Measuring Sex, Gender Identity, and Sexual Orientation (2022) / Chapter Skim
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5 Measuring Sexual Orientation and Identifying Sexual Minority Populations
5 Measuring Sexual Orientation and Identifying Sexual Minority Populations
Pages 51-73
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From page 51... ...
THE ROLE OF MEASUREMENT CONTEXT 51 and death certificates.4 However, the actual design of certificates is determined at the state level and implemented variously in hospitals, funeral homes, and local government offices (see, e.g., National Research Council, 2009; Hahn et al., 2002)
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From page 52... ...
In these settings, information on sexual orientation, gender identity, transgender experience and identity, and intersex/ DSD status are generally not collected, because they are not needed for purposes of identification. At the same time, data on sex or gender are often collected without a clearly designated purpose and without clarity regarding which of the two constructs is of interest.
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From page 53... ...
. Some studies show disparities for sexual minority populations as defined by same-sex sexual behavior in prisons and jails (Zaller, et al.
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From page 54... ...
For applicants, some employers collect data on gender, transgender, or sexual orientation identities.9 These practices are consistent with Supreme Court rulings, which have found that the legal prohibition of discrimination based on sex extends more broadly to protections against discrimination based on sexual orientation and gender identity.10 To our knowledge, information on intersex status has not been collected in any administrative setting. As is the case for vital statistics and legal identification data, an important feature of these administrative data is the ability to link this information to a specific individual.
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From page 55... ...
As in other administrative settings, this access can leave individuals vulnerable to mistreatment, and some respondents may prefer not to disclose this information due to fear of mistreatment or loss of services. For this reason, data collection and use of case management files requires high levels of competence among staff when they ask about or discuss sexuality and gender, particularly when sexual orientation and gender identity questions are open ended.
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From page 56... ...
Although the collection of data on sex, gender identity, and sexual orientation can facilitate mistreatment, these data are also necessary to document its occurrence, as well as design and implement policies and procedures to counter it. For this reason, it is important that data collection in administrative settings serve a clearly defined purpose, be limited to data that are needed to support that purpose, and minimize the likelihood of data disclosure or misuse.
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From page 57... ...
lists stratified performance data as a pillar in its strategy to advance health equity. Thus, collecting data on sex, gender identity, and sexual orientation in medical settings is important for quality improvement and the advancement of health equity.
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From page 58... ...
Unlike population surveys, clinical settings provide many points of contact in which information can be collected, which necessitates the development of work flows and organizational policies that identify when, how, and by whom data are collected to ensure that patient privacy is adequately protected (Antonio et al., 2022)
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From page 59... ...
The U.S. Office of the National Coordinator for Health Information Technology has identified various terms that can be used to capture sex assigned at birth, gender identity, and sexual orientation in electronic health records,14 but little work has been done on how to measure intersex status as a demographic measure.
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From page 60... ...
Although such clear legal protections against disclosure do not exist in all administrative contexts, clearly defined plans to restrict unauthorized access to the data need to be in place before they are collected, particularly when such data are used to inform interpersonal interactions. When this information is collected and reported in the identification portion of vital statistics records or in other identification documents, it may be inappropriate and potentially harmful to collect data that enable the identification of sexual and gender minority populations.
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From page 61... ...
• When data are collected to enumerate populations and conduct research that elucidates the structural mechanisms through which population-based disparities are created and could be addressed, measures that can identify the relevant sexual and gender minority populations, such as sexual orientation identity, gender identity, transgender experience, and intersex status are the most relevant. Even when collecting data on sex, gender identity, and sexual orientation is relevant in a specific context, data collection efforts need to balance the benefits of the data with the risks associated with unauthorized data disclosure and the potential misuse of data by those with authorized access.
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From page 63... ...
After discussing commonly used evaluation criteria, the chapter concludes with a set of criteria the committee used to assess and ultimately select the recommended measures in the rest of the report. CRITERIA FOR DEVELOPING AND EVALUATING MEASURES When developing standardized questions, the primary goal is to establish their construct validity -- alignment between what the item(s)
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From page 64... ...
. Similarly, item nonresponse rates can provide information regarding whether questions meet cognitive and usability standards.
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From page 65... ...
When discussing response options, ordering is also considered. Because sex, gender identity, and sexual orientation are nominal variables, there is no inherent ordering to their response categories.
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From page 66... ...
. Adjustments to existing well-tested measures that appear on prominent national surveys, such as the National Health Interview Survey sexual orientation identity item, are often proposed by minority communities as a way of giving the community voice, better representation, or legitimation within the data collection process.
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From page 67... ...
This can occur when a person fits the definition of a category or experience but does not recognize the terminology provided, finds the response options offensive, or is otherwise uncomfortable reporting an identity that is marginalized or stigmatized. Although it is almost impossible to entirely eliminate false positives and false negatives, careful pretesting of items through cognitive interviews and experimental studies that compare results from different wordings help to minimize these misclassifications and improve data validity.
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From page 68... ...
Similarly, the use of specific terminology may vary with age or other respondent characteristics, such as race, ethnicity, and geography. Data collection efforts that target these populations may wish to consider modifying the recommended questions and response options.
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From page 69... ...
. For the response options, we used the following criteria: 1.
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From page 70... ...
For administrative settings, which cover a wide range of contexts and practices, and, with the exception of vital statistics and legal identification documents, tend to be privately maintained, very little information is available on the practices that are in use, and even less information is publicly available on how those measures perform. As noted in Chapter 3, there may be specific contexts in administrative settings in which the collection of some of these data, such as sex assigned at birth, may be considered invasive; therefore, it may be necessary to modify the recommended measures for these contexts.
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From page 71... ...
Part II Recommended Measures
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From page 73... ...
Following this brief overview, we review existing approaches for assessing sexual orientation identity as an indicator of sexual orientation, allowing for the enumeration of sexual majority and sexual minority populations. We then offer our recommendations for measurement practices to document sexual orientation identities, and we conclude with recommendations for future research.
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