1 

Federal Interagency Working Group on 

Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys 

Evaluations of Se┝ual Orientation and 

Gender Identit┞ Surve┞ Measures: 

What Have We Learned?

 September 23, 2016 

Contents 

Executive Summary...................................................................................................................................... 3 

I. Background and Purpose of the Working Paper...................................................................................... 8 

II. Relevant Concepts.................................................................................................................................... 8 

a. Orientation, Identity, and Relationships............................................................................................. 9 

Sexual Orientation................................................................................................................................ 9 

Sex and Gender..................................................................................................................................... 9 

Household Relationships....................................................................................................................10

b. Measurement Error............................................................................................................................10

Sources of Error ..................................................................................................................................11

Detecting Measurement Error...........................................................................................................11

III. Research Methods ................................................................................................................................12

IV. Results of Evaluation Studies ...............................................................................................................13

a. Sexual Orientation..............................................................................................................................13

Sexual Identity....................................................................................................................................13

Sexual Attraction................................................................................................................................19

Sexual Behavior..................................................................................................................................22

Congruency of Multiple Measures of Sexual Orientation................................................................. 23

b. Gender Identity ..................................................................................................................................23

Gender Expression..............................................................................................................................28
2 

c. Household Relationships....................................................................................................................29

V. Discussion: Best Practices and Areas for Further Research..................................................................31

a. Sexual Orientation..............................................................................................................................31

Sexual Identity....................................................................................................................................31

Sexual Attraction................................................................................................................................32

Sexual Behavior..................................................................................................................................32

b. Gender Identity .................................................................................................................................. 32 

c. Household Relationships....................................................................................................................33

d. Conclusion ..........................................................................................................................................34

References..................................................................................................................................................35

Appendices.................................................................................................................................................40

A. Surveys Measuring Sexual Identity in Cited Work............................................................................40

B. Sexual Identity Items Used in Cited Work.........................................................................................41

C. Sexual Attraction Items Used in Cited Work.....................................................................................49

D. Sexual Behavior Items Used in Cited Work.......................................................................................52

E. Gender Identity Items Used in Cited Work .......................................................................................53

F. Gender Identity Items in Federal Surveys .........................................................................................58

G. Scales Used to Measure Gender Expression.....................................................................................60

H. Measures of Household Relationships.............................................................................................. 61

 
3 

Executive Summary 

At a time when sexual and gender minority (SGM) populations are becoming more visible in social and 

political life, there remains a lack of data on the characteristics and well-being of these groups. In order 

to better understand the diverse needs of SGM populations, more representative and better quality 

data need to be collected. The U.S. Federal Government is taking several steps to more efficiently 

coordinate data collection efforts across its many departments. The Office of Management and Budget 

(OMB) convened the Federal Interagency Working Group on Measuring Sexual Orientation and Gender 

Identity (SOGI IWG) to begin addressing the deficiency of information for these populations and the 

concerns surrounding methodological issues in collecting such data. This document is the second in a 

series of working papers from the Federal Interagency Working Group that describe what is known 

about current measures on sexual orientation, gender identity, and household relationships and 

highlights the methodological questions that remain to be answered. 

Although a few Federal agencies have collected information describing SGM populations for over a 

decade, some aspects of sexual orientation and gender identity (SOGI) have been more routinely 

measured than others. Federal agencies not currently collecting data on SOGI have expressed interest in 

doing so. However, before adopting a particular measure in any Federal data collection, it is important 

to evaluate the rigor of the measure, understand its measurement properties for the population of 

interest, and determine whether the measure is fit for its intended purpose. 

This working paper identifies any current survey measures of SOGI where measurement error has been 

assessed and determines the nature and extent of such error. It also describes best practices based on 

these assessments to minimize SOGI measurement error in surveys. 

For a meta-analysis of evaluations of SOGI measurement error in surveys, a comprehensive literature 

review was conducted. This included a review of Federal agency directed—or sponsored—reports, 

proceedings papers of the American Association for Public Opinion Research (AAPOR) conferences, and 

literature searches related to the topic of SOGI measurement. For literature searches, keywords related 

to さse┝ual oヴieミtatioミ suヴ┗e┞ マeasuヴeマeミtざ aミd さgeミdeヴ ideミtit┞ suヴ┗e┞ マeasuヴeマeミtざ ┘eヴe used to 

search online academic research databases. These searches yielded reports, articles, and chapters from 

academic journals and books, including those in the fields of sociology, psychology, demography, public 

health, survey methodology, sexuality and gender research, and public opinion research. In order to 

yield the most relevant findings for the purposes of this paper, the scope of this literature review was 

limited to publications occurring between January 2011 and July 2016 (exceptions as noted). The review 

focused primarily on SOGI measurement research from surveys conducted in the United States, but 

some international studies were included. 

Results of evaluation studies 

The major findings from evaluation studies on the measurement of SOGI are organized around the 

concepts of sexual orientation, natal sex, gender identity, and same-sex and opposite-sex households. 

Sexual orientation has three main dimensions: sexual identity, sexual attraction, and sexual behavior. 

Research on sexual identity, defined as the way someone identifies with a given sexual orientation, was 

found to be the most prevalent among the studies reviewed. Research in this area has focused on a 

diverse group of respondents, including sexual and gender minority populations, adult and adolescent 

populations, and English- and Spanish-speaking populations. The sexual identity studies reviewed used 
4 

both quantitative and qualitative methods to examine item performance and item nonresponse. In 

general, sexual identity items tested in these studies performed well, and most respondents appeared 

to have little difficulty answering the items. Some research did identify differences in 

responses/estimates, depending on how the item was worded and collected. Terminology differences 

and comprehension issues were particularly poignant for older adults (ages 70 and older) and less 

educated adults. For example, respondents experienced comprehension issues ┘ith さheteヴose┝ual,ざ 

suggesting さstヴaightざ is the more common term. Research on sexual identity measurement has also 

revealed issues related to language, particularly among Spanish-speaking respondents, as terms like 

さstヴaightざ ha┗e ミo tヴaミslatioミ; theヴefoヴe, tヴaミslatioミs pヴeseミtiミg the さミot ga┞ざ ふi.e., さNo ga┞, o sea, 

heteヴose┝ualざぶ e┝plaミatioミ fiヴst aヴe ヴeIoママeミded. While soマe ヴeseaヴIh ┘ith adolesIeミts has fouミd 

sexual identity items to perform well, other research has found that sexual identity implies a degree of 

permanence that adolescents are not comfortable addressing. Additionally, some research identified 

social desirability biases when sexual identity questions were asked in less private modes. Finally, while 

item nonresponse rates to sexual identity items were relatively low across studies, they were found to 

┗aヴ┞ H┞ ヴespoミdeミts’ deマogヴaphiI IhaヴaIteヴistiIs, iミIludiミg se┝, age, ヴaIe, and ethnicity. 

Research on sexual attraction, which refers to the sex or gender to which someone feels attraction (e.g., 

whether an individual is attracted to males/men, females/women, or both), was more limited than the 

research on sexual identity. Half of the studies reviewed used cognitive interviewing techniques, while 

the other half involved quantitative evaluations of survey questions. The target populations differed 

across the studies, including adult women only, younger persons ages 12 to 21, and adults of all ages. 

One study found no significant differences in the reporting of same-sex attraction when a method that 

was proven to reduce social desirability was used. Another study found that respondents not only 

described sexual attraction as physical, but also included other factors such as affection, affiliation, and 

emotional preference. Consistent with this finding, interviews with younger respondents, ages 15 to 21, 

felt that the foIus oミ さse┝ualざ attヴaItioミ ┘as too ヴestヴiIti┗e, aミd ヴepoヴted otheヴ t┞pes of attヴaItioミ. This 

same research also examined a combined question (identity and attraction), and found mixed results, 

including confusion between the two terms, which led to conflating the experiences (i.e., some 

respondents described themselves as gay or lesbian, but also felt some attraction to members of the 

opposite sex). In particular, among adolescent participants, research found that a sexual attraction 

ケuestioミ マa┞ He easieヴ to aミs┘eヴ siミIe the┞ マa┞ still He iミ the pヴoIess of さfiguヴiミg outざ theiヴ se┝ual 

identity. Finally, quantitative results of multiple question formats for sexual attraction, including other 

items on sexual identity and behavior, found that item nonresponse varied by question wording, 

┘hetheヴ oヴ ミot the IoミIepts ┘eヴe IoマHiミed, adマiミistヴatioミ of the suヴ┗e┞, aミd H┞ ヴespoミdeミts’ 

characteristics. 

The studies that examined sexual behavior, which ヴefeヴs to the se┝ of a peヴsoミ’s se┝ual paヴtミeヴs ふe.g., 

individuals of the same sex, different sex, or both sexes), focused on how sexual behavior items 

peヴfoヴマed, iteマ ミoミヴespoミse, aミd ヴespoミdeミts’ ヴeaItioミs to Iaptuヴiミg theiヴ se┝ual Heha┗ior. In general, 

researchers assess sexual behavior by asking respondents to report the sex of their sexual partners 

during a specified period of time in the past and/or during their lifetimes. Participants had mixed 

reactions to sexual behavior items, including feeling that items were too personal or being excited to see 

sexual behavior being measured in a health survey. Consistent with other research, nonresponse on 

sexual behavior items was found to vary by respondent age, education, and income. Research also 

found issues of misreporting, that is, when non-heterosexuals reported their behavior as exclusively 

heterosexual and when heterosexuals did not report same-sex sexual behavior. This also varied by sex, 

income, and age. 
5 

Additionally, a few studies examined the congruency of various measures of sexual orientation. In 

general, research found that a peヴsoミ’s se┝ual ideミtit┞ is ミot ミeIessaヴil┞ Ioミgヴueミt ┘ith theiヴ se┝ual 

attraction or behaviors. Some researchers have concluded that sexual orientation may be viewed on 

more of a continuum of sexuality. Given these findings, the appropriate measurement of sexual 

orientation will depend on the primary focus of the research. 

There is a growing body of research on gender identity, oヴ aミ iミdi┗iduals’ self-identified sense of gender. 

Nonetheless, there is still no consensus on how to collect gender identity in surveys. The majority of 

research supports using a two-step method (capturing assigned sex at birth and current gender 

identity), per the recommendation of the Gender Identity in the U.S. Surveillance (GenIUSS) Group, 

World Professional Association for Transgender Health (WPATH), and Center of Excellence for 

Transgender Health (CoE). For example, research collecting SOGI at medical intake found that 

participants understood and were willing to answer the two-step items. Among other populations 

researched, including youth, the majority of respondents found questions on both natal sex and gender 

identity to be straightforward. Research has also tested this among Spanish-speaking participants who 

were able to answer the item related to natal sex, but the majority conflated sexual identity and gender 

identity. However, respondents still responded in a manner that was consistent with a gender item 

collected during the study screener. Even with this research, there are a number of open questions, 

including how to the order the items, whether to include reference to a birth certificate, and how the 

items perform in languages other than English and Spanish. Also unresolved is the appropriateness of 

using gender identity in realms that typically utilize binary measures of sex, such as gendered questions. 

Research on gender expression, oヴ aミ iミdi┗idual’s e┝teヴミal マaミifestatioミ of geミdeヴ, is also growing, but 

the number of evaluation studies is small. The studies examined on this topic asked respondents how 

they perceive their masculinity and femininity (first-order scales) and also how they think others 

perceive them (third-order scales), for a total of four scales. Research suggests that there is utility in 

asking all four scales, and that the masculine and feminine scales should be separated. The research also 

recommends asking the first-order scales if researchers have to choose one set of scales. 

Household relationship data can be used to provide an indirect estimate of the SGM population through 

the measurement of same-sex couples. There were several studies identified in this working paper that 

attempted to quantify inconsistencies and over-reports in the measurement of same-sex couples using 

household data, and identify question design changes to improve the performance of sex and 

relationship questions for estimating the number of same-sex couples. These studies identified 

persistent inconsistencies in reports of sex and relationship to householder, leading to overestimates of 

same-sex households in the decennial Census, ACS, and other Federal surveys. The overestimates were 

laヴgel┞ attヴiHuted to aIIideミtal マisマaヴkiミg oミ se┝ H┞ a ┗eヴ┞ sマall pヴopoヴtioミ of opposite‐se┝ マaヴヴied 

couples. While identifying and addressing the issues behind the documented inconsistencies is 

important for producing accurate estimates of same-sex couple households (and a number of other 

couple types), relying on sex and relationship information does not provide a direct measure of sexual 

orientation. 

Areas for future research 

This working paper reviewed recent studies evaluating the measurement of SOGI in surveys and has 

identified areas where future research is needed. 
6 

For sexual identity, the literature reveals a number of ways to ensure that reliable and accurate data can 

be collected. Question order studies are also an area of future inquiry, as placing sexual identity items 

near demographic survey questions rather than around sexual attraction and behavior questions may 

lead to less biased responses. Future research may be best focused on sexual identity measures among 

certain populations, including adolescents, older adults, and racial, ethnic, and language minorities, 

where research is more limited and the understanding of sexual identity terminology may differ. Finally, 

other areas for future research include survey operations and administration, pertaining to interviewer 

training and limitations to using proxy measurement. 

Future research on sexual attraction should consider the definition of attraction as well as challenges 

with the understanding of question response options. There is research needed on question wording 

and response options, as well as mode of data collection. Question context and placement should also 

be considered. Nonresponse may also be a concern when measuring sexual attraction, and the 

conflation of sexual attraction and sexual identity common to many existing measures may contribute to 

item nonresponse. Consistent with sexual identity, it is recommended that more testing be conducted 

with adolescents to understand how they comprehend measures of sexual orientation broadly as well as 

sexual attraction specifically. 

More research on sexual behavior that focuses on the structure and content of questions and that looks 

at how responses vary by demographic group would be beneficial. Also, both nonresponse and 

misreporting are areas that would benefit from future research, as existing findings suggest that 

nonresponse and misreporting vary by respondent demographics. 

There are a number of areas in which Federal research could add to the literature on how best to 

measure gender identity. While many organizations support a two-step measure, more research is 

needed on the assessment of gender identity using a one versus two-step approach. In addition, little is 

known about how question order may affect response for the two-step measure. Also benefiting from 

fuヴtheヴ ヴeseaヴIh is the effeIt of ヴefeヴeミIiミg さoヴigiミal Hiヴth IeヴtifiIateざ foヴ the ミatal se┝ ケuestioミ.

Evaluation research would also benefit from the inclusion of different racial, ethnic, cultural, and 

language minorities. For example, future evaluation research focused on increased recruitment or 

oversampling of transgender individuals, people of color, and people from cultures in which a third 

gendeヴ e┝ists ふe.g., さt┘o-spiヴitざ iミ AマeヴiIaミ Iミdiaミ tヴiHes aミd さhijヴasざ iミ “outh Asiaミ Iultuヴesぶ would 

advance the literature. Recent variations of the two-step measure have included a verification item 

when natal sex and current gender identity do not agree. While items like these have been shown to 

reduce measurement error in the measurement of same-sex households, there are no studies examining 

their application to the measurement of gender identity. Finally, there are other methodological 

challenges related to the measurement of gender identity, including how to best to ask questions that 

have implications for public health, such as questions about mammograms, Pap tests, and birth control, 

once a respondent is identified as transgender. 

Moreover, there appears to be limited research evaluating items measuring gender expression, or an 

iミdi┗idual’s e┝teヴミal マaミifestatioミ of geミdeヴ. Additioミal ヴeseaヴIh addヴessiミg this topiI ┘ould pヴo┗e 

beneficial and further develop knowledge on this concept central to SOGI research. 

Studies measuring same-sex and opposite-sex households identified persistent inconsistencies in sex 

and relationship-to-householder reports, leading to overestimates of same-sex households in the 

decennial Census, ACS, and other Federal surveys. The overestimates are largely attributed to accidental 

マisマaヴkiミg oミ se┝ H┞ a ┗eヴ┞ sマall pヴopoヴtioミ of opposite‐se┝ マaヴヴied Iouples. While マaミ┞ of the 
7 

testing efforts described recommend the use of a revised relationship to householder question, the 

evidence to date suggests that inconsistencies and overestimates of same-sex couple households are 

still likely. Additionally, a number of the reviewed studies mentioned the importance of automated edits 

in interviewer-administered surveys for reducing sex-relationship inconsistency rates. However, these 

studies failed to quantify the extent to which these edits led to changes in reporting of sex, 

relationships, or both. Furthermore, we know very little about the behavior of interviewers when 

confronted with these edits. 

 
8 

I. Background and Purpose of the Working Paper 

At a time when sexual and gender minority (SGM)1

 populations are becoming more visible in social and 

political life, there remains a lack of data on the characteristics and well-being of these groups. In order 

to better understand the diverse needs of SGM populations, more representative and better quality 

data are needed. The U.S. Federal Government is taking several steps to more efficiently coordinate 

data collection efforts across its many departments. The Office of Management and Budget (OMB) 

convened the Federal Interagency Working Group on Measuring Sexual Orientation and Gender Identity 

(SOGI IWG) to begin addressing the dearth of data for these populations and the methodological issues 

in collecting such data. 

Although a few Federal agencies have collected information describing SGM populations for over a 

decade, some aspects of sexual orientation and gender identity (SOGI) have been more routinely 

measured than others. Further, there are Federal agencies not currently collecting data on SOGI that 

have expressed interest in doing so. However, before adopting a particular measure in any Federal 

information collection, it is important to evaluate the rigor of the measure, understand its measurement 

properties for the population of interest, and determine its fit for its intended purpose. 

This working paper identifies current survey measures of SOGI for which an assessment of measurement 

error has been conducted, determines the nature and extent of such error, and, based on those 

assessments, identifies best practices to avoid SOGI measurement error in surveys.2

 Specifically, this 

paper describes the ways in which SOGI has been measured, discusses quantitative and qualitative 

findings on the quality of existing measures, and identifies areas where future research is needed. Close 

attention has been paid to how SOGI is defined, how SOGI concepts are understood by respondents, and 

how measurement challenges (such as respondent misinterpretation, item nonresponse, and social 

desirability) lead to biased outcomes. 

This document is the second in a series of working papers from the Federal Interagency Working Group. 

The first working paper, Current Measures of SOGI in Federal Household Surveys, provides an overview 

of concepts and current measurement in Federal household surveys and serves as the foundation for 

this document. A third working paper, Toward a Research Agenda for SOGI in Federal Household

Surveys, will address the knowledge gaps identified in this working paper by proposing research 

priorities and strategies that will make the greatest impact on improving SOGI measurement in Federal 

surveys. Other working papers may be developed as research in this area matures. 

II. Relevant Concepts 

This section defines key terms and concepts central to this paper, consistent with definitions provided in 

the first working paper, Current Measures of SOGI in Federal Household Surveys. 

 

1

 This working paper refers to the population of interest as SGM rather than as lesbian, gay, bisexual, and 

transgender (LGBT). We believe that SGM is more inclusive than LGBT because it allows for the inclusion of persons 

not specifically referenced by the acronym, such as genderqueer, two-spirit, etc. 

2

 Evaluations of SOGI measures used in non-Federal surveys, such as the California Health Interview Survey (CHIS), 

have been reviewed for this paper because they can inform Federal measurement. 
9 

a. Orientation, Identity, and Relationships 

Both the purpose of the survey and the specific dimension of SOGI being measured are important design 

and measurement considerations. Definitions for several key concepts are presented below. These 

include sexual orientation, natal sex, and gender identity. The concept of same-sex and opposite-sex 

households is also presented. 

Sexual Orientation 

Sexual orientation has three main dimensions: sexual attraction, sexual behavior, and sexual identity. 

Sexual attraction refers to the sex or gender to which someone feels attraction (e.g., whether an 

individual is attracted to males/men, females/women, or both). Sexual behavior refers to the sex of a 

person’s se┝ual paヴtミeヴs (e.g., individuals of the same sex, different sex, or both sexes). Sexual identity

refers to the way a person self-identifies with a given sexual orientation (Sexual Minority Assessment 

Research Team, 2009).

The most commonly used terms to describe different sexual orientations are lesbian, gay, bisexual, and 

heterosexual/straight.3

In general, people who self-identify as gay or lesbian are primarily attracted to 

and/or have sex with people of the same sex. However, the concepts of sexual identity, attraction, and 

behavior do not always follow these patterns (e.g., individuals may not want to identify as gay or lesbian 

even if they are attracted to the same sex or only occasionally have different-sex relations). Therefore, 

although some surveys focus only on sexual identity, others measure all three components of sexual 

orientation. 

When selecting among measures of sexual orientation, the purpose of the study should guide the 

dimension(s) measured (Sexual Minority Assessment Research Team, 2009). For example, surveys 

intended to describe sexual health may feature measures of sexual behavior, while surveys of early 

adolescents may better feature measures of sexual attraction or identity since early adolescents may be 

less likely to have sexual behavior experiences. Determining the さヴightざ question for the purpose of the 

information collection can be challenging. Conceptual dimensions may be fluid over time for individuals 

and across age cohorts. Academically, these distinctions are clear, but the perceptions by the general 

public often are not. 

Sex and Gender 

Sex and gender are foundational concepts in research on SOGI. Generally speaking, the term sex refers 

to the biological characteristics that are used to categorize individuals as male, female, or intersex. Sex 

ヴefeヴs to さthe geミetiI, hoヴマoミal, aミatoマiIal, and physiological characteristics on whose basis one is 

laHeled at Hiヴth as eitheヴ マale oヴ feマaleざ ふInstitute of Medicine, 2011, p. 25). The term, gender, on the 

other hand, refers to さthe soIiall┞ IoミstヴuIted IhaヴaIteヴistiIs of ┘oマeミ aミd マeミ—such as norms, roles, 

aミd ヴelatioミships of aミd Het┘eeミ gヴoups of ┘oマeミ aミd マeミざ ふWorld Health Organization, 2016). 

 

3

 The term heterosexual corresponds to those with straight identities and/or different-sex attraction and/or 

partners. The term homosexual is sometimes used to describe individuals who are attracted to those of the same 

gender, engage in sexual activity with those of the same gender, and/or self-identify as lesbian or gay. Because of 

its appearance as a mental disorder in the DSM-I and DSM-II, homosexual is sometimes seen as unfavorable. It was 

declassified as a mental disorder beginning with the publication of the DSM-III in 1973. 
10

While male and female refer to sex, words like masculine, feminine, man, and woman all refer to 

gender.4 Gender is a multidimensional construct that has psychological, social, and behavioral 

diマeミsioミs that iミIlude geミdeヴ ideミtit┞ aミd geミdeヴ e┝pヴessioミ. It ヴefeヴs to the さIultuヴal マeaミiミgs of 

patterns of behavior, experience, and peヴsoミalit┞ that aヴe laHeled マasIuliミe oヴ feマiミiミeざ ふInstitute of 

Medicine, 2011, p.ヲヵぶ. Geミdeヴ ideミtit┞ ヴefeヴs to a peヴsoミ’s iミteヴミal seミse of geミdeヴ ふe.g., Heiミg a マaミ, a 

woman, or genderqueer) and potential affiliation with a gender community (e.g., women, trans women, 

or genderqueer). 

The term transgender refers to a diverse population that departs significantly from gender norms 

(Institute of Medicine, 2011). Often, a person's gender identity is consistent with their sex assigned at 

birth. A person whose gender identity and sex assigned at birth are consistent can be referred to as 

cisgender ふthat is, a peヴsoミ ┘ho geミdeヴ is さIoミsisteミt iミ se┝.ざぶ. The teヴマ transgender describes anyone 

who has a gender identity that differs from their sex assigned at birth (Spade, 2008). Some transgender 

individuals use hormones or elect for gender-affirming surgery, but not all transgender individuals do 

this. 

There are several dimensions of gender that can be measured: gender identity, gender expression, and 

gender dysphoria. Some surveys might aim to measure gender identity, oヴ aミ iミdi┗idual’s self-identified 

sense of gender. Others might be more interested in measuring gender expression, oヴ aミ iミdi┗idual’s 

external manifestation of gender. A survey may also aim to identify all individuals who experience 

gender dysphoria, or the experience of a marked difference between self-identified gender and assigned 

gender for a period of at least six months associated with clinically significant distress caused by this 

incongruence (American Psychiatric Association, 2013). Someone may be diagnosed with gender 

dysphoria whether or not that person has taken any steps to align their gender expression with their 

(inner) gender identity.5

 

Household Relationships 

Many Federal surveys collect household relationship data for all individuals living in the same housing 

unit. Household relationship data can be used to provide an indirect estimate of the SGM population 

through the measurement of same-sex couples. This approach, however, does not provide a direct 

measure of sexual orientation, and yields an incomplete estimate, since persons not living in the same 

household as their partner will not be identified (Interagency Working Group on Measuring 

Relationships in Federal Household Surveys, 2014). 

b. Measurement Error 

The goal of any survey question is to accurately measure the construct of interest, that is, achieve 

construct validity. However, even when the question or questions represent a valid measure of the 

 

4

 Some argue that the concepts of sex, male, and female are also socially constructed (Kelly, 2016).

5

 Gender dysphoria is classified as a mental disorder by the DSM-5. However the DSM-5 states that gender 

nonconformity is not a mental disorder. Rather, it is the presence of clinically significant stress associated with the 

untreated condition. Nevertheless, there is some controversy around the categorization of the term, and especially 

its predecessor, gender identity disorder, as a mental illness (Lev, 2016). In fact, a recent study found additional 

support for classifying health-related categories related to transgender identity outside the classification of mental 

disorders in the ICD-11 (Robles et al., 2016). 
11

underlying construct, measurement error may occur. For our purposes, measurement error represents 

the difference between the true value of the measurement or question and the provided response. 

Sources of Error 

Measurement error can occur for multiple reasons. Perhaps chief among these is clarity (or lack thereof) 

of the concept to be measured. The complexity and familiarity of the relevant concept can affect the 

ease with which a participant can respond accurately. Providing an answer involves comprehension of 

the question and survey task, retrieval of information from long-term memory, assessing the 

completeness and relevance of memories and a judgment of the level of precision that is called for by 

the question, and mapping an answer onto the appropriate scale or response option (Tourangeau et al., 

2000). 

For example, both sexual and gender identity can be conceptualized on a continuum, but they are often 

measured in nominal categories. Measurement error may occur when respondents feel that they are 

さHet┘eeミ Iategoヴies,ざ ┞et ha┗e to マap theiヴ ideミtities oミto a fi┝ed Iategoヴ┞. Vrangalova and SavinWilliams (2012) found that sexual identity categorized as five groups (i.e., heterosexual, mostly 

heterosexual, bisexual, mostly gay/lesbian, gay/lesbian) compared to three groups (i.e., heterosexual, 

bisexual, gay/lesbian) better reflected the nature of sexual orientation components. 

Language, translation, and cultural differences can also affect question comprehension. As another 

example, although sex and gender are defined in research literature as two different concepts, common 

usage of these terms does not make the same distinction. Indeed, Federal surveys sometimes conflate 

these terms (Westbrook and Saperstein, 2015). In some cases, this may be done with the objective of 

collecting the data intended, rather than the data requested. For example, a question designed to 

マeasuヴe ミatal se┝ マa┞ He posed as さWhat is ┞ouヴ geミdeヴ?ざ This disconnect often contributes to 

measurement and design issues. Question format, response option order, and placement within the 

body of a survey can also affect comprehension (DeMaio and Bates, 2012). 

Sensitive questions tend to elicit anxiety in respondents, leading them to alter their responses in 

attempts to protect their privacy, avoid embarrassment, or avoid providing responses that violate social 

norms. Asking them in face-to-face interviews, therefore, may lead to social desirability bias, the 

tendency for a respondent to present him/herself favorably by under-reporting less desirable qualities 

and over-reporting more desirable traits (Shoemaker et al., 2002; Tourangeau et al., 2000). In addition, 

social desirability may affect the objectivity and reliability of the manner in which SOGI questions are 

administered by interviewers. Further, perceived sensitivity of questions can affect the willingness of 

survey practitioners to include SOGI questions even when inclusion of these measures would support 

agency mission and data needs. 

Detecting Measurement Error 

Question evaluation methods such as expert content reviews, focus groups, cognitive interviewing, and 

usability testing in laboratory settings prior to the launch of a survey are particularly useful for detecting 

measurement error. The analysis of paralanguage and question probing through read-aloud, reasonaloud, and respond-aloud methods helps the suヴ┗e┞ マethodologist Hetteヴ uミdeヴstaミd the paヴtiIipaミt’s 

understanding and difficulty with target questions. 
12

Field pretests can be especially beneficial. They can feature a target test question and related questions 

to assess anticipated correlations, known as concurrent validity, and can enable statistical approaches 

such as behavior coding, item response theory, and latent class analysis. Field pretests can also feature 

split-ballot experiments in which the answers to alternative question wordings, obtained from 

comparable samples of respondents, are compared for robustness. 

Two common indicators of measurement error that can be assessed using pretest as well as production 

survey data are item nonresponse and the analysis of survey breakoffs. 

Item nonresponse is the failure of a survey respondent to answer a specific survey item. A soft refusal 

マa┞ oIIuヴ ┘heミ the ヴespoミdeミt Ihooses さdoミ’t kミo┘ざ foヴ a ヴespoミse. A haヴd ヴefusal oIIuヴs ┘heミ the 

ヴespoミdeミt Ihooses さヴefuse.ざ This is another way that social desirability may influence respondent 

behavior; respondents whose true answer is ミot soIiall┞ desiヴaHle マa┞ He マoヴe likel┞ to ヴespoミd さdoミ’t 

kミo┘ざ oヴ ヴefuse to aミs┘eヴ the ケuestioミ at higheヴ ヴates thaミ ヴespoミdeミts ┘hose tヴue aミs┘eヴ is Hetteヴ 

accepted by society.6

 However, item nonresponse may also be an important indicator of potential 

problems in survey wording or response options. Past ヴeseaヴIh has sho┘ミ that さdoミ’t kミo┘ざ aミd 

さヴefusedざ responses may represent distinct forms of item nonresponse attributed to question sensitivity 

and cognitive effort (Shoemaker, et al. 2002). Questions requiring greater cognitive effort may lead to 

satisficing – the Ihoosiミg of aミ aミs┘eヴ, suIh as さdoミ’t kミo┘,ざ that is adeケuate ヴatheヴ thaミ optiマal 

(Krosnick, et al. 1996). 

Survey break-offs occur when survey respondents do not complete a survey. Break-offs may be 

intentional or unintentional and may be understood in context to respondent ability, motivation, and 

task difficulty. When surveys are administered in the field, interviewers may fail to administer specific 

questions for a number of reasons, resulting in nonresponse error. 

Finally, item nonresponse and survey break-offs can contribute to nonresponse bias. Nonresponse bias 

can occur if the answers of respondents differ from the potential answers of those who did not answer 

(Little and Rubin, 1987; Singer, 2006). Generally speaking, the lower the response rate, the greater the 

likelihood of nonresponse bias. SOGI estimates could be susceptible to nonresponse bias if SGM 

populations are harder to reach or less likely to participate in the survey for other reasons. In addition, 

given the relatively low percentage of adults identifying as SGM, if nonresponse to SOGI questions is 

ヴelated to ヴespoミdeミts’ se┝ual oヴieミtatioミ oヴ geミdeヴ ideミtit┞ ふa Iase of ミoミigミoヴaHle ミoミヴespoミseぶ, the 

potential for bias in estimates of SGM may be considerable. 

III. Research Methods 

This section describes the methods used to assess possible measurement errors associated with 

measurement of SOGI. 

To conduct the proposed meta-analysis of evaluations of SOGI measurement error in surveys, the 

authors conducted a comprehensive literature review. This included a review of Federal agency 

directed- or sponsored- reports relevant to the topic. The authors also reviewed proceedings papers of 

the American Association for Public Opinion Research (AAPOR) conferences that related to the topic of 

 

6

 It is important to note that foヴ soマe ケuestioミs, さdoミ’t kミo┘ざ ヴespoミses マa┞ He ┗alid ヴefleItioミs of the tヴue 

┗alue. This Iould espeIiall┞ He tヴue ┘ith “OGI ケuestioミs ┘heヴe a ヴespoミdeミt’s ideミtit┞ マa┞ ┞et to He formed, is 

fluid, or is in flux. 
13

SOGI measurement. In addition, the writing group conducted literature searches using keywords related 

to さse┝ual oヴieミtatioミ suヴ┗e┞ マeasuヴeマeミtざ aミd さgeミdeヴ ideミtit┞ suヴ┗e┞ マeasuヴeマeミtざ using online 

academic research databases. These searches yielded reports, articles, and chapters from academic 

journals and books, including those in the fields of sociology, psychology, demography, public health, 

survey methodology, sexuality and gender research, and public opinion research. Papers identified 

during review of the aforementioned materials were also examined. 

To manage the breadth of this review in a way that would yield the most relevant findings for the 

purposes of this paper, the literature review was limited to publications occurring between January 

2011 and July 2016 (exceptions as noted). In addition, the review centrally focused on SOGI 

measurement research on surveys conducted in the United States, but some international studies were 

also reviewed. In total, the search yielded approximately 100 references. 

Each eligible publication was coded according to dimension of SOGI, question format, testing for 

measurement error, and findings and recommendations regarding measurement. 

IV. Results of Evaluation Studies 

This section presents the results of evaluation studies on the measurement of SOGI. First, findings from 

research on sexual orientation questions, including questions on sexual identity, sexual attraction, and 

sexual behavior, are discussed. Second, findings from research on gender identity questions, including 

questions on gender identity and gender expression, are discussed. Lastly, results from studies on samesex relationship questions are presented. For each set of questions, the questions used in the studies, 

the sample characteristics of the population studied, the methods of analysis and evaluation in the 

studies, and the major findings are examined. 

a. Sexual Orientation 

As noted above, sexual orientation includes the concepts of sexual identity, sexual behavior, and sexual 

attraction. Researchers often use the term sexual orientation as a synonym for sexual identity (Coffman 

et al., 2013; Gruskin et al., 2001; VanKim et al., 2010). For example, Vrangalova and Savin-Williams 

(2012) used the term sexual orientation identity in their study although they asked respondents to 

identify their sexual orientation. Fisher and colleagues (2001) used the term sexual orientation, which 

included sexual identity and sexual behavior. Other researchers simply use the term sexual identity 

when asking respondents to self-identify their sexual orientation (Gates, 2011; Miller and Ryan, 2011). 

Sexual Identity 

As noted earlier in this memo, sexual identity is defined as the way someone self-identifies with a given 

sexual orientation. We found more than 20 quantitative and qualitative studies that attempted to assess 

the measurement of various sexual identity items (see Appendix A). These studies examined the 

performance of sexual identity items, how various item responses compared to each other, item 

ミoミヴespoミse, aミd ヴespoミdeミts’ ヴeaItioミs to Iaptuヴiミg theiヴ se┝ual ideミtit┞ (see Appendix B for sexual 

identity item wording). 
14

Population Surveyed 

Studies measuring sexual identity have been conducted with respondents of widely varying populations. 

Some researchers select a population of interest Hased oミ ヴespoミdeミts’ sexual identity (Austin et al., 

2007; Clark et al., 2005; Fisher et al., 2001; NCES). For example, Fisher et al. (2001) focused on lesbian, 

bisexual, and transgender women in the Washington, DC, area. In cognitive testing for the High School 

Longitudinal Study of 2009 (HSLS:09), the National Center for Education Statistics had 10 of 30 

respondents identify as LGBTQ and the remaining respondents as straight or heterosexual. Of the 40 

women who paヴtiIipated iミ Claヴk aミd Iolleagues’ ふヲヰヰヵぶ Iogミiti┗e iミteヴ┗ie┘s, ヱΓ were women who 

partner with women (WPW) and 21 were women who partner with men (WPM). 

Some research studies have been conducted with particular age groups, such as the adult and 

adolescent noninstitutionalized U.S. populations (e.g., Dahlhamer et al., 2014; Jans et al., 2015; Martinez 

et al., 2016; Miller and Ryan, 2001; Poston and Chang, 2015; Saewyc et al., 2004; Cahill et al., 2014; Clark 

et al., 2005; Coffman et al., 2013; Gruskin et al., 2001; Joloza et al., 2010; Martinez et al., 2016; Ridolfo 

et al., 2012; Stern et al., 2016; VanKim et al., 2010). For the research reviewed in this paper, the 

minimum age of respondents was typically 12, 16, or 18 years and the maximum was 65 and older. 

Research by Grant and Jans (n.d.) discusses differences in responses of respondents who were 70 and 

older. 

Most studies included respondents across race/ethnic groups. In general, respondents included persons 

who were Hispanic or Latino; White; Black or African American; Asian or Asian Pacific Islander; and 

Native American (Coffman et al., 2013; Fisher et al., 2001; Martinez, et al., 2016; Miller and Ryan, 2011; 

NCES; Vrangalova and Savin-Williams, 2012). Some studies included both English- and Spanish-speaking 

respondents (Miller and Ryan, 2001; Stern et al., 2016; VanKim et al., 2010).

Other studies have identified the population of interest based on occupation or program participation, 

such as students (McCabe et al., 2012), Medicare beneficiaries (Stern et al., 2016), and members of 

health programs (Gruskin et al., 2001). Some recent research has also begun to examine sexual identity 

in the adult incarcerated population (Glaze, 2015). 

Although not the intended focus of the research, populations included in these studies also varied by 

educational attainment of the respondent. For example, Fisheヴ aミd Iolleagues’ ふヲヰヰヱぶ ヴespoミdeミts ┘eヴe 

highly educated in that more than half had graduate or professional degrees. In the HSLS:09 cognitive 

testing, about 70% were currently or previously enrolled in a postsecondary program (National Center 

for Education Statistics, forthcoming). 

Quantitative Analyses: Concurrent/Congruent Validity 

The sexual identity studies reviewed in this paper used a number of quantitative methods to examine 

measure validity. For item performance, some studies compared concordance on responses to several 

versions of the question or to other survey findings (Case et al., 2006; Dahlhamer et al., 2014; Saewyc et 

al., 2004). To look at item response, one study used test-retest reliability and factor analysis to 

determine if the items used to measure sexual identity conformed to expectations (Mohr and Kendra, 

2011). Other studies completed both univariate and multivariate analyses to examine the functioning of 

items (Coffman et al., 2013; Fisher et al., 2001; Joloza et al., 2010). Overall, based on these quantitative 

findings, the majority of respondents appear to have no difficulty answering sexual identity items. In 
15

particular, LGBT respondents feel that the questions presented on surveys allow them to accurately 

describe their sexual orientation (Cahill et al., 2014). 

The National Health Interview Survey (NHIS) examined responses to follow-up questions regarding what 

respondents meant when indicating さsoマethiミg elseざ oヴ さI doミ’t kミo┘ the aミs┘eヴざ (Dahlhamer, et al., 

2014). The most common responses to the "something else" follow-up question(s) were "You do not use 

labels to identify yourself" and "You do not think of yourself as having sexuality." The majority (90%) of 

adult respondents who initially aミs┘eヴed さI doミ’t kミo┘ the answerざ said that the┞ had ミot figuヴed out 

or were in the process of figuring out their sexuality, they did not understand the words, they did not 

know the answer, or simply refused. When comparing sexual identity estimates before and after backcoding using the follow-up question responses, there were no changes found in the sexual identity 

distribution. Therefore, the NHIS stopped featuring these follow-up questions in the 2015 survey. 

Cogミiti┗e ヴeseaヴIh H┞ Claヴk et al. ふヲヰヰヵぶ fouミd that ヴespoミdeミts ┘ho aミs┘eヴed さthiミk of ┞ouヴself iミ 

diffeヴeミt teヴマsざ used teヴマs iミIludiミg asexual, questioning, and crossdresser to describe themselves 

(Clark et al. 2005). 

When comparing the findings in the NHIS to the National Health and Nutrition Examination Survey 

(NHANES) and the National Survey of Family Growth (NSFG), differences were found in the 

measurement of sexual identity: a higher percentage of adults identified as gay or lesbian in the NHIS 

compared to the NHANES, and a higher percentage of women identified as gay or lesbian in the NHIS 

compared to the NSFG (Dahlhamer et al., 2014). Additionally, a substantially lower percentage of NHIS 

adults identified as bisexual compared to adults in the NSFG and NHANES. The various survey features, 

including question wording, mode of administration, survey content, and placement of the questions, 

were suggested as possible reasons for these differences (Dahlhamer et al., 2014). 

One study used an expanded measuヴe of se┝ual ideミtit┞, addiミg さマostl┞ heteヴose┝ualざ aミd さマostl┞ 

ga┞/lesHiaミざ as ヴespoミse Iategoヴies ふVヴaミgalo┗a and Savin-Williams, 2012). This research found that 

さマostl┞ heteヴose┝ualざ ┘as the マost fヴeケueミtl┞ Ihoseミ ミoミ-heterosexual label for men and women. Sex 

diffeヴeミIes iミ the ミuマHeヴ of ┘oマeミ Ioマpaヴed to マeミ Ihoosiミg the さマostl┞ heteヴose┝ualざ laHel ┘as 

highl┞ sigミifiIaミt. Foヴ the さマostl┞ ga┞/lesHiaミざ ヴespoミses, マoヴe paヴtiIipaミts ideミtified as Hise┝ual oヴ 

gay/lesbian than as mostly gay/lesbian. Overall, this research supported the addition of the two 

さマostl┞ざ Iategoヴies ふVヴaミgalo┗a and Savin-Williams, 2012). 

Some research has examined social desirability in responses to sexual identity. Coffman et al. (2013) 

argued that the standard methods of eliIitiミg ヴespoミdeミts’ se┝ual oヴieミtatioミ uミdeヴestiマates the tヴue 

fraction of individuals who identify as something other than heterosexual. The authors concluded that 

stigma is still felt by many in this population, often leading to social desirability bias in responses to 

sexual identity questions. 

Research generally has found congruence between several measures of sexual identity (McCabe et al., 

2012). In addition, concordance between reported sexual identity on a pilot study and the cohort study 

was high (Case et al., 2006). Mohr and Kendra (2011) generally found support for the validity and 

reliability of Lesbian, Gay, and Bisexual Identity Scale (LGBIS) subscale scores among university students 

that identified as LGB. This suggests that the LGBIS may be an appropriate means of assessing the 

different dimensions of LGB persons in this particular population. 
16

Quantitative Analyses: Item Nonresponse 

To examine potential item nonresponse bias, several studies used regression analyses by including other 

demographic characteristics as covariates (Kim and Fredriksen-Goldsen, 2013; Gruskin et al., 2001). 

Other studies looked at descriptive analyses of item nonresponse (Grant and Jans, n.d.; Ridolfo et al., 

2012; VanKim et al., 2010). One study had the capability to compare nonresponse over time (Jans et al., 

2015). Overall, nonresponse appears to be relatively low across all studies that have examined sexual 

identity, varying from less than 1% to just over 6% (Case et al., 2006; Dahlhamer et al., 2014; Grant and 

Jans, n.d.; Ridolfo et al., 2012; VanKim et al., 2010). 

Iミ geミeヴal, studies that looked at ミoミヴespoミse Iouミted さミot suヴe,ざ さdoミ’t kミo┘,ざ aミd ヴefusals as iteマ 

nonresponse (Dahlhamer et al., 2014; Kim and Fredriksen-Goldsen, 2013; VanKim et al., 2010). Some 

ヴeseaヴIheヴs also tヴeated さsoマethiミg elseざ ヴespoミses as マissiミg foヴ seleIt aミal┞ses ふDahlhaマeヴ et al., 

2014). In some cases, researchers excluded respondents that did not answer all of the related sexual 

identity items (Mohr and Kendra, 2011). 

Although low overall, item nonresponse was found to vary by respondent demographic characteristics. 

For example, research has found that nonresponse to sexual identity questions tends to increase with 

age (Gruskin et al., 2001). Focusing on the time spent on the sexual identity question, the NHIS found 

that there were significantly more adults ages 65 and older in the shortest and longest time groups 

(based on quintiles), suggesting possible comprehension problems often associated with item 

nonresponse (Dahlhamer et al., 2014). 

Nonresponse also varied by sex of the respondent, although the direction of this finding seemed to vary 

by age. Item nonresponse has been found to be higher for women compared to men (Grant and Jans, 

n.d.; Gruskin et al., 2001). In some cases, it is particularly high for women who speak a language other 

than English (Grant and Jans, n.d.) In contrast, Saewyc et al., (2004) found that boys had higher 

nonresponse than girls in a survey of students ages 12 to 20. 

The majority of studies found that rates of item nonresponse varied by race and ethnicity. In general, 

non-Hispanic African Americans, Asians, and Hispanics had higher nonresponse rates than non-Hispanic 

whites (Grant and Jans, n.d.; Gruskin et al., 2001; Jans et al., 2015; Kim and Fredriksen-Goldsen, 2013; 

Saewyc et al., 2004). This finding also held when other covariates correlated with item nonresponse, 

such as age, income, education, were examined (Kim and Fredriksen-Goldsen, 2013). Specifically, nonHispanic African Americans, Asians, and Hispanics were about 2.6, 12.5, and 6.4 times more likely, 

respectively, than non-HispaミiI ┘hites to ヴespoミd さミot suヴe oヴ doミ’t kミo┘ざ ふKiマ aミd FヴedヴikseミGoldsen, 2013). Item nonresponse has also been found to be higher among persons who speak 

languages other than English (Dahlhamer et al., 2014; Grant and Jans, n.d.; Jans et al., 2015; Saewyc et 

al., 2004). NHIS time analyses have also shown evidence of question shortcutting for adults answering in 

Spanish—that is, there were more respondents answering in Spanish who were in the shortest-time 

group to complete the question than respondents answering in English (Dahlhamer et al., 2014). 

Nonresponse on sexual identity items also varies by education. Persons with less education (less than a 

high school degree or no college education) were less likely than those with at least some college 

education to respond to sexual identity questions (Dahlhamer et al., 2014; Gruskin et al., 2001). NHIS 

time analyses have also shown evidence of question shortcutting for adults with less education 

(Dahlhamer et al., 2014). 
17

Item nonresponse may also vary by the question wording. For example, the NSFG modified its sexual 

identity question to include more commonly used identity categories and dropped the definition that 

had been included in previous versions. These changes reduced the level of さotheヴざ ヴespoミses from 

about 4.2% in 2002 to 0.4% in 2006 (Ridolfo et al., 2012). 

Context of administration and scope of items included in the survey also appear to affect item 

nonresponse. Research completed by Saewyc et al., (2004) with students ages 12 to 20 found that for 

surveys without the sexual behavior questions, the combined self-labeling/attraction questions had the 

lowest nonresponse, followed by the combined attraction/intentions questions. The selflabeling/attraction item conflates the two concepts, which is likely a contributing factor to the item 

nonresponse. Lower nonresponse was observed in surveys administered by public health nurses 

compared to teachers. Items with the shortest stems, fewest response options, and fewest words had 

the lowest nonresponse rates. Identity and attraction items that followed sexual behavior questions had 

higher item nonresponse than similar questions that appeared before the behavior items. 

Item nonresponse may also vary over time. In the California Health Interview Survey (CHIS), sexual 

minority self-identification increased over time as item nonresponse declined (Jans et al., 2015). CHIS 

respondents whose interviews were completed in non-English languages showed the greatest declines 

over time in item nonresponse for sexual identity (Jans et al., 2015). 

Qualitative Analyses: Cognitive Testing 

The reviewed studies also assessed items using cognitive interviewing to observe paヴtiIipaミts’ reactions 

and responses to measures of sexual identity. These studies completed cognitive interviews with 

participants of various demographic groups, including adolescents and adults, and LGB and non-LGB 

persons. (Clark et al., 2005; Ingraham et al., 2015; Martinez et al., 2016; National Center for Education 

Statistics, forthcoming; Ridolfo et al., 2012; Stern, et al., 2016; National Opinion Research Center 

(NORC), 2016). 

The terminology used in sexual identity questions has been one area of focus in available cognitive 

interviewing research. Some have found that participants have comprehension difficulty with the term 

さheteヴose┝ual,ざ aミd ヴespoミdeミts recognize さstヴaightざ as the more common term (Miller and Ryan, 

2011; National Center for Education Statistics, forthcoming). However, some straight participants felt 

that the terms さheterosexualざ aミd さhomosexualざ were more proper and less offensive than さstraight,ざ

さgay,ざ aミd さlesbianざ (National Center for Education Statistics, forthcoming). Similar comprehension 

issues were found in other cognitive testing. In particular, some participants, especially low-income 

participants, did not know how to define さheterosexualざ (Ridolfo et al., 2012). Further, Hispanic 

cognitive interview participants with less education (particularly those who completed the survey in 

Spanish) were less likely to be familiar with the sexual identity terms (Ridolfo et al., 2012). Research has 

also found that certain participants, particularly those of lower socioeconomic status and Spanishspeakers, had diffiIult┞ ┘ith the teヴマ さHise┝ual,ざ Ioミfusiミg it ┘ith heteヴose┝ual oヴ IoミIeptualiziミg it as 

behavior (Miller and Ryan, 2011). This research, however, recommended keeping the term as it is the 

appropriate term used by bisexual respondents (Miller and Ryan, 2011). 

Participant reactions to sexual identity items varied by demographic characteristics, as well. 

Heterosexual participants tended to define theマsel┗es as さミot ga┞,ざ that is, distancing themselves from 

the stigmatized gay identity (Ridolfo et al., 2012). Among heterosexual participants, there was a mix of 
18

pヴefeヴeミIe foヴ the teヴマs さstヴaightざ aミd さミot ga┞ざ ふMilleヴ and Ryan, 2011; Ridolfo et al., 2012). 

Transgender participants who associate with the queer community may have problems associating 

theマsel┗es ┘ith the teヴマ さheteヴose┝ualざ e┗eミ though this may be the appropriate description; for 

instance, transgender male-to-female may have relationships with men (Ridolfo et al., 2012). 

Testing from the CHIS showed a high rate of misclassification of adults ages 70 and older into the 

bisexual category. Because of these findings, CHIS limited the sample universe to persons age 70 and 

younger (Grant and Jans, n.d.). Additional testing of sexual identity items among an older population of 

adults revealed that the items tested well for English-speaking adults (Stern et al., 2016). Sexual identity 

items tested in the context of a victimization survey among persons ages 16 and older performed well 

for both adolescents and adults (Martinez et al., 2016). Other testing among adolescents found that 

many respondents felt that sexual identity was difficult to answer, in some cases because it implied a 

degree of permanence with which they were not comfortable (Austin et al., 2007; Saewyc, 2011). 

Ridolfo et al. (2012) identified a complex relationship between gender and sexual identity specifically for 

transgender persons. That is, sexual identity may be difficult to answer for persons who are in the 

pヴoIess of Ioマiミg out oヴ tヴaミsitioミiミg geミdeヴs. These ヴespoミdeミts マost ofteミ Ihose さotheヴざ oヴ さdoミ’t 

kミo┘ざ ヴespoミses iミ lieu of the otheヴ optioミs pヴo┗ided. In other cases, transgender respondents chose 

さheteヴose┝ualざ HeIause they had fully re-conceptualized their gender identity and were in a relationship 

with partners of their previous genders. These cognitive interviews illustrated that transgender 

respondents rejecting traditional terms used to describe sexual identities were more likely to experience 

difficulty in responding. 

Research on sexual identity measurement also revealed issues related to language. The sexual identity 

measure for the NSFG was cognitively tested and showed using terms such as さstraightざ and さgayざ

produced better comprehension in English administration; however, there is no translation for 

さstraightざ in the Spanish language (Ridolfo et al., 2012). Some have concluded that the presence of the 

┘oヴd さheteヴose┝ualざ oミ the “paミish laミguage ケuestioミ helps respondents make sense of other response 

Iategoヴies ふMilleヴ aミd R┞aミ, ヲヰヱヱぶ. Aミd iミ the saマe マaミミeヴ, the aHseミIe of the ┘oヴd さheteヴose┝ualざ oミ 

the English-language question is helpful to reduce response difficulty (Miller and Ryan, 2011). Cognitive 

interviewing of an older adult population revealed some comprehension problems among Spanishspeaking respondents and recommended changing the order of the sexual identity response category 

fヴoマ さHeteヴose┝ual, o sea, ミo ga┞ざ to さNo ga┞, o sea, heteヴose┝ualざ ふ“tern et al., 2016). The reasoning 

for this change was to improve Spanish-speaking ヴespoミdeミts’ ability to properly report their sexual 

identity by pヴeseミtiミg the さミot ga┞ざ e┝plaミatioミ fiヴst ふ“teヴミ et al., 2016). This was further tested with 

Spanish-speaking adults, and the recommended change tested well (NORC, 2016). 

Glaze (2015) examined the functioning of a sexual identity item used in the Survey of Prison Inmates 

(SPI). Overall, interviewers did not report negative or unusual reactions to the question. Consistent with 

otheヴ ヴeseaヴIh, soマe ヴespoミdeミts had tヴouHle ┘ith the teヴマ さheteヴose┝ual,ざ particularly Spanishspeaking inmates, but after the question was reread they were able to answer appropriately (L. Glaze, 

BJS and T. Smith, RTI International, personal communication, February 22, 2016). In doing so, some 

respondents strongly asserted that they were straight. There were no differences observed between 

Spanish-speaking and English-speakiミg ヴespoミdeミts’ ヴeaItioミs (L. Glaze, BJS and T. Smith, RTI 

International, personal communication, February 22, 2016). 

Future Research 
19

Researchers evaluating sexual identity measures often note directions for future research to improve 

sexual identity measurement. For example, with regard to measuring health outcomes related to sexual 

identity, Gruskin and colleagues (2001) note that their study may not have completely captured 

respondents’ experiences because they only included one question on sexual orientation, compared to 

asking multiple questions on sexual orientation and sexual behavior. Saewyc and colleagues (2004) 

suggest that future research focus on additional measures of behavior and either self-labeling or sexual 

attraction when trying to effectively measure health outcomes related to sexual identity. 

Several researchers recommend further research on the effect of context in which sexual identity 

questions are administered. Specifically, an important component of survey methodology and 

interviewing is interviewer training. Research suggests that data quality can be improved by focusing 

interviewer training on the implications of invalid data and asking questions as worded, especially 

questions on sensitive topics (Grant and Jans, n.d.; Ridolfo et al., 2012). Furthermore, sensitive 

questions, like questions on sexual identity, may need to be asked in private areas so the respondent is 

comfortable. Research related to privacy and discreteness when administering sexual identity questions 

is needed (Grant and Jans, n.d.; Ridolfo et al., 2012). Other areas of future research related to survey 

administration of sexual identity questions include the consistent administration of questions and issues 

related to administering these questions via different survey modes (Grant and Jans, n.d.). Further, 

Ridolfo and colleagues (2012) suggest putting the sexual identity items near demographic questions 

rather than around sexual attraction and behavior questions; not doing so may lead to biased responses 

(Ridolfo et al., 2012). 

Other researchers have urged exploring innovative ways to measure sexual orientation that would 

address alternative sexual identity terms that may be more relevant to other racial and ethnic groups 

(e.g., same-gender loving, down-low) (Sexual Minority Assessment Research Team, 2009). This research 

is important to fully measure sexual identity in the national population (Kim and Fredriksen-Goldsen, 

2013). Saewyc et al. (2004) also suggest a closer examination of adolesIeミts’ uミdeヴstaミdiミg of se┝ual 

identity questions. 

Sexual Attraction 

As defined earlier, sexual attraction refers to the sex or gender to which someone feels attraction (e.g., 

whether an individual is attracted to males/men, females/women, or both). Four studies were identified 

that evaluated questions on sexual attraction. Two of these studies used cognitive interviewing 

techniques, while the other two involved quantitative evaluations of survey questions. The target 

populations differed considerably across the four studies, including women ages 40 and older, 

adolescents between the ages of 12 and 21, and adults of all ages. Appendix C lists the questions tested 

in the cited studies. 

Although they found differences for sexual identity and behavior, Coffman et al. (2013) found no 

significant difference in the reporting of same-sex attraction when using a method that was proven to 

reduce social desirability bias.7

 This may indicate that current best practices that ensure privacy and 

 

7

 Coffman and colleagues utilized a variatioミ of さiteマ Iouミtざ teIhミiケue. The authoヴs ヴaミdoマized ヴespoミdeミts iミto 

two groups. The control group was given a baseline set of four innocuous questions, told to indicate the total 

ミuマHeヴ of さ┞esざ ヴespoミses, aミd theミ iママediatel┞ asked a seミsiti┗e ケuestion. The other group was told to indicate 
20

confidentiality, in this case the use of a self-administered online survey, may be sufficient for collecting 

information about sexual attraction. However, the authors note that incorrect interpretation of the 

question resulted in increased reports of both non-heterosexual identity and same-sex sexual behavior, 

and may be related to the experimental method used. Further research is needed. 

Based on cognitive interviews of women ages 40 and older, Clark et al. (2005) evaluated the following 

questioミ oミ se┝ual attヴaItioミ: さPeople diffeヴ iミ theiヴ ph┞siIal attヴaItioミ to otheヴ people. WhiIh 

statement best describes your feelings? Would you say ... only attracted to women, mostly attracted to 

women, equally attracted to women and men, mostly attracted to men, only attracted to men, not sure, 

ミoミe of the aHo┗e stateマeミts desIヴiHe ┞ouヴ feeliミgs.ざ The pヴiマaヴ┞ ヴespoミse pヴoHleマ to eマeヴge fヴoマ 

an initial round of interviewing was the request for clarification of the type of attraction being asked 

about in the question. A ヴe┗ised ケuestioミ ┘as tested that added the teヴマ さph┞siIall┞ざ to the fiヴst fi┗e 

response options (see Appendix C). Using the revised question, when participants were asked to define 

physical attraction, answers included sexual, chemical, and erotic examples. Although 80% of the 

participants provided a definition of attraction that included sexual intimacy, other factors were 

mentioned including affection, affiliation, and emotional preference. These constitute important 

alternative interpretations of physical attraction among middle-aged and older women. 

Austin and colleagues (2007) performed cognitive interviews with 30 adolescents between the ages of 

15 and 21. In addition to questions on sexual identity and behavior, the study authors evaluated a 

combined identity-attraction question and an attraction-only question (see Appendix C). The results 

were mixed for the combined question, with some of the participants noting the intermediate response 

optioミs Het┘eeミ さIoマpletel┞ heteヴose┝ualざ aミd さHise┝ualざ aミd Het┘eeミ さHise┝ualざ aミd さIoマpletel┞ 

hoマose┝ualざ as positi┗e featuヴes of the ケuestioミ. Ho┘e┗eヴ, se┗eヴal se┝ual マiミority participants found 

the identity terms and parenthetical statements of attraction to be confusing, conflating two different 

e┝peヴieミIes. Foヴ e┝aマple, soマe ┞outh ミoted the dileママa pヴeseミted H┞ the Iategoヴ┞ さIoマpletel┞ 

hoマose┝ualざ ┘ith its paヴeミthetiIal attヴaItioミ stateマeミt of さga┞/lesHiaミ, attヴaIted to peヴsoミs of the 

saマe se┝.ざ “oマe of these paヴtiIipaミts stated that the┞ desIヴiHe theマsel┗es as ga┞ oヴ lesHiaミ, Hut also 

feel some attraction to members of the opposite sex. The combined question also presented problems 

foヴ tヴaミsgeミdeヴ ┞outh ┘ho ┘eヴeミ’t suヴe if the┞ should aミs┘eヴ Hased oミ theiヴ HiologiIal se┝ oヴ theiヴ 

geミdeヴ ideミtit┞. “oマe tヴaミsgeミdeヴ ┞outh aミs┘eヴed さミot suヴeざ oヴ さHise┝ualざ as a ┘a┞ to a┗oid Ihoosiミg 

between the two. 

The sexual attraction-only question (second item listed in Appendix C) appeared to work well with the 

participants, with all but two youth describing the item as specific, clear, and easy to answer. Consistent 

with the Clark et al. (2005) study, the two dissenting youth thought the foIus oミ さse┝ualざ attヴaItioミ to 

be too restrictive, and reported other types of attraction including romantic-emotional attraction. For 

most of the youth, however, this narrow definition of attraction was regarded as a positive aspect of the 

item. Other positive aspects included self-explanatory response options and the less-threatening nature 

of the question, relative to the sexual identity item. Some of the participants thought that young 

adolescents in particular would find this question easier to answer since they are still in the process of 

さfiguヴiミg outざ theiヴ se┝ual ideミtit┞.

 

the total ミuマHeヴ of the さ┞esざ ヴespoミses to a set of fi┗e ケuestioミs that iミIluded the oヴigiミal fouヴ ケuestioミs gi┗eミ to 

the control group plus the sensitive question. The true value of the sensitive question was deduced by comparing 

the responses between groups. 
21

In a quantitative study of survey responses, Saewyc and colleagues (2004) analyzed five questions 

combining elements of sexual identity and sexual attraction and one question combining elements of 

sexual attraction and sexual intentions. As shown in Appendix C, three of the five sexual 

identity/attraction questions shared the same response options but differed in their question stems. The 

other two identity/attraction questions also shared response options but used different question stems. 

One or more of these questions was asked in each of eight adolescent health surveys with varying 

sampling designs and demographic compositions. All eight surveys were administered in schools. 

Overall, the surveys covered students in grades 7-12, with the ages of participants ranging from 12 to 

20. 

The authors compared item nonresponse rates to the questions across surveys as the primary 

performance measure. Overall, the identity/attraction items produced item nonresponse rates in the 

range of 0.6% to 16.2% for females and 0.7% to 18.2% for males. These large variations in item 

nonresponse rates were also observed across years and surveys for identically-worded questions, 

suggesting causal factors other than question wording. For example, for surveys without sexual behavior 

questions, the combined identity/attraction questions produced the lowest nonresponse, followed by 

the combined attraction/intention question. However, when the identity and attraction items followed 

sexual behavior questions they tended to produce higher item nonresponse than similar questions that 

appeared before the behavior items, highlighting the importance of question context and location as 

factors affecting performance. While all surveys were administered in classrooms via paper and pencil, 

some were administered by teachers, some by research staff, and some by public health nurses. 

Interestingly, lower item nonresponse was observed in surveys administered by the public health 

nurses. The authors also noted that the conflation of attraction and identity in these questions likely 

contributed to item nonresponse, although no questions that tapped identity alone or attraction alone 

were available for comparison. 

Only two of the eight surveys included an attraction/intention question, with each survey using a slightly 

different question stem from the other (but same response options). The item nonresponse rates were 

vastly different between the two surveys, with one producing rates of 25.5% (females) and 23.2% 

(males), and the other producing rates of 6.0% (females) and 6.8% (males). The authors noted that these 

questions were confusing and likely produced comprehension problems since they ask about both 

current feelings and future behaviors. 

Across all seven identity/attraction and attraction/intention questions, higher item nonresponse was 

observed for boys, younger students, students with a learning disability, students held back a grade, 

students who reported speaking a language other than English at home, and African-American and 

Southeast Asian students. Finally, students who were "not sure" of their orientation were more likely to 

piIk さミot suヴeざ to otheヴ ケuestioミs iミ the suヴ┗e┞.

Saewyc and colleagues strongly suggested that more testing is needed to understand how adolescents 

comprehend measures of sexual orientation. As for recommeミdatioミs, the┞ suggested that さ[t]o 

effectively measure the highest priority health concerns, the best choice would include behavior plus 

either self-labeling or attraction" (345.e12). 
22

Sexual Behavior 

As mentioned above, sexual behavior refers to the sex of a peヴsoミ’s se┝ual paヴtミeヴs (e.g., individuals of 

the same sex, different sex, or both sexes). We identified four quantitative and qualitative studies that 

attempted to assess the measurement of sexual behavior. These studies looked at how sexual behavior 

items performed, iteマ ミoミヴespoミse, aミd ヴespoミdeミts’ ヴeaItioミs to capturing their sexual behavior. In 

general, researchers assess sexual behavior by asking respondents to report the sex of their sexual 

partners, during a specified period of time in the past and/or during their lifetime. Notably, only one 

study focused solely on sexual behavior (Berg and Lien, 2006). The other studies simultaneously 

measured two or three dimensions of sexual orientation (behavior and identity, or behavior, identity, 

and attraction) (Case et al., 2006; Poston and Chang, 2015; Vrangalova and Savin-Williams, 2012). A 

discussion of measures of sexual behavior in conjunction with identity and attraction can be found in the 

section entitled Congruency of Multiple Measures of Sexual Orientation. The current section discusses

findings related to sexual behavior. Appendix D lists the questions tested in the cited studies. 

Populations Surveyed 

The populations included in studies that evaluate sexual behavior questions vary by demographic 

characteristics of respondents. These demographic characteristics include sexual identity, sexual 

attraction, sex, income, race, and marital status. Demographic characteristics also varied by educational 

attainment, age, city size, and language. 

Qualitative Analyses of Sexual Behavior Items 

Case et al. (2006) piloted a sexual identity question ふヴefeヴヴed to as さidentity or oヴieミtatioミざぶ and a sexual 

behavior question on a sample drawn of never married, previously married, and currently married 

female participants of the 1993 Nuヴses’ Health “tud┞ II (NHSII). Pilot participants were asked to write in 

their reactions to the sexual identity and behavior questions. Regarding the sexual behavior item (see 

Appendix D), soマe paヴtiIipaミts foIused oミ the ケuestioミ ┘oヴdiミg, IoヴヴeItiミg gヴaママaヴ ふsuggestiミg さ┘ith 

┘hoマ ┞ou ha┗e had se┝ざ ┗s. さ┘ho ┞ou ha┗e had se┝ ┘ithざぶ and indicating confusion with the use of the 

phヴases さマaミ/マeミざ aミd さ┘oマaミ/┘oマeミ.ざ “e┗eヴal paヴtiIipaミts also ミoted that the teヴマ さadult 

lifetiマeざ did ミot iミIlude teeミage ┞eaヴs. Some participants felt the item was too personal, but others 

were excited to see sexual behavior being iミIluded as aミ aspeIt of ┘oマeミ’s health. 

Quantitative Analyses: Item Nonresponse and Misreporting 

Berg and Lien (2006) developed a probability model that simultaneously dealt with misreporting and 

item nonresponse using a self-reported question on sexual behavior in the General Social Survey (GSS). 

The goal of the model was to estimate the frequency of same-sex sexual behavior in the presence of 

non-ignorable item nonresponse and misreporting. The researchers included income, race/ethnicity, 

marital status, parental status, education, age, and city size as covariates in the model, and they 

performed separate analyses by sex. Among women, Berg and Lien found that item nonresponse 

decreases as income increases, increases as age increases, and increases as education level increases. 

Among men, they found item nonresponse decreases as city size increases. 

Misreporting, a type of measurement error, occurred in the study when non-heterosexuals reported

their behavior as exclusively heterosexual and when heterosexuals did not report same-sex sexual 

behavior. The authors found that among men, misreporting increased as income increased and 
23

misreporting decreased as age increased. They also found that white men had a higher probability of 

misreporting compared to men of all other races. Among men and women, misreporting decreased as 

city size increased. 

Congruency of Multiple Measures of Sexual Orientation 

Some studies that were reviewed examined multiple dimensions of sexual orientation (sexual identity, 

sexual attraction, and sexual behavior), and whether respondents answered consistently among these 

dimensions. In general, research finds that a peヴsoミ’s se┝ual ideミtit┞ is ミot ミeIessaヴil┞ Ioミgヴueミt ┘ith 

their sexual attraction or behaviors (Fisher et al., 2001; Poston and Chang, 2015; Ridolfo et al., 2012; 

Saewyc, 2011; Saewyc et al., 2004; Vrangalova and Savin-Williams, 2012). Some researchers have 

concluded that sexual orientation may be viewed on more of a continuum of sexuality (Poston and 

Change, 2015; Vrangalova and Savin-Williams, 2012). 

Research among adolescents and adults has found that persons who reported being heterosexual or gay 

or lesbian, did not necessarily also report consistent responses to sexual attraction or behavior items 

(Fisher et al., 2001; Poston and Chang, 2015; Saewyc et al., 2004; Ridolfo et al., 2012; Vrangalova and 

Savin-Williams, 2012). That is, some persons who identify as gay or lesbian also report opposite-sex 

attraction or behaviors; and some persons who identify as heterosexual report same-sex attraction or 

behaviors. Using aミ e┝paミded IategoヴiIal マeasuヴe of se┝ual ideミtit┞ that iミIluded さマostl┞ ga┞/lesHiaミざ 

aミd さマostl┞ heteヴose┝ual,ざ Vrangalova and Savin-Williams (2012) found that respondents who reported 

these non-exclusive responses also reported non-exclusive responses to other sexual orientation 

components, particularly in terms of attraction. This same research found that males typically reported 

more consistent responses to their sexual orientation than females. 

Given incongruent responses to questions tapping the three dimensions of sexual orientation (i.e., 

identity, behavior, and attraction), the appropriate measure depends on the primary objective of the 

research (Saewyc, 2011; Vrangalova and Savin-Williams, 2012). For example, some have suggested that 

health researchers or educators may want to focus more on sexual behavior, while still including 

measures of identity and attraction, in order to gain appropriate information from respondents (Fisher 

et al., 2001; Saewyc et al., 2004). It is also important to note that prevalence rates of homosexuality, 

bisexuality, and heterosexuality may vary by definition and are found to be highest when a more 

inclusive definition is used (Poston and Chang, 2015).

b. Gender Identity 

In its 2011 report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation 

for Better Understanding, the Institute of Medicine (IOM) recommended the expansion of research 

methods yielding data to inform decisions about LGBT health. Although advances have been made in the 

measurement of sexual identity since the ヴepoヴt’s release, much of the literature on transgender 

individuals has relied on data from convenience samples in limited geographic areas and may not be 

generalizable to the overall transgender population. Initial research has shown that transgender 

individuals are at greater risk of discrimination in housing, employment, and health (Center for American 

Progress, 2015). Other research points to a higher likelihood of binge drinking (Scheim, Bauer, and 

Shokoohi, 2016), higher likelihood of suicide attempt (Grant et al., 2010) and higher levels of sexual 

victimization in prisons and jails (Beck et al., 2014). 
24

Yet, at the tiマe of this ┘oヴkiミg papeヴ’s ヴelease, fe┘ Federal surveys have included measures of gender 

identity. In part, this is because measures of gender identity have not been tested by Federal agencies 

until just recently. While it is clear that the measurement of gender identity is important, researchers 

face a choice between different measures. Without an evaluation of measurement functioning, Federal 

agencies may be reluctant to collect these data for fear that measurement problems would affect the 

quality of the statistics produced (and used to inform policy making). Another challenge is that, where 

gender identity measures are included, different measures are used in different surveys. As with other 

measures (e.g., functional disability), the use of different measures can make it difficult to compare 

estimates across surveys. The purpose of this section is to summarize recent evaluations of gender 

identity measures in the U.S. 

Gender Identity Measures 

At their most basic level, gender identity measures can be broken into two types: single-item and twostep measures. 

Single-item measures, as the name implies, use a single item to capture gender identity. In their 2014 

report, Best Practices for Asking Questions to Identify Transgender and Other Gender Minority 

Respondents on Population-Based Surveys, the Gender Identity in the U.S. Surveillance (GenIUSS) Group 

recommended using single-iteマ マeasuヴes さ┘heミ ┗alid, self-report measures of assigned sex at birth and 

curreミt geミdeヴ ideミtit┞ aヴe ミot oミ a suヴ┗e┞ aミd Iaミミot He added ふoヴ ヴeplaIe e┝istiミg マeasuヴesぶざ 

(GenIUSS Group, 2014). 

A number of Federal surveys utilize a single-item measure. The Behavioral Risk Factor Surveillance 

System (BRFSS) introduced an optional single gender identity item in 2013 (see Appendix F). Baker and 

Hughes (2016) reported that states utilizing the BRFSS sexual and gender identity (SOGI) module 

reported that it is well-received by respondents and does not negatively affect the quality of data 

collected. The authors also said that the Missouri state BRFSS coordinator reported no survey break-offs 

and minimal item nonresponse. 

The National Inmate Survey (NIS) also uses a single-item approach to gender identity. While 

groundbreaking in its ability to estimate the transgender-identified inmate population in U.S. prisons 

aミd jails, the NI“ さIhoose oミe ヴespoミseざ appヴoaIh Ioマpels iミマates who ideミtif┞ as Hoth さマaleざ oヴ 

さfeマaleざ and さtヴaミsgeミdeヴざ to deIide Het┘eeミ Hoth ideミtities. Aミotheヴ Ihalleミge ┘ith the NIS 

measures, which also affects the BRFSS measure, is related to respondents who do not identity as 

transgender but whose gender identities are incongruent with their natal sex. If these respondents 

Ihoose さマaleざ oヴ さfeマale,ざ the BRFSS and NIS may undercount the transgender population. 

The Population Assessment of Tobacco and Health (PATH) uses a variation of the single-item approach. 

After a definition of transgender is read to respondents, those who respond that they are transgender 

are asked a follow-up item to further clarify their gender identity. This item, however, may suffer from 

the same analytic challenges as the BRFSS and NIS items described above. 

Two-item measures generally capture assigned sex at birth (i.e., natal sex) and current gender identity. 

The GeミIU““ Gヴoup ヴeIoママeミds utiliziミg t┘o step マeasuヴes, さ┘heミ t┘o deマogヴaphiI iteマs Iaミ He 

added to an adult survey (or, in most instances, a standing measure of sex replaced and a measure of 

Iuヴヴeミt geミdeヴ ideミtit┞ addedぶ.ざ T┘o-step measures are also recommended for use by the Center of 
25

Excellence for Transgender Health (CoE)8 and the World Professional Association for Transgender Health 

(WPATH; Deutsch et al., 2013). The Federal surveys utilizing two-step measures are the National Crime 

Victimization Survey (NCVS), Survey of Prison Inmates (SPI), and the National Adult Tobacco Survey (see 

Appendix F). 

Although there has been limited testing on the single-item method, there have been a number of tests 

of the two-part method. The challenge with these methods is that the language of these items varies 

across tests (see Appendix E for the language used in the studies cited in this section), making the 

comparison of results difficult. Regardless, each study advances the understanding of how respondents 

understand and react to questions about both sex and gender. 

Lombardi and Banik (2016) recruited a convenience sample of transgender and cisgender people in Ohio 

(n=50) to examine how they understood and answered a two-step gender identity item. Both cisgender 

and transgender participants were able to answer the question about natal sex, referring to their 

physiology (e.g., genitalia) or birth certificate.9 Cisgender participants were split about whether sex was 

inherently biological/physiological or assigned by someone like a physician, while approximately twothirds of transgender participants described sex as being assigned by a health professional or someone 

else. Cisgender participants ┘eヴe aHle to aミs┘eヴ the さse┝ oヴ geミdeヴざ ケuestioミ ┘ithout hesitatioミ. AHout 

half felt that sex and gender measured the same concepts, and all of them responded in the same 

manner as they responded to natal sex. All but two of the transgender participants chose a gender that 

differed from their natal sex, and all but one saw sex and gender as measuring different concepts. There 

┘as, ho┘e┗eヴ, a pヴefeヴeミIe aマoミg tヴaミsgeミdeヴ paヴtiIipaミts to dヴop さse┝ざ fヴoマ さse┝ oヴ geミdeヴ.ざ Based 

on these results, the authors felt the two-step measure could be used to distinguish between the 

transgender and cisgender populations. 

In a study examining the collection of SOGI at medical intake, Cahill et al. (2014) tested a version of the 

two-step gender identity items on a diverse group of 301 patients in four community health centers. The 

researchers found that study participants understood and were willing to answer the tested two-step 

items. In fact, 84% of participants strongly agreed or somewhat agreed that they would answer the 

question on natal sex, and 86% of participants strongly agreed or somewhat agreed that they would 

answer the gender identity question. More than three-quarters of participants strongly agreed that they 

understood the gender identity item response options. Compared to younger participants, participants 

ages 65 and older were less likely to understand what the questions were asking or the response 

options. But their mean responses were in the neutral range of the scale indicating an average level of 

understanding. 

Reisner et al. (2014) studied the validity of natal sex and gender identity in youth. Their study found 

that, compared to cisgender participants, gender minority participants scored higher on both recalled 

childhood gender nonconformity measures (criterion-related validity) and current socially assigned 

gender nonconformity measures (construct validity). Both gender minority participants and cisgender 

participants indicated that the natal sex question was clear and easy to answer. Both groups mentioned 

that さph┞siIal aミatoマ┞ざ ┘as used to assigミ se┝ at Hiヴth. All paヴtiIipaミts felt the ヴespoミse optioミs of 

さマaleざ aミd さfeマaleざ ┘eヴe appヴopヴiate, iミIludiミg a siミgle iミteヴse┝ paヴtiIipaミt ┘ho aIkミo┘ledged that 

 

8

 See http://transhealth.ucsf.edu/trans?page=lib-data-collection. 

9

 It is worth noting that the tested item did not refer to birth certificate. 
26

these are the only options available on birth certificates in the U.S. More than three-quarters of 

paヴtiIipaミts uミdeヴstood geミdeヴ to He aミ iミteヴミal IoミIept that Iould diffeヴ fヴoマ oミe’s ミatal se┝. As ┘ith 

natal sex, all participants felt that the gender identity question was straightforward, but gender minority 

participants did express difficulty in choosing the most appropriate response option. Some expressed 

switching their responses given that they were only allowed to select one gender. The majority of 

cisgender participants were not sure what was マeaミt H┞ the さdo ミot ideミtif┞ざ ヴespoミse optioミ. That 

being said, they were still able to respond accurately, and two participants who identified as gender 

non-conforming or gender ┗aヴiaミt seleIted the さdo ミot ideミtit┞ざ ヴespoミse optioミ. More than threequarters of participants liked the response options offered in the gender identity questions, but one 

who identified as genderqueer suggested a write-in response option. 

In a cognitive test of English-speaking, cisgender individuals (ages 16 and older), Martinez et al. (2016), 

examined how direct the natal sex item should be. The authors found that the majority of study 

paヴtiIipaミts pヴefeヴヴed a diヴeIt ミatal se┝ ケuestioミ ふi.e., さOn your original birth certificate, was your sex 

assigned as male or female?ざぶ o┗eヴ a less diヴeIt, Hut マoヴe Ioママoミ, ケuestioミ ふi.e., さWhat sex were you 

assigned at birth, on your original birth certificate?ざぶ Regaヴdless of pヴefeヴeミIe, ho┘e┗eヴ, alマost all 

respondents (89%) said they understood both questions equally well. The researchers also examined 

┘hetheヴ paヴtiIipaミts pヴefeヴヴed geミdeヴ laHels ふi.e., さDo ┞ou Iuヴヴeミtl┞ desIヴiHe ┞ouヴself as a マaミ, ┘oマaミ, 

oヴ tヴaミsgeミdeヴ peヴsoミ?ざぶ o┗eヴ se┝ laHels ふi.e., さDo ┞ou Iuヴヴeミtl┞ desIヴiHe ┞ouヴself as マale, feマale, oヴ 

tヴaミsgeミdeヴ?ざぶ The マajoヴit┞ of study participants preferred sex labels (i.e., male, female) to gender (i.e., 

man, woman) labels, but the majority of respondents said that both questions were understood equally 

well. That said, it was pointed out that cisgender youth may not consider themselves to be old enough 

to He さマaミざ oヴ さ┘oマaミ.ざ

Glaze (2015) tested the two-part gender identity item while testing the functionality of the SPI 

instrument with a group of cisgender prison inmates. Unlike prior studies, the two-step measure was 

implemented without specific follow-up, but the reactions of the inmates were observed. The research 

found that participants did not react negatively to the items and were able to provide their responses. 

The studies discussed so far have only looked at comprehension of the two-step gender identity method 

in English. Stern et al. (2016) examined comprehension of these items in the English- and Spanishspeaking Medicare disabled (ages 18-64) and aged (ages 65 and older) populations. The authors found 

that English speakers had no problems comprehending the item related to natal sex. When asked about 

the gender identity item, the majority of English-speaking cisgender participants associated the term 

さtヴaミsgeミdeヴざ ┘ith the ph┞siIal Ioマpoミeミt of tヴaミsitioミiミg. “oマe Eミglish-speaking respondents 

conflated sexual identity (i.e., being straight, bisexual, lesbian, or gay) with gender identity, but all of 

them responded to the gender identity item in a manner that was consistent with a gender item 

collected during the study screener. 

Spanish-speaking study participants were able to answer the item related to natal sex, though some 

ヴespoミded ┘ith theiヴ geミdeヴ e┝pヴessioミ ふe.g., さマasIuliミeざ oヴ さfeマiミiミeざぶ ヴatheヴ thaミ theiヴ se┝ ふ“teヴミ et 

al., 2016). The majority of Spanish-speaking participants conflated sexual identity and gender identity, 

and some expressed discomfort in being asked about their gender identity. In addition, a number of 

Spanish-speakiミg Iisgeミdeヴ paヴtiIipaミts e┝pヴessed that theiヴ geミdeヴ ideミtit┞ ┘as さミoヴマalざ oヴ さミoミde┗iaミt.ざ E┗eミ ┘ith the issues the ヴeseaヴIheヴs ideミtified iミ the “paミish-speaking population, all of them 
27

responded to the gender identity item in a manner that was consistent with a gender item collected 

during the study screener. 

Future Federal Research 

There are a number of areas in which Federal research could add to the literature on how best to 

measure gender identity. First, little is known about how question order in the two-step measure may 

affect response. Saperstein and Westbrook (2014) used a randomized design in a large Web panel and 

found no evidence of an order effect. However, Lombardi and Banik (2016) found that most transgender 

participants in their study preferred current gender identity be asked prior to natal sex. The GenIUSS 

Group recommends asking natal sex first, while WPATH and CoE recommend asking current gender 

identity first. More research is needed. 

Another unresolved issue in the literature is whether to include a reference to oミe’s original birth 

certificate in the natal sex item. While there have been no studies focusing on this specific issue, there is 

anecdotal evidence that transgender individuals preferred its exclusion. The GenIUSS group 

recommended that the two-step approach includes a birth certificate reference, while CoE’s マost 

recent recommendation excludes it. Again, more research is needed. 

The literature reviewed above points to a widespread ability to respond to the two-step measure in 

varied populations, including elders, prison inmates, and Spanish speakers. However, current research 

would also benefit from the inclusion of racial, ethnic, and cultural minorities, as well as language 

minorities other than Spanish.10 Current gender identity research has focused mostly on comprehension 

in the English- and, more recently, Spanish-speaking populations. Future research, specifically Federal 

research, may benefit from increased recruitment of transgender individuals, people of color, and 

people fヴoマ Iultuヴes iミ ┘hiIh a thiヴd geミdeヴ e┝ists ふe.g., さt┘o-spiヴitざ in American Indian tribes and 

さhijヴasざ iミ “outh Asiaミ Iultuヴesぶ. 

Finally, recent variations of the two-step measure have included a verification item when natal sex and 

current gender identity do not agree. These verification measures are utilized in the NCVS and the CHIS 

as questions asked directly of respondents and in the SPI as an interviewer instruction. They were also 

used in the measures tested by Lombardi and Banik (2016). While items like these have been shown to 

reduce measurement error in the measurement of same-sex households (O’Coミミell aミd Feliz, ヲヰヱヱ), 

there are no studies examining their application to the measurement of gender identity. 

Additional Challenges Related to Measuring Gender Identity 

In addition to how best to ask gender identity, there are other methodological challenges. For example, 

little is known on how best to ask gendered questions, such as questions about mammograms and birth 

control, once a respondent is identified as transgender. Deutsch et al., (2013) recommends collecting an 

organ inventory in a medical setting to ensure proper gendering of these type of questions. Instead of 

an organ inventory, it may be possible to use introductory language (e.g., "The next question was 

designed for women who are not transgender, so let me know if it does not apply to you"), but research 

 

10 Ryan (2013) reports that in 2011, 20.8% of the U.S. population spoke a language other than English at home, of

┘hoマ ヲヲ.ヴ% spoke Eミglish eitheヴ さミot ┘ellざ oヴ さミot at all.ざ “paミish speakeヴs Ioマpヴise ヶヲ.ヰ% of those ┘ho spoke a 

language other thaミ Eミglish at hoマe ふヲヵ.Γ% of ┘hoマ spoke Eミglish さミot ┘ellざ oヴ さミot at allざぶ, follo┘ed H┞ Chiミese 

speakeヴs ふヴ.Β%, ヲΓ.ヶ% of ┘hoマ spoke Eミglish さミot ┘ellざ oヴ さミot at allざぶ. 
28

is needed on the most effective language. Neither of these strategies has been applied in a Federal 

survey setting.

Deutsch and colleagues (2013) also recommend the collection of name and pronoun preferences in a 

medical setting, but this may be just as important in a survey setting. This information can be used to 

properly tailor mailing materials to transgender participant preferences (e.g., using the proper salutation 

in a survey mailing) (Ingraham et al., 2015). This information can also be used to properly gender 

transgender respondents in a proxy survey. 

Summary 

Since the 2011 IOM report, research on transgender measurement has increased, but there is still no 

consensus on how to collect gender identity in surveys. The majority of research supports using a twostep method, per the recommendation of the GenIUSS Group, WPATH, and CoE, but there are a number 

of open questions, including how to order the items, whether to include reference to a birth certificate, 

and how the items perform in languages other than English and Spanish. Also unresolved is the 

appropriateness of using gender identity in realms that typically utilize binary measures of sex, such as 

gendered questions. With a growing number of Federal agencies interested in measuring gender 

identity and engaging in evaluation of these measures, the Federal government can play an important 

role in advancing the literature. 

Gender Expression

Gender expression is defined as the way one sees themselves or their outward display of gender. 

Research on gender expression is limited. We identified only two studies that examined how 

respondents perceive their masculinity and femininity and also how they think others perceive them 

(Correll et al., 2014; Magliozzi et al., 2016). Both studies were based on surveys administered using 

Amazon Mechanical Turk (MTurk). Respondents were required to be age 18 or older and U.S. residents. 

The final number of respondents in both surveys was approximately 1,520. Gender expression was 

measured through the use of first-order and third-order scales. Appendix E presents the wording and 

response options for the scales included in Correll et al. (2014) and Magliozzi et al. (2016). 

For the first-order and third-order scales, respondents were presented with two separate scales – one 

for masculinity and one for femininity, for a total of four scales (Correll et al., 2014; Magliozzi et al., 

2016). Seven response categories were given for each scale, ranging fヴoマ さミot at allざ to さ┗eヴ┞.ざ Coヴヴell 

aミd Iolleagues ふヲヰヱヴぶ assigミed ミuマHeヴs to the poles, Iategoヴies ヱ ふさミot at allざぶ aミd Α ふさ┗eヴ┞ざぶ. 

Categories 2 through 6 were only given numerical values and were not assigned nominal values in order 

to avoid any negative connotations if respondents didミ’t Iategoヴize theマsel┗es oミ eitheヴ pole of the 

scale. Response categories were the same for the first-order and third-order scales. 

Magliozzi and colleagues (2016) presented response options slightly different than Correll and 

colleagues (2014). The ミoマiミal Iategoヴies gi┗eミ to pole ヴespoミses ┘eヴe the saマe iミ Hoth studies, さミot 

at allざ aミd さ┗eヴ┞.ざ Ho┘e┗eヴ, the pole ヴespoミses ┘eヴe ミot gi┗eミ a ミuマeヴiIal ┗alue to go aloミg ┘ith the 

nominal response. Numerical values 1 through 5 were given to response options between the poles. A 

┗alue of ヱ ┘as Ilosest to the ヴespoミse さミot at allざ aミd a ┗alue of ヵ ┘as the Iategoヴ┞ Ilosest to さ┗eヴ┞ざ 

(Magliozzi et al., 2016). Response categories were the same for the first-order and third-order scales. 
29

Correll and colleagues (2014) recommend that future researchers keep the masculine and feminine 

scales separate and administer the four separate scales to respondents. Magliozzi and colleagues (2016) 

echo these recommendations, ミotiミg that さfeマiミiミit┞ aミd マasIuliミit┞ sIales ┘ill allo┘ ヴeseaヴIheヴs to 

aIIouミt foヴ ┗aヴiatioミs ┘ithiミ geミdeヴ Iategoヴies...ざ ふp. Αぶ. Theヴefore, based on the current research, there 

appears to be value and utility in providing separate scales to respondents. Correll and colleagues (2014) 

also recommend asking the first-order scales if researchers have to choose one set of scales. The 

authors mention that the first-oヴdeヴ sIales offeヴ さthe Ileaヴest Iouミteヴpoiミt to the iミteヴ┗ie┘eヴ’s 

IlassifiIatioミ of the ヴespoミdeミt’s se┝/geミdeヴ that oIIuヴs at the Hegiミミiミg of the G““ざ ふCoヴヴell et al., 

2014).

Given the paucity of studies evaluating gender expression items, additional research addressing this 

topic would prove beneficial and further develop knowledge on this concept central to SOGI research. 

c. Household Relationships 

As noted in the previous working paper, Current Measures of SOGI in Federal Household Surveys, several 

Federal surveys collect household relationship data for all individuals living in the same housing unit. 

This information, in conjunction with sex, can be used to produce indirect estimates of the SGM 

population through the measurement of same-sex couples. For example, in a two-person household if 

person two is said to be the husband, wife, or spouse of person one and both persons were reported to 

be of the same sex, these individuals would be coded as a same-sex married couple. Relying on entries 

to separate questions to derive this status, however, increases the potential for erroneous 

categorization due to keying errors in computer-assisted surveys or ambiguous markings on mail surveys 

to one or both of these questions. Not surprisingly, past research has identified sex-relationship 

inconsistencies that have led to the overestimation of the number of same-sex couples ふO’Coミミell aミd 

Feliz, 2011; DeMaio et al., 2013; Kreider and Lofquist, 2014; Lewis et al., 2015). This is usually attributed 

to aIIideミtal マisマaヴkiミg oミ se┝ H┞ a ┗eヴ┞ sマall pヴopoヴtioミ of opposite‐se┝ マaヴヴied Iouples. As 

opposite‐se┝ Iouples aヴe suHstaミtiall┞ laヴgeヴ iミ ミuマHeヴ thaミ saマe‐se┝ Iouples, this ofteミ ヴesults iミ a 

large over-Iouミt of saマe‐se┝ Iouples ふLewis et al., 2015). We identified six (6) quantitative and 

qualitative studies that attempted to quantify these inconsistencies and over-reports, and/or identify 

question design changes to improve the performance of sex and relationship questions for estimating 

the number of same-sex couples. 

Usiミg a statistiIal ミaマes diヴeItoヴ┞ iミ ┘hiIh fiヴst ミaマes aヴe assigミed a pヴoHaHilit┞ of さマaleミess,ざ DeMaio 

et al. (2013) estimated that 28.3% of reported same-sex couple households in the 2010 Census were 

likely opposite-sex. In addition, the majority of sex-relationship inconsistencies occurred in the 

enumerator-administered nonresponse follow-up (NRFU) form. The matrix format used with the NRFU, 

as opposed to the sequential format used with the standard Census form, appeared to be the primary 

cause of data-reporting errors with opposite-sex couples. Data from the 2010 American Community 

Survey (ACS), using the same sex and relationship questions, revealed fewer reports of same-sex 

couples. In this case, the pヴeseミIe of autoマated edits iミ the telephoミe aミd peヴsoミal‐┗isit data IolleItioミ 

phases of the ACS, where inconsistencies in sex-relationship reporting prompted interviewers to verify 

entered responses (see Appendix H, Figure 1 for an exampleぶ, appeaヴed to gヴeatl┞ ヴeduIe saマe‐se┝ 

couple over-ヴepoヴts ふO’Coミミell aミd Feliz, ヲヰヱヱぶ.

Kreider and Lofquist (2014) corroborated the findings of DeMaio et al. (2013) via research in which 

Iouples’ se┝ as ヴepoヴted oミ the ヲヰヱヰ Ceミsus oヴ ヲヰヱヰ AC“ ┘as マatIhed to sex on file with the Social 
30

Security Administration (SSA). Over 57% of couples reported as same-sex married in the ACS and nearly 

73% of these couples in the 2010 Census were found to be opposite-sex in SSA data. The concomitant 

figures for same-sex unmarried couples were around 7% for both the Census and ACS. In contrast, less 

than 1.0% of reported opposite-sex married couples in both the ACS and decennial Census, and 1.6% of 

opposite-sex unmarried couples in the ACS and 0.8% of these couples in the 2010 Census appeared to 

be same-sex in the SSA data. Again, the lower rate of inconsistencies in the ACS data were attributed to 

the automated edits in the telephone and personal-visit instruments. 

Cognitive interviewing and focus group testing of the relationship question used in the 2010 Census and 

the 2010 ACS (see Appendix H, Figure 2) showed that both same-sex and opposite-sex couples 

interpreted the relationship question to be asking about legal status (Bates et al., 2010). Same-sex 

couples who were legally married classified themselves as married couples, while unmarried, same-sex 

couples classified themselves accordingly. However, based on these studies, a set of changes were 

recommended to the e┝istiミg ヴelatioミship ケuestioミ, iミIludiミg ヱぶ the additioミ of さspouseざ to the 

さhusHaミd/┘ifeざ Iategoヴ┞; ヲぶ マo┗iミg the さuミマaヴヴied paヴtミeヴざ Iategoヴ┞ up fヴoマ ミeaヴl┞ last to seIoミd oミ 

the list of optioミs; aミd ンぶ addiミg sepaヴate Iategoヴies foヴ さopposite-sex husHaミd/┘ife/spouse,ざ 

さopposite-se┝ uミマaヴヴied paヴtミeヴ,ざ さsaマe-se┝ husHaミd/┘ife/spouse,ざ aミd さsaマe-sex unmarried 

paヴtミeヴ.ざ Cogミiti┗e testiミg of these ヴe┗isioミs uミIo┗eヴed fe┘ ヴespoミse pヴoHleマs ふDeMaio aミd Bates, 

2012; Smirnova and Scanlon, 2013). 

The revised relationship question that emerged from these testing efforts (see Appendix H, Figure 3) 

was added to the 2013 American Housing Survey (AHS) as part of an interviewer-administered, splitpanel test. Using the experimental AHS data, Lewis et al. (2015) explored inconsistencies in sex and 

relationship reporting. Like the DeMaio et al. (2013) study, the research used probable sex based on the 

Ceミsus Buヴeau’s ミaマes diヴeItoヴ┞ to assess ┘heヴe マisヴepoヴtiミg oIIuヴヴed. While the ミe┘ ヴelatioミship 

question, along with built-in edits, appeared to reduce the level of inconsistencies and, therefore, 

misreporting, measurement error remained. For example, of 82 couples reported to be same-sex 

married at the relationship question, yet opposite sex at the sex question, all 82 were found to be 

opposite-sex couples. Hence, relationship-sex inconsistency appeared to be driven by errors at the 

relationship question. Results were largely similar for couples reported to be same-sex unmarried at the 

relationship question. Of the 21 couples with information on probable sex, 23.8% were likely same-sex, 

with the remaining 76.2% judged to be opposite-sex. Shifting to couples reported to be opposite-sex 

unmarried at the relationship question (52 with probable sex information), 72.2% appeared to be samesex couples, with the remaining 27.8% judged to be opposite-sex. As observed with reported same-sex 

couples, the bulk of misreporting took place at the relationship item. Finally, of the couples reported to 

be opposite-sex married at the relationship question, 14.2% were judged to be same-sex couples, with 

the remaining 85.8% of couples deemed to be opposite-sex. In contrast to the other couple types, 

misreports at the sex question were the far more prevalent problem for these couples. In sum, for three 

of the four couple types, misreporting at the relationship question was more prevalent. However, errors 

at the sex question were more prevalent for reported opposite-sex married couples, and since these 

couples are the most prevalent couple type, errors at the sex question explained relationship-sex 

inconsistency for a substantial portion of couples overall (Lewis et al., 2015). 
31

The six reviewed studies identified persistent sex-relationship to householder inconsistencies, leading to 

overestimates of same-sex households in the decennial Census, ACS, and other Federal surveys. The 

overestimates are largely attributed to accidental mismarking on sex by a very small proportion of 

opposite‐se┝ マaヴヴied Iouples. While many of the testing efforts described above recommend the use of 

a revised relationship to householder question (see Figure 5), the evidence to date suggests that 

inconsistencies and overestimates of same-sex couple households are still likely. While the revised 

design shows promise, the current ACS, for example, continues to use the relationship question fielded 

with the 2010 ACS. 

A number of the reviewed studies mentioned the automated edits in the interviewer-administered 

phases of the ACS as an explanation for the lower sex-relationship inconsistency rates compared to the 

2010 Census. However, these studies failed to quantify the extent to which these edits led to changes in 

reporting of sex, relationships, or both. We know very little about the behavior of interviewers when 

confronted with these edits. Do they verify the entered information with respondents? How often do 

they suppress the edit to keep the interview moving? Are the error messages intuitive and easy to 

navigate? 

Finally, while identifying and addressing the issues behind the documented inconsistencies is important 

for producing accurate estimates of same-sex couple households (and a number of other couple types), 

relying on sex and relationship information does not provide a direct measure of sexual orientation. 

Furthermore, it yields an incomplete estimate, since persons not in a relationship or not living in the 

same household as their partner will not be identified (MRFHS 2014). 

V. Discussion: Best Practices and Areas for Further Research 

This working paper reviewed recent studies evaluating the measurement of SOGI in surveys. With the 

goal of identifying best practices for collecting SOGI data, this paper described the ways in which SOGI 

has been measured, discussed quantitative and qualitative findings on the quality of existing measures, 

and identified areas where future research is needed. The current literature has paid close attention to 

how SOGI is defined, how SOGI concepts are understood by respondents, and how measurement 

challenges, such as respondent misinterpretation, item nonresponse, and social desirability, lead to 

biased outcomes. 

The paper began with a review of the key concepts of sexual orientation (including sexual identity, 

sexual attraction, and sexual behavior), gender identity, and household relationships, and then reviewed 

evaluation studies on each topic. 

a. Sexual Orientation

Sexual Identity

The literature on sexual identity measures reveals a number of ways to improve their performance and 

enhance their validity and reliability. Research on question order effects could improve data quality, as 

placing sexual identity items near demographic survey questions rather than around sexual attraction 

and behavior questions may lead to less biased responses. In addition, the literature on sexual identity 

may benefit from more research on how best to reduce racial and ethnic bias, including the use of 

terminology that may be more relevant to other racial, ethnic, and language minorities. Future research 

on adolesIeミts’ uミdeヴstaミdiミg of se┝ual identity questions would be beneficial, as research on 
32

adolescents is limited and existing research has identified age differences in comprehension and 

interpretation. Similarly, potential differences in the responses provided by older adults would benefit 

from further study. 

Other areas of future research include survey operations and administration, specifically interviewer 

training and whether proxy measurement should be allowed. Research suggests that data quality can be 

improved by focusing interviewer training on the implications of invalid data and asking questions as 

worded, especially questions on sensitive topics. Research related to privacy and discretion when 

administering sexual identity questions is also needed. Other areas of future research include the 

consistent administration of questions across different survey modes (e.g., telephone, face-to-face, 

internet survey) and the use of proxy respondents. 

Sexual Attraction

Sexual attraction refers to the sex or gender to which someone feels attraction. Future research is 

needed on question wording, response options, as well as mode of data collection. A better 

understanding of how adolescents and adults interpret and define さattヴaItioミざ is also warranted. 

We encourage a focus on question context and placement in future research. For example, in one study, 

when the identity and attraction items followed sexual behavior questions they tended to produce 

higher item nonresponse than when identity and attraction items appeared before the behavior items. 

This highlights the importance of question context and location as factors affecting performance. 

Nonresponse is also a concern when measuring sexual attraction. The conflation of sexual attraction and 

sexual identity may contribute to item nonresponse. It is recommended that more testing be conducted 

with adolescents in particular to understand how they comprehend measures of sexual orientation 

broadly as well as sexual attraction specifically. 

Sexual Behavior

Sexual behavior, operationalized for our purposes as se┝ of a peヴsoミ’s se┝ual paヴtミeヴs, is one of three 

dimensions of sexual orientation. Current studies investigate how sexual behavior items perform, item 

ミoミヴespoミse, aミd ヴespoミdeミt’s ヴeaItions to capturing their sexual behavior. The reviewed evaluations 

drew upon groups that varied by demographic characteristics (e.g., income, race, marital status, age, 

language). More research on the structure and content of questions and how responses vary by 

demographic group would help advance valid measurement across subgroups. 

Nonresponse is a fertile area for future research. Findings suggest that item nonresponse decreases as 

income increases, increases as age increases, and increases with higher levels of education. 

Misreporting, a type of measurement error, is another area for future investigation. One study found 

that when non-heterosexuals reported their behavior as exclusively heterosexual and when 

heterosexuals did not report same-sex sexual behavior, misreporting became apparent. These authors 

found that among men, misreporting increased as income increased, white men had a higher probability 

of misreporting compared to men of all other races, and misreporting decreased as age increased. 

Among men and women, misreporting decreased as city size increases. 

b. Gender Identity 
33

There are a number of areas in which Federal research could add to the literature on how best to 

measure gender identity. While many organizations support a two-step measure, more research is 

needed on the assessment of gender identity using a one versus two-step measure. In addition, little is 

known about how question order in the two-step measure may affect response; some literature found 

that most transgender participants preferred current gender identity be asked prior to natal sex. The 

GenIUSS Group recommends asking natal sex first, while WPATH and CoE recommend asking current 

gender identity first. More research is needed on question order as well as survey design. 

Aミotheヴ uミヴesol┗ed issue is ┘hetheヴ to iミIlude a ヴefeヴeミIe to oミe’s oヴigiミal Hiヴth IeヴtifiIate iミ the ミatal 

sex item. While there have been no studies focusing on this specific issue, there is anecdotal evidence 

that transgender individuals preferred its exclusion. The GenIUSS group recommended two-step items 

iミIlude a Hiヴth IeヴtifiIate ヴefeヴeミIe, ┘hile CoE’s マost ヴeIeミt ヴeIoママeミdatioミ e┝Iludes it. Agaiミ, マoヴe 

research is needed. 

Current research would also benefit from the inclusion of racial, ethnic, and cultural minorities, as well 

as language minorities other than Spanish. The literature to date has focused mostly on comprehension 

in the English and, more recently, Spanish-speaking populations. Future research, specifically Federal 

research, may benefit from increased recruitment of transgender individuals, people of color, and 

people fヴoマ Iultuヴes iミ ┘hiIh a thiヴd geミdeヴ e┝ists ふe.g., さt┘o-spiヴitざ iミ AマeヴiIaミ Iミdiaミ tヴiHes aミd 

さhijヴasざ iミ “outh Asiaミ Iultuヴesぶ. 

Recent variations of the two-step measure have included a verification item when natal sex and current 

gender identity do not agree. These verification measures are utilized in the NCVS and the CHIS as 

questions asked directly of respondents, and in SPI as an interview instruction. While items like these 

have been shown to reduce measurement error in the measurement of same-sex households, there are 

no studies examining their application to the measurement of gender identity. 

In addition to how best to ask gender identity, there are other methodological challenges related to the 

measurement of gender identity. For example, little is known about how best to ask gendered 

questions, such as questions about mammograms and birth control, once a respondent has identified as 

transgender. Researchers have recommended the collection of name and pronoun preferences in a 

medical setting, but this may be just as important in a survey setting. This information can be used to 

properly tailor mailing materials to transgender participant preferences (e.g., using the proper salutation 

in a survey mailing). This information can also be used to properly refer to the gender of transgender 

respondents in a proxy survey. 

Moreover, there appears to be limited research evaluating items measuring gender expression, or an 

iミdi┗idual’s e┝teヴミal マaミifestatioミ of geミdeヴ. Additional research addressing this topic would prove

beneficial and further develop knowledge on this concept central to SOGI research. 

c. Household Relationships 

The studies evaluated identified persistent sex-relationship to householder inconsistencies, leading to 

overestimates of same-sex households in the decennial Census, ACS, and other Federal surveys. The 

overestimates are largely attributed to accidental mismarking on sex by a very small proportion of 

opposite‐se┝ マaヴヴied Iouples. While many of the testing efforts described recommend the use of a 

revised relationship to householder question, the evidence to date suggests that inconsistencies and 
34

overestimates of same-sex couple households are still likely. While the revised design shows promise, 

the current ACS, for example, continues to use the relationship question fielded with the 2010 ACS. 

A number of the reviewed studies mentioned the automated edits in the interviewer-administered 

phases of the ACS as an explanation for the lower sex-relationship inconsistency rates compared to the 

2010 Census. However, these studies failed to quantify the extent to which these edits led to changes in 

reporting of sex, relationships, or both. We know very little about the behavior of interviewers when 

confronted with these edits. 

Finally, while identifying and addressing the issues behind the documented inconsistencies is important 

for producing accurate estimates of same-sex couple households (and a number of other couple types), 

relying on sex and relationship information does not provide a direct measure of sexual orientation. 

d. Conclusion 

Federal agencies have expressed interest and enthusiasm for improving the measurement SOGI. The 

Federal Government is interested in better understanding the SGM community in order to better serve 

its needs. This cannot be accomplished without sound data on the population. This working paper 

described what is known about current measures on sexual orientation, gender identity, and household 

relationships and highlighted the methodological questions that remain to be answered. 
35

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Appendices 

A. Surveys Measuring Sexual Identity in Cited Work

Author(s) Survey/method 

Austin, Conron, et al., 2007 30 cognitive interviews of adolescents 

Cahill et al., 2014 Survey of 301 English-speaking patients randomly selected from 4 

CHARN-affiliated Community Health Centers (CHCs) 

Case et al., 2006 Pilot stud┞ usiミg Nuヴses’ Health “tud┞ II

Clark et al., 2005 Cancer Screening Project for Women – Cognitive Test 

Coffman et al., 2013 Experiment via Amazon Mechanical Turk (MTurk) 

Dahlhamer et al., 2014 National Health Interview Survey (NHIS), 2013 

Fisher et al., 2001 Needs assessment with LBT women in Washington, DC, metro area 

Grant and Jans, n.d. California Health Interview Survey (CHIS)

Gruskin et al., 2001 Health survey of Kaiser Permanente Mental Care program members in 

Northern California

Ingraham et al., 2015 Community Health Center Case Study

Jans et al., 2015 CHIS, 2003-2011

Joloza et al., 2010 UK Integrated Household Survey (IHS)

Kim and Fredriksen-Goldsen, 2013 Washington State Behavioral Risk Factor Surveillance System (BRFSS) 

Martinez, Henderson, and Luck, 2016 National Crime Victimization Survey (NCVS) – cognitive interviews 

McCabe, Hughes, Bostwick, Morales, 

and Boyd, 2012 

Simple random sample of 19,370 undergraduates at large, Midwestern 

university 

Miller, 2001 National Center for Health Statistics (NCHS) cognitive testing/evaluation 

study 

Miller and Ryan, 2011 NCHS cognitive testing/evaluation study 

Mohr and Kendra, 2011 Sample of university students in which the majority identified as 

lesbian/gay 

National Center for Education 

Statistics, U.S. Department of 

Education, forthcoming 

High School Longitudinal Study of 2009 (HSLS:09) 

Poston and Chang, 2015 NSFG, 2006-2008 

Ridolfo and Schoua-Glusberg, 2009 NCHS cognitive testing/evaluation study 

Ridolfo et al., 2010 NCHS cognitive testing/evaluation study 

NCHS cognitive testing/evaluation study 

National Survey of Family Growth (NSFG), 2002 

NSFG, 2006-2008 

2001-2008 National Health and Nutrition Examination Survey (NHANES) 

Saewyc et al., 2004 Eight student surveys, 7th-12th grades, ages 12 to 20 

Stern et al., 2016 Medicare Current Beneficiary Survey (MCBS) – cognitive interviews 

VanKim et al., 2010 2007-2008 Behavioral Risk Factor Surveillance System (BRFSS)

VanKim et al., 2010 2003 New Mexico Adult Tobacco Survey (ATS) 

Vrangalova and Savin-Williams, 2012 Online survey via Facebook focused on sexual morality 
41

B. Sexual Identity Items Used in Cited Work

Authors, year Survey 

(if applicable) 

Question wording Response options 

Austin, Conron, et 

al., 2007 

--- 1. Sexual identity: Which of the following best 

describes you? 

2. Sexual identity/attraction: Which of the following 

best describes your feelings? 

_ Heterosexual (straight) 

_ Gay or lesbian 

_ Bisexual 

_ Not sure 

_ Completely heterosexual (attracted to persons of the 

opposite sex) 

_ Mostly heterosexual 

_ Bisexual (equally attracted to men and women) 

_ Mostly homosexual 

_ Completely homosexual (gay/lesbian, attracted to 

persons of the same sex) 

_ Not sure 

Cahill et al., 2014 --- Do you think of yourself as: 1) Lesbian, gay or homosexual 

2) Straight or heterosexual 

3) Bisexual 

4) Something else, please describe________________ 

ヵぶ Doミ’t kミo┘

Case et al., 2006 --- Whether you are currently sexually active or not, 

what is your sexual identity or orientation? 

Please choose one answer: 

1) Heterosexual 

2) Bisexual 

3) Lesbian, gay, or homosexual 

4) None of the above 

5) Prefer not to answer 

Clark et al., 2005 --- The next question is about how do you think of 

yourself? Please answer all that apply to you. 

1) Lesbian, gay or homosexual 

2) Straight or heterosexual 

3) Bisexual 

4) Transgendered 

5) Not sure 

6) You think of yourself in different terms (please 

describe) 

Coffman et al., 

2013

--- Do you consider yourself to be heterosexual? Yes 

No

I consider myself to be heterosexual. (Respondents were asked to determine if the statement 

applied to them) 
42

Authors, year Survey 

(if applicable) 

Question wording Response options 

Dahlhamer et al., 

2014

NHIS, 2013 Which of the following best represent how you think 

of yourself? 

 Gay (Lesbian or gay) 

 Straight, that is, not gay (lesbian or gay) 

 Bisexual 

 Something else 

 I don't know the answer 

BJS, 2015 2016 Survey of 

Prison Inmates 

Which of the following best represents how you 

think of yourself? 

-Lesbian or gay 

-Straight, that is not lesbian or gay 

-Bisexual 

-Something else 

-You doミ’t kミo┘ the aミs┘eヴ

(Refused) 

Grant and Jans, 

n.d. 

2003-present 

California Health 

Interview Survey 

(CHIS) 

Do you think of yourself as straight or heterosexual, 

as gay {, lesbian} or homosexual, or bisexual? 

Gruskin et al., 

2001

--- What is your sexual orientation? 1) Heterosexual (straight) 

2) Homosexual (gay, lesbian) 

3) Transsexual 

Ingraham, Pratt, 

and Gorton, 2015 

--- How do you identify yourself, sexually? 1) Lesbian 

2) Gay 

3) Queer 

4) Bisexual 

5) Heterosexual 

6) Celibate 

7) Other ____ 

8) Decline 

My sexual orientation is: 1) Lesbian 

2) Gay 

3) Queer 

4) Bisexual 

5) Heterosexual 

6) Celibate 

7) Other____ 

8) Decline 

Jans et al., 2015 CHIS, 2003-2013 Do you think of yourself as straight or heterosexual, 

as [gay/gay, lesbian] or homosexual, or bisexual? 
43

Authors, year Survey 

(if applicable) 

Question wording Response options 

Joloza, et al., 2010 --- Face-to-face: 

Which of the options on this card best describes how 

you think of yourself? Just read out the number next 

to the description. 

27)Heterosexual/straight 

21) Gay/lesbian 

24) Bisexual 

29) Other 

Telephone: 

I will now read out a list of terms people sometimes 

use to describe how they think of themselves. 

1) Heterosexual or straight 

2) Gay or lesbian 

3) Bisexual 

4) Other 

Interviewer then reads the question a second time and 

asks the respondent to say 'yes' when they hear the 

option that best describes how they think of 

themselves. 

Kim and 

FredriksenGoldsen, 2013 

2003-2010 

Washington State 

BRFSS

Not stated 1) Heterosexual, that is straight 

2) Homosexual, that is gay or lesbian 

3) Bisexual 

4) Other 

Martinez, 

Henderson, and 

Luck, 2016 

National Crime 

Victimization Survey 

(NCVS) 

Which of the following best represents how you 

think of yourself? 

-[Lesbian or] Gay 

-Straight, that is, not [lesbian or] gay 

-Bisexual 

-Something else 

-I doミ’t kミo┘ the aミs┘eヴ

(Refused) 

McCabe, Hughes, 

Bostwick, Morales, 

and Boyd, 2012 

--- How would you define your sexual identity? Would 

┞ou sa┞ that ┞ou aヴe...

(1) Only lesbian/gay 

(2) Mostly lesbian/gay 

(3) Bisexual 

(4) Mostly heterosexual 

(5) Only heterosexual 

(6) Other/specify 

versus 

(1) Heterosexual 

(2) Lesbian/gay 

(3) Bisexual 

(4) Refused 
44

Authors, year Survey 

(if applicable) 

Question wording Response options 

Miller, 2001 

Ridolfo and 

Schoua-Glusberg, 

2009

2001-2008 NHANES Do you think of yourself as 1) Heterosexual or straight (that is, sexually attracted 

only to women/men) 

2) Homosexual or gay/lesbian (that is, sexually attracted 

only to men/women) 

3) Bisexual (that is, sexually attracted to men and 

women) 

4) Something else 

ヵぶ Oヴ ┞ou’ヴe ミot suヴe?

Miller and Ryan, 

2011

--- Do you think of yourself as: For men, 

1) Gay 

2) Straight, that is not gay 

For women, 

1) Lesbian or gay 

2) Straight, that is, not lesbian or gay 

3) Bisexual 

4) Something else 

5) Don't know 

By something else, do you mean that... 1) You are not straight, but identify with another label 

such as queer, trisexual, omnisexual, or pan-sexual 

2) You are transgender, transsexual or gender variant 

3) You have not figured out your sexuality or are in the

process of figuring it out 

4) You do not think of yourself as having sexuality 

5) You do not use labels to identify yourself 

6) You made a mistake and did not mean to pick this 

answer 

7) You mean something else. 

Mohr and Kendra, 

2011

The Lesbian, Gay, 

and Bisexual Identity 

Scale (LGBIS) 

1. I prefer to keep my same-sex romantic 

relationships rather private. 

2. If it were possible, I would choose to be 

straight. 

3. I’マ ミot totall┞ suヴe ┘hat マ┞ se┝ual oヴieミtatioミ 

is. 

4. I keep careful control over who knows about my 

same-sex romantic relationships. 

5. I often wonder whether others judge me for my 

sexual orientation. 

For each statement, respondents are asked to choose 

one of the following: 

1) Disagree strongly 

2) Disagree 

3) Disagree somewhat 

4) Agree somewhat 
45

Authors, year Survey 

(if applicable) 

Question wording Response options 

6. I am glad to be an LGB person. 

7. I look down on heterosexuals. 

8. I keep changing my mind about my sexual 

orientation. 

9. I Iaミ’t feel IoマfoヴtaHle kミo┘iミg that otheヴs 

judge me negatively for my sexual orientation. 

10. I feel that LGB people are superior to 

heterosexuals. 

11. My sexual orientation is an insignificant part of 

who I am. 

12. Adマittiミg to マ┞self that I’マ aミ LGB peヴsoミ has 

been a very painful process. 

13. I’マ pヴoud to He paヴt of the LGB Ioママuミit┞.

14. I Iaミ’t deIide ┘hetheヴ I aマ Hise┝ual oヴ 

homosexual. 

15. My sexual orientation is a central part of my 

identity. 

16. I think a lot about how my sexual orientation 

affects the way people see me. 

17. Adマittiミg to マ┞self that I’マ aミ LGB peヴsoミ has 

been a very slow process. 

18. Straight people have boring lives compared 

with LGB people. 

19. My sexual orientation is a very personal and 

private matter. 

20. I wish I were heterosexual. 

21. To understand who I am as a person, you have 

to kミo┘ that I’マ LGB.

22. I get very confused when I try to figure out my 

sexual orientation. 

23. I have felt comfortable with my sexual identity 

just about from the start.

24. Being an LGB person is a very important aspect 

of my life. 

25. I believe being LGB is an important part of me. 

26. I am proud to be LGB 
46

Authors, year Survey 

(if applicable) 

Question wording Response options 

27. I believe it is unfair that I am attracted to people 

of the same sex. 

National Center 

for Education 

Statistics, 

forthcoming 

. 

High School 

Longitudinal Study 

of 2009 (HSLS:09) 

Do you think of yourself as ... 1) Lesbian or gay 

2) Straight, that is, not gay 

3) Bisexual 

4) Something else (please specify) 

ヵぶ Doミ’t Kミo┘

Now look at this other way of asking the question. 

SHOWCARD. How would you answer if it was 

phrased like this? 

2nd SHOWCARD: 

1) Homosexual 

2) Heterosexual 

3) Bisexual 

4) Something else (please specify) 

ヵぶ Doミ’t Kミo┘

Poston and Chang, 

2015

NSFG, 2006-2008 Do you think of yourself as heterosexual or straight; 

as homosexual, gay, or lesbian; as bisexual; or as 

something else? 

Ridolfo and 

Schoua-Glusberg, 

2009

2001-2008 NHANES ¿Se considera usted a si mismo 1) Heterosexual (le atraen las mujeres/los hombres) 

2) Homosexual o gay/lesbiana (le atraen los 

hombres/las mujeres) 

3) Bisexual (le atraen los hombres y las mujeres) 

4) Alguna otra cosa 

5) No está seguro(a)? 

--- 2002-2003 National 

Survey of Family 

Growth (NSFG) 

Do you think of yourself as 1) Heterosexual 

2) Homosexual 

3) Bisexual 

4) Something else? 

Ridolfo et al., 2010 --- What sexual orientation do you consider yourself to 

be? 

1) Heterosexual 

2) Gay or lesbian 

3) Bisexual 

4) Other 

ヵぶ Doミ’t kミo┘

Ridolfo et al., 2010 --- Do you consider yourself to be 1) Heterosexual or straight 

2) Gay or lesbian, 

3) Bisexual? 
47

Authors, year Survey 

(if applicable) 

Question wording Response options 

--- 2006-2008 National 

Survey of Family 

Growth (NSFG) 

Do you think of yourself as 1) Heterosexual or straight 

2) Homosexual, gay,(or lesbian, 

3) Bisexual 

4) Or something else? 

--- 2006-2007 National 

Survey of Family 

Growth (NSFG) 

Wheミ ┞ou sa┞ さsoマethiミg else,ざ ┘hat do ┞ou マeaミ?

--- 2006-2008 National 

Survey of Family 

Growth (NSFG) 

¿Usted se Ioミsideヴa... 1) Heterosexual 

2) Homosexual 

3) Bisexual 

4) O alguna otra cosa? 

--- 2006-2007 NSFG Cuaミdo usted diIe さalguミa otヴa Iosaざ, ¿ケué se 

refíere? 

Saewyc et al., 

2004

--- 1. Which of the following best describes your 

feelings: 

2. Many people say that they have different feelings 

about themselves when it comes to questions of 

being attracted to other people. Which of the 

following best describes your feelings? SAME 

RESPONSE OPTIONS AS #1 

3. People have different feelings about themselves 

when it comes to questions of being attracted to 

other people. Which of the following best describes 

your feelings? SAME RESPONSE OPTIONS AS #1 

4. How would you describe your sexual 

orientation/preference? 

5. How would you describe your sexual orientation? 

SAME RESPONSE OPTIONS AS #4 

Response options for #1, 2, and 3: 

100% heterosexual (attracted to persons of the 

opposite sex) 

Mostly heterosexual 

Bisexual (equally attracted to men and women) 

Mostly homosexual 

100% homosexual ("gay/lesbian"; attracted to persons 

of the same sex) 

Response options for #4 and 5: 

Heterosexual—attracted to the opposite sex 

Bisexual—attracted to both sexes 

Homosexual (gay or lesbian)—attracted to same sex 

Not sure 

Stern et al., 2016 MCBS Which of the following best represents how you 

think of yourself? 

-[Lesbian or] Gay 

-Straight, that is, not [lesbian or] gay 

-Bisexual 

-Something else 

-I doミ’t kミo┘ the aミs┘eヴ
48

Authors, year Survey 

(if applicable) 

Question wording Response options 

-Refused 

VanKim et al., 

2010 

--- Do you consider yourself to be ...? 1) Heterosexual or straight, 

2) Homosexual (gay or lesbian), 

3) Bisexual, 

4) Other, 

ヵぶ Doミ’t kミo┘/ミot suヴe.

Vrangalova and 

Savin-Williams, 

2012

--- Participants chose one of six labels to identify their 

sexual orientation: 

1) Heterosexual 

2) Mostly heterosexual 

3) Bisexual 

4) Mostly gay/lesbian 

5) Gay/lesbian 

6) Questioning/ uncertain. 

Aミ さotheヴざ Iategoヴ┞ ┘as also pヴeseミted. 

--- 2001 California 

Health Interview 

Survey (CHIS) 

This next question is about your sexual orientation 

and I want to remind you again that your answers 

are completely confidential. 

Are you gay, {lesbian,} or bisexual? 

If yes, 

Is that gay, {lesbian} or bisexual? 
49

C. Sexual Attraction Items Used in Cited Work 

Authors Mode Notes Question wording Response Options 

Austin, 

Conron, et 

al., 2007 

Cognitive testing 

based on 

retrospective talkaloud method. 

Interviews averaged 75 minutes, recorded 

and transcribed. 30 adolescents near a 

New England metropolitan area. 

Participants were of diverse age (15-21), 

gender identity, sexual orientation, and 

race-ethnicity. 

Which of the following 

best describes your 

feelings? 

_ Completely heterosexual (attracted to persons of 

the opposite sex) 

_ Mostly heterosexual 

_ Bisexual (equally attracted to men and women) 

_ Mostly homosexual 

_ Completely homosexual (gay/lesbian, attracted to 

persons of the same sex) 

_ Not sure 

People are different in 

their sexual attraction to 

other people. Which 

best describes your 

feelings? 

_ Only attracted to males 

_ Mostly attracted to males 

_ Equally attracted to males and females 

_ Mostly attracted to females 

_ Only attracted to females 

_ Not sure 

Clark et al., 

2005

Cognitive interviews 40 women participated in the cognitivebased interviews: 19 women who partner 

with women (WPW) and 21 women who 

partner with men (WPM). Participants had 

a mean age of 55.0 years, were 

predominantly White (39/40), highly 

educated (38/40 some college or more), 

working for pay (27/40), and currently 

insured (36/40). 

When asked to define the term physical 

attraction, answers included sexual, 

chemical, and erotic examples. 

People differ in their 

physical attraction to 

other people. Which 

statement best 

describes your feelings? 

Would you say ...

_Only physically attracted to women 

_Mostly physically attracted to women 

_Equally physically attracted to women and men 

_Mostly physically attracted to men 

_Only physically attracted to men 

_Not sure 

_None of the statements describe your feelings 
50

Authors Mode Notes Question wording Response Options 

Although the definition of physical 

attraction included sexual intimacy for the 

majority of women, it also included other 

factors such as affection, affiliation, and 

emotional preference. 

Coffman, 

Coffman, and 

Ericson, 2013 

Online survey Study examines whether measurements 

are biased when responses to sexual 

orientation, behavior, and related 

opinions are private and anonymous. 

Experiment on 2,516 U.S. participants who 

were randomly assigned to a "best 

practices method" that used a computer 

and provided privacy and anonymity or 

assigned to a "veiled elicitation method" 

that further conceals individual responses. 

Are you sexually 

attracted to members of 

the same sex? 

(1) Yes 

(2) No 

Saewyc et al., 

2004

Face to face? The questions assessed came from eight 

student surveys with varying sampling 

designs and subsequent demographic 

characteristics. In general, the surveys 

covered students in grades 7-12, ages 12-

20. Three of the eight surveys were 

conducted by research staff in the 

classrooms; two were conducted by public 

health nurses in the classrooms; two were 

conducted by other teachers in the 

classrooms; and one was conducted by 

research staff in closed classrooms. 

How would you describe 

your sexual 

orientation/preference? 

 Heterosexual—attracted to the opposite sex 

 Bisexual—attracted to both sexes 

 Homosexual (gay or lesbian)—attracted to same sex 

 Not sure 

How would you describe 

your sexual orientation? 

 Heterosexual—attracted to the opposite sex 

 Bisexual—attracted to both sexes 

 Homosexual (gay or lesbian)—attracted to same sex 

 Not sure 

Which of the following 

best describes your 

feelings: 

I am only attracted to people of the same sex as 

mine, and I will only be sexual with persons of the 

same sex 
51

Authors Mode Notes Question wording Response Options 

I am strongly attracted to people of the same sex, 

and most of my sexual experiences will be with 

persons of the same sex as mine 

I am equally attracted to men and women and would 

like to be sexual with both 

I am strongly attracted to persons of the opposite 

sex, and most of my sexual experience will be with 

persons of the opposite sex 

I am only attracted to persons of the opposite sex, 

and I will only be sexual with persons of the opposite

sex 

When you think or 

daydream about sex, do 

you think about: 

Males 

Females 

Both 
52

D. Sexual Behavior Items Used in Cited Work

Authors, year Survey 

(if applicable) 

Question wording Response options 

Berg and Lien, 

2006

GSS, 1991-2000 Not described Not described 

Case et al., 2006 Pilot study 

participants sampled 

from 1993 NHSII 

compared to NHSII 

1995 cohort 

Whether you are currently sexually active or not, 

which response best describes who you have had sex 

with over your adult lifetime and over the last five 

years? Please choose one answer in each column. 

Please choose one answer: 

(a) Over your adult lifetime: 

_Never had sex 

_Sex with a woman/women 

_Sex with a man/men 

_Sex with both men and women 

_Prefer not to answer 

(b) Over the last five years: 

_Never had sex 

_Sex with a woman/women 

_Sex with a man/men 

_Sex with both men and women 

_Prefer not to answer 

Poston and Chang, 

2015

NSFG, 2006-2008 Sexual behavior: 

Female 1: Counting all of your male partners, even 

those you had intercourse with only once, how many 

men have you had sexual intercourse with? 

Female 2: Thinking about your entire life, how many 

female sex partners have you had? 

Male 1: How many different females have you ever 

had intercourse with? This includes any female you 

had intercourse with, even if it was only once or if 

you did not know her well. 

Male 2: Thinking about your entire life, how many 

male sex partners have you had? 

Female: 

Number of male partners 

Number of female partners 

Male: 

Number of female partners 

Number of male partners 

Vrangalova and 

Savin-Williams, 

2012

--- Participants provided in two separate questions the 

total number of male and female partners with 

whom they have had a genital sexual experience, 

defined as including penile-vaginal penetration, oral

sex, anal sex, and mutual masturbation. 

Number of male partners 

Number of female partners 
53

E. Gender Identity Items Used in Cited Work

Authors Mode Notes Question wording Response Options 

Cahill et al., 2014 Selfadministered 

(PAPI) 

What is your current 

gender identity? (Check 

all that apply) 

Male 

Female 

Female-to-Male (FTM)/Transgender Male/Trans Man 

Male-to-Female (MTF)/Transgender Female/Trans 

Woman 

Genderqueer, neither exclusively male nor female 

Additional Gender Category/(or Other), please 

specify 

What sex were you 

assigned at birth on 

your original birth 

certificate? (Check one) 

Male 

Female 

Decline to Answer, please specify why 

Deutsch et al., 

2013

Electronic 

Medical Record 

Current Gender 

Identity 

Male 

Female 

Transmale/Transman/FTM 

Transfemale/Transwoman/MTF 

Genderqueer/Gender-non-conforming 

Different identity (please state) 

Sex assigned at birth Male 

Female 

Other 

BJS 2015 CAPI What sex were you 

assigned at birth, on 

your original birth 

certificate? 

(Male) 

(Female) 

(Refused) 

ふDoミ’t kミo┘ぶ

How do you describe 

yourself (select one)? 

Male 

Female 

Transgender 

Do not identify as male, female, or transgender 

(Refused) 

ふDoミ’t kミo┘ぶ
54

Authors Mode Notes Question wording Response Options 

This is a soft error in the CAPI system that 

allows the interview to verify the values 

were correctly recorded. 

(If SEX ASSIGNED AT 

BIRTH does not equal 

CURRENT IDENTITY) 

Verify the values for 

PH3 and PH4 were 

correctly recorded. 

Interviewer should verify the values were correctly 

recorded 

Ingraham et al, 

2015

Selfadministered 

(PAPI) 

Patient demographic information form My gender identity is: Female 

Male 

Trans (MTF) 

Trans (FTM) 

Genderqueer 

Other: __________ 

Decline 

My sex assigned at 

birth is: 

Female 

Male 

Intersex 

Other: ___________ 

Decline 

Patient demographic update form My gender identity is: Female 

Male 

Trans (MTF) 

Trans (FTM) 

Genderqueer 

Other: __________ 

Decline 

Lombardi and 

Banik, 2016

Face-to-face (45) 

/Adobe Connect 

(5)

Part of cognitive interview; Participants 

were asked to read each question aloud, 

answered it, and explain why they 

answered the way that they did. 

Researchers used scripted, semistructured, and spontaneous probes when 

appropriate. 

What is your sex or 

gender? (Check ALL 

that apply) 

Male 

Female 

Other: Please specify 

What sex were you 

assigned at birth? 

(Check one) 

Male 

Female 

Unknown or Question Not Asked 

Decline to State 
55

Authors Mode Notes Question wording Response Options 

Just to confirm, you 

were assigned {sex 

assigned at birth} at 

birth and now describe 

yourself as a {current 

gender}. Is that 

correct? 

Yes 

No

Doミ’t kミo┘

Refused 

Martinez et al., 

2016

Face-to-face (58) 

/ Telephone (2)

Part of cognitive interview; In addition to 

asking the questions, interviewers also 

asked respondents probing questions that 

were designed to address specific testing 

issues for particular questions. The 

specific type of cognitive interview 

consisted of both concurrent and quasiretrospective probing. After asking the sex 

question below, researchers probed about 

the ケuestioミ, さWhat se┝ ┘eヴe ┞ou 

assigned at birth, on your original birth 

IeヴtifiIate?ざ

On your original birth 

certificate, was your 

sex assigned as male or 

female? 

Male 

Female 

Refused 

Doミ’t Kミo┘

Do you currently 

describe yourself as a 

man, woman, or 

transgender person? 

Man 

Woman 

Transgender person 

None of these 

Reisner et al., 

2014

What sex were you 

assigned at birth, on 

your original birth 

certificate? (check one) 

Female 

Male 

How do you describe 

yourself? (check one) 

Female 

Male 

Transgender 

Do not identify as female, male, or transgender 

Saperstein and 

Westbrook, 2014

Selfadministered 

(electronic) 

Order of items switched at random What sex were you 

assigned at birth? 

Male 

Female 

Intersex 
56

Authors Mode Notes Question wording Response Options 

What is your current 

gender? 

Woman 

Man 

Transgender 

Stern et al., 2016 Face-to-face Part of cognitive interview; implemented 

retrospective probing for MCBS cognitive 

interviews, in which participants answer 

questions as normal and then interviewers 

probe with additional questions aimed at 

confirming comprehension of questions 

and terms, identifying sources of 

confusion or ambiguity in survey 

questions, and learning how participants 

arrive at answers. 

What sex were you 

assigned at birth, on 

your original birth 

certificate? 

Male 

Female 

How do you describe 

yourself? 

Male 

Female 

Transgender 

Do not identify as female, male, or transgender 

The GenIUSS 

Group 2014 

Recommended measures for the two-step 

approach 

What sex were you 

assigned at birth, on 

your original birth 

certificate? 

Male 

Female 

How do you describe 

yourself? (check one) 

Male 

Female 

Transgender 

Do not identify as female, male, or transgender 

Promising measure to replace the gender 

identity step in the two-step approach 

(more testing is needed) 

What is your current 

gender identity? 

Male 

Female 

Trans male/Trans man 

Trans female/Trans woman 

Genderqueer/Gender non-conforming 

Different identity (please state): 
57

Authors Mode Notes Question wording Response Options 

Recommended measures for the singleitem approach Some people describe 

themselves as 

transgender when they 

experience a different 

gender identity from 

their sex at birth. For 

example, a person born 

into a male body, but 

who feels female or 

lives as a woman. Do 

you consider yourself 

to be transgender? 

Yes, transgender, male to female 

Yes, transgender, female to male 

Yes, transgender, gender non-conforming 

No
58

F. Gender Identity Items in Federal Surveys

Single-item gender identity measures used in Federal surveys 

Behavioral Risk Factor Surveillance System (BRFSS) National Inmate Survey (NIS) 

Do you consider yourself to be transgender?1,2 

Yes, Transgender, male-to-female 

Yes, Transgender, female-to-male 

Yes, Transgender, gender non-conforming 

No 

Don’t know/not sure 

Refused 

INTERVIEWER NOTE: If asked about definition of 

transgender: Some people describe themselves as 

transgender when they experience a different gender 

identity from their sex at birth. For example, a person 

born into a male body, but who feels female or lives as

a woman would be transgender. Some transgender 

people change their physical appearance so that it 

matches their internal gender identity. Some 

transgender people take hormones and some have 

surgery. A transgender person may be of any sexual 

orientation—straight, gay, lesbian, or bisexual. 

INTERVIEWER NOTE: If asked about definition of 

gender non-conforming: Some people think of 

themselves as gender non-conforming when they do 

not identify only as a man or only as a woman. 

Are you male, female, or transgender? 

Male 

Female 

Transgender 

Population Assessment of Tobacco and Health 

(PATH) 

Some people describe themselves as transgender 

when they experience a different gender identity from

their sex at birth. For example, a person born into a 

male body, but who feels female or lives as a woman 

would be transgender. Do you consider yourself to be 

transgender? 

Yes 

No

Don’t know

Refused 

Not Sure 

[If R answers YES] Do you consider yourself to be 

male-to-female, female-to-male, or non-conforming? 

Yes, Transgender, male to female 

Yes, Transgender, female to male 

Yes, Transgender, gender nonconforming 

No

Not sure 

Don’t know

Refused 

Not Sure

 
59

Two-step gender identity measures used in Federal surveys

National Crime Victimization Survey (NCVS) Survey of Prison Inmates (SPI) 

What sex were you assigned at birth, on your original 

birth certificate? 

Male 

Female 

(Refused) 

ふDon’t knowぶ

Do you currently describe yourself as male, female or 

transgender? 

Male 

Female 

Transgender 

None of these 

[If SEX ASSIGNED AT BIRTH does not equal CURRENT 

IDENTITY] Just to confirm, you were assigned {SEX 

ASSIGNED AT BIRTH} at birth and now describe 

yourself as {CURRENT IDENTITY}. Is that correct? 

Yes 

No

(Refused) 

ふDon’t knowぶ

What sex were you assigned at birth, on your original 

birth certificate? 

(Male) 

(Female) 

(Refused) 

ふDon’t knowぶ

[Field Interviewer Note: Did they tell you that you 

┘eヴe Hoヴミ マale oヴ feマale?ざ]

How do you describe yourself (select one)? 

Male 

Female 

Transgender 

Do not identify as male, female, or transgender 

(Refused) 

ふDon’t knowぶ

IF (PH3 = 1 AND PH4 ne 1) OR (PH3 = 2 AND PH4 ne 2)] 

VERIFY THE VALUES FOR PH3 AND PH4 WERE 

CORRECTLY RECORDED 

National Adult Tobacco Survey (NATS)

What sex were you at birth? 

Male 

Female 

Do you currently consider yourself to be: 

Male 

Female
60

G. Scales Used to Measure Gender Expression

Authors, year Scale wording Response options 

Correll et al., 2014 First-order scale –

さIミ geミeヴal, ho┘ do ┞ou see ┞ouヴself? 

Please answer on both scales Helo┘.ざ

Separate scales for feminine and 

masculine. 

Not at all – 1 

2 

3 

4 

5 

6 

Very – 7 

Same response options for 

feminine and masculine scales. 

Third-order scale –

さIミ geミeヴal, ho┘ do ┞ou thiミk マost 

people see you? Please answer on 

Hoth sIales Helo┘.ざ

Separate scales for feminine and 

masculine. 

Not at all – 1 

2 

3 

4 

5 

6 

Very – 7 

Same response options for 

feminine and masculine scales. 

Magliozzi et al., 2016 First-order scale –

さIミ geミeヴal, ho┘ do ┞ou see ┞ouヴself? 

Please aミs┘eヴ oミ Hoth sIales Helo┘.ざ

Separate scales for feminine and 

masculine. 

Not at all 

1 

2 

3 

4 

5 

Very 

Same response options for 

feminine and masculine scales. 

Third-order scale –

さIミ geミeヴal, ho┘ do マost people see 

you? Please answer on both scales 

Helo┘.ざ

Separate scales for feminine and 

masculine. 

Not at all 

1 

2 

3 

4 

5 

Very 

Same response options for 

feminine and masculine scales. 
H. Measures of Household Relationships

Figure 1. Example of a sex and relationship to householder edit check: 2016 National Health Interview 

Survey

Figure 2. Relationship question used in the 2010 Decennial Census and 2010 American Community 

Survey 

How is this person related to Person 1? Mark (X) ONE box.

[ ] Husband or wife [ ] Paヴeミt ‐iミ‐la┘

[ ] Biological son or daughter [ ] “oミ‐iミ‐la┘ oヴ daughteヴ‐iミ‐la┘

[ ] Adopted son or daughter [ ] Other relative 

[ ] Stepson or stepdaughter [ ] Roomer or boarder 

[ ] Brother or sister [ ] Housemate or roommate 

[ ] Father or mother [ ] Unmarried partner 

[ ] Grandchild [ ] Other nonrelative

Figure 3. Revised Relationship to Householder Question Tested in the 2013 American Housing Survey 

How is this person related to Person 1? Mark (X) ONE box. 

[ ] Opposite‐se┝ husHaミd/┘ife/spouse [ ] Grandchild 

[ ] Opposite‐se┝ uミマaヴヴied paヴtミeヴ [ ] Paヴeミt ‐iミ‐la┘

[ ] “aマe‐se┝ husHaミd/┘ife/spouse [ ] “oミ‐iミ‐la┘ oヴ daughteヴ‐iミ‐la┘

[ ] “aマe‐se┝ uミマaヴヴied paヴtミeヴ [ ] Other relative 

[ ] Biological son or daughter [ ] Roomer or boarder

[ ] Adopted son or daughter [ ] Housemate or roommate

[ ] Stepson or stepdaughter [ ] Foster child 

[ ] Brother or sister [ ] Other nonrelative 

61