldn't use these items in my own research that specifically targets the LGBT community because we tend to include more items that better reflect difference dimensions of sexuality.

What do you think about these items? Would you have been confused by the words "heterosexual" or "straight?" 

| Read the Report | This copy of the report was obtained from the Network for LGBT Health Equity.  Photo credit: IMPACT Program.

Dr. Mustanski is the Director of the IMPACT LGBT Health and Development Program . You can follow the Sexual Continuum blog by becoming a fan on Facebook.

 

Brian Mustanski, Ph.D., is Associate Professor at Northwestern University and the founding Director of the IMPACT LGBT Health and Development Program.

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