1 

Federal Interagency Working Group on Improving Measurement of Sexual Orientation and 

Gender Identity in Federal Surveys 

Current Measures of Sexual Orientation 

and Gender Identity in Federal Surveys

 August, 2016 

Contents 

I. Introduction and Purpose of the Working Paper................................................................................ 2 

II. What to Measure: Concepts................................................................................................................ 2 

a. Sex and Gender................................................................................................................................. 2 

b. Transgender...................................................................................................................................... 3 

c. Sexual Orientation............................................................................................................................ 3 

d. Household Relationships.................................................................................................................. 4 

III. Current Measurement.......................................................................................................................... 4 

a. Sexual Identity.................................................................................................................................. 4 

b. Sexual Attraction.............................................................................................................................. 9 

c. Sexual Behavior..............................................................................................................................11

d. Gender Identity...............................................................................................................................12

e. Household Relationships................................................................................................................14

f. Administrative Records and Program Data...................................................................................15

IV. Choosing a Measure...........................................................................................................................16

a. Selecting the Concept.....................................................................................................................16

b. Considerations and Context...........................................................................................................17

c. Methods Considerations ................................................................................................................19

d. Post-Survey Analysis.......................................................................................................................20

V. Conclusion ..........................................................................................................................................21

References..................................................................................................................................................22

Appendix A: Acronyms...............................................................................................................................26

 
2 

I. Introduction 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 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 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) to begin 

addressing the dearth of data for these populations and the issues surrounding methodological issues in 

collecting such data. 

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

decade, some aspects of 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. The 

purpose of this working paper is to describe how the concepts of SOGI are currently measured in U.S. 

Federal surveys.2

 This document is one of three working papers anticipated to be developed through the 

Interagency Working Group. A second working paper will review evaluations of questionnaire 

measurement, and a third will propose a research agenda to further improve sexual orientation and 

gender identity measures. Other working papers may be developed as research in this area further 

matures. 

II. What to Measure: Concepts 

Several key concepts are central to discussions of SOGI. These include sex, gender, transgender, and 

sexual orientation. Terms related to these concepts, such as lesbian, gay, bisexual, and transgender 

(LGBT), may have more than one meaning based on social context. For Federal surveys, both the 

purpose of the survey and the specific dimension of SOGI intended to be measured are important design 

and measurement considerations. A related measure is the identification of same-sex households. 

However, the identification of same-sex households is not a direct measure of SOGI for the individuals in 

those households. 

a. 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 

refers to さthe genetic, hormonal, anatomical and physiological characteristics on whose basis one is 

labeled at birth as either male or femaleざ (IOM, 2011, p. 25). The term, gender, on the other hand, 

ヴefeヴs 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 and 

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WHO, 2016). 

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

gender.3 Gender is a multidimensional construct that has psychological, social, and behavioral 

dimensions that include gender identity and gender expression. It refers to the さIultuヴal マeaミiミgs of 

patterns of behavior, experience, and personality that are labeled masculine or feminineざ (IOM, 2011, 

 

1

 This working paper refers to the population of interest as sexual and gender minority (SGM) rather than the more 

commonly used reference as lesbian, gay, bisexual, and transgender (LGBT). We believe that SGM is more inclusive 

as it would include persons not specifically referenced by LGBT such as genderqueer, among others. 

2

 For the purposes of this working paper, non-federal SOGI measures, such as those included in the California 

Health Interview Survey (CHIS), are discussed solely in the context of our review of federal measures. 

3

 Some argue that the concepts of sex, male, and female are also socially constructed (Kelly, 2016).
3 

p.25). Geミdeヴ ideミtit┞ ヴefeヴs to a peヴsoミげs iミteヴミal seミse of gender (e.g., being a man, a woman, or 

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

genderqueer). 

b. Transgender 

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

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 a cis-gender person (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 term transgender describes anyone whose gender 

identity 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げs self-identified 

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

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

gender dysphoria, 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 (APA, 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.4 

c. Sexual Orientation 

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

Sexual attraction ヴefeヴs to the ヴelatioミship Het┘eeミ a peヴsoミげs geミdeヴ and the gender(s) of the 

individuals to whom that person is sexually attracted (for example, whether an individual is attracted to 

men, women, or both men and women. Sexual behavior refers to the relatioミship Het┘eeミ a peヴsoミげs 

gender and the gender(s) of the individuals with whom that person engages in sexual activity (for 

example, whether an individual has sex partners who are of the same sex, the opposite sex, or both). 

Sexual identity refers to the way a person self-identifies with a given sexual orientation (for example, 

how an individual thinks of the iミdi┗idualげs self) (SMART, 2009). 

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

heterosexual/straight.5

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, or 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. 

 

4

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

nonconformity is not itself 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).

5

 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 and gay. The term 

heterosexual similarly corresponds to those with straight identities and/or different-sex attraction and/or partners. 

Because of its appearance as a mental disorder in the DSM-I and DSM-II, the term homosexual is sometimes seen 

as unfavorable. Homosexuality was declassified as a mental disorder beginning with the publication of the DSM-III 

in 1973. 
4 

Surveys should focus on accurate measurement of the dimension(s) in which they are interested for the 

purposes of the study (SMART, 2009). Askiミg the けヴightげ ケuestioミ for the purpose of the information 

collection can be challenging. Conceptual dimensions may be fluid over time and may not necessarily 

align for a given person. Academically, these distinctions are clear but the perceptions of the general 

public are often not. For example, while sex and gender can be defined as two different concepts, most 

people do not think of it that way. This disconnect often contributes to measurement and design issues. 

d. 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 in a relationship or 

not living in the same household as their partner will not be identified (MRFHS 2014). 

III. Current Measurement 

Currently, there are eleven Federal surveys and one Federal study that collect data on sexual 

orientation, including identity, attraction, and behavior, and gender identity. The eleven surveys include: 

Health Center Patient Survey (HCPS), National Adult Tobacco Survey (NATS), National Health and 

Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), National Inmate 

Survey (NIS), National Crime Victimization Survey (NCVS), National Survey of Family Growth (NSFG), 

Youth Risk Behavior Surveillance System (YRBSS), National Survey on Drug Use and Health (NSDUH), 

National Survey of Older Americans Act Participants (NSOAAP), and Behavior Risk Factor Surveillance 

System (BRFSS). The one study includes Population Assessment of Tobacco and Health (PATH). Ten of 

the twelve surveys/study are collected by the Department of Health and Human Services. Two surveys, 

the NIS and the NCVS, are collected by the Department of Justice.6

All of these surveys/study collect data on sexual identity. Three of the surveys/study collect sexual 

attraction (PATH, NSFG, and NSDUH); four collect sexual behavior (NSFG, NHANES, NIS, YRBSS); and six 

collect gender identity (PATH, HCPS, NATS, NIS, NCVS, BRFSS). 

a. Sexual Identity 

Table III.a summarizes current measures of sexual identity. In brief, there are two main ways sexual 

identity is asked in Federal surveys /studies: 

 Which of the following best represents how you think of yourself? (NHIS/NHANES, NCVS, 

NSOAAP)7

 and 

 

6

 At the time of this writing, several Federal agencies have planned, field tested, or prepared additional, national 

information collections including measures of sexual orientation and/or gender identity. These include the High 

School Longitudinal Survey and the Medicare Current Beneficiary Study, among others. 

7

 For the 2013 and 2014 NHIS, follow-up ケuestioミs ┘eヴe asked foヴ iミitial ヴespoミses of さsoマethiミg elseざ aミd さI 

doミげt kミo┘ the aミs┘eヴざ in an effort to reduce misreporting and to accommodate more inclusive terms. Upon 

analysis, NHIS found that the percentage of sample adult respondents who received these follow-up questions was 

quite low (~0.6% in both 2013 and 2014). Further, comparisons of sexual orientation estimates before and after 

back-coding of responses to account for follow-up question responses revealed no substantive differences. Hence, 

the follow up questions were removed starting with the 2015 survey. NHANES questions were changed in 2015-

2016 to be consistent with the questions used in other surveys at NCHS. 
5 

 さDo you think of yourself as...ざ (NSFG/NSDUH/PATH/NATS/BRFSS)8

. 

Table III.a Current Measures of Sexual Identity in Federal Surveys 

Survey Name Current Question Mode Population 

NHIS 

(DHHS/CDC/ 

NCHS) 

Topic asked: 

2013-present 

Current 

Question: 

2015-present 

(ACISIM/F) Which of the following best represents how

you think of yourself? 

[If R is female then Lesbian or] Gay 

Straight, that is, not [If R is female then Lesbian or] Gay

Bisexual 

Something else 

I doミげt kミo┘ the aミs┘eヴ

(Refused) 

 

CAPI, with 

some 

telephone 

follow-up

U.S. adult 

civilian, noninstitutionali

zed 

population 

aged 18+ 

NHANES 

(DHHS/CDC/ 

NCHS) 

Topic asked: 

2001-present 

Current 

Question: 

2015-present 

(SXQ.295/296) Which of the following best represents 

how you think of yourself? 

[If R is female then Lesbian or] Gay 

Straight, that is, not [If R is female then Lesbian or] Gay

Bisexual 

Something else 

I doミげt kミo┘ the aミs┘eヴ 

ACASI U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 18-59

NSFG 

(DHHS/CDC/ 

NCHS) 

Years asked: 

2002, 2006-

2010, 2011-13

Current 

Question: 

2006-2013 

ふO‘IENTぶ Do ┞ou thiミk of ┞ourself as...

Heterosexual or straight 

Homosexual or Gay [If R is female then Lesbian] 

Bisexual 

Something else 

ふDoミげt Kミo┘ぶ

(Refused) 

ACASI U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 15-44 

 

8

In 2002, NSFG featured different response options (that is, heterosexual, homosexual, bisexual, something else).

NSFG has used the current response options starting in 2006. HCPS and NIS are variants on the NSFG question 

format. NSDUH has a modified response option, listing the most common response option first. It does not include 

a さsoマethiミg elseざ optioミ. Iミ ヲヰヱン PATH used the N“FG ケuestioミ ふDo ┞ou thiミk of ┞ouヴself asぶ ┘ith マodified NHI“ 

follow-up. In 2014-2015, PATH moved to the single NSFG question format without the modified NHIS follow up 

question. The YRBSS uses a unique question format (that is, さ┘hich of the following best describes you?ざ).
6 

Table III.a Current Measures of Sexual Identity in Federal Surveys 

Survey Name Current Question Mode Population 

NSDUH 

(DHHS/ 

SAMHSA/ 

CBHSQ) 

Years asked: 

2015-present 

(QD63) Which one of the following do you consider 

yourself to be? 

Heterosexual, that is, straight 

[If R is female then Lesbian or] Gay

Bisexual 

ふDoミげt Kミo┘ぶ

(Refused)

ACASI U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 18 and 

older 

PATH 

(DHHS/ NIH 

and 

DHHS/FDA) 

Topic asked: 

2013-present 

Current 

Question: 2014 

(R02_AM0063/R03_AM0063) Do you consider yourself 

to He...

Straight 

Lesbian or Gay

Bisexual 

Something else 

Doミげt kミo┘

Refused 

ACASI U.S. civilian, 

noninstitutio

nalized 

population 

aged 14 and 

older 

HCPS 

(DHHS/HRSA/ 

BPHC) 

Year asked: 

2014 

(DMO8a] Do you think of yourself as straight or 

heterosexual, as gay, lesbian or homosexual, or as 

bisexual? 

Straight or heterosexual 

Gay, Lesbian, homosexual 

Bisexual 

Not sexual/celibate/none 

Other, please specify 

CAPI All health 

center 

patients, 

ages 15 and 

older 

NATS 

(DHHS/CDC) 

Years asked: 

2012-2014 

(SEXUALORIENT1) Do ┞ou thiミk of ┞ourself as...?

[If R is female then Lesbian or] Gay 

Straight, that is, not [If R is female then Lesbian or] Gay

Bisexual 

Something else 

ふDoミげt Kミo┘ぶ

(Refused)

[If ‘ seleIts さ“oマethiミg elseざ in SEXUALORIENT1] 

(SEXUALORIENT2) By something else, do you mean 

that ... 

You are not straight, but identify with another label 

such as queer, trisexual, omnisexual or pansexual 

CATI U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 18 and 

older 
7 

Table III.a Current Measures of Sexual Identity in Federal Surveys 

Survey Name Current Question Mode Population 

You are transgender, transsexual or gender variant 

You have not figured out your sexuality or are in the 

process of figuring it out 

You do not think of yourself as having sexuality 

You do not use labels to identify yourself 

You made a mistake and did not mean to pick this 

answer 

You mean something else. 

ふDoミげt Kミo┘ぶ

(Refused)

[If ‘ seleIts さYou マeaミ soマethiミg elseざ iミ 

SEXUALORIENT2]

(SEXUALORIENT3)You ga┗e さDoミげt kミo┘ざ as aミ 

aミs┘er. Is that HeIause ... 

You doミげt uミdeヴstaミd the ┘oヴds. 

You understand the words, but you have not figured out 

your sexuality or you are in the process of figuring it out 

You mean something else 

ふDoミげt Kミo┘ぶ

(Refused)

 

[If ‘ seleIts さYou マeaミ soマethiミg elseざ iミ 

SEXUALORIENT3] 

Please tell マe ┘hat ┞ou マeaミ H┞ さsoマethiミg elseざ?

Open ended 

NIS 

(DOJ/BJS) 

Years asked: 

2007, 2008-

2009, 2011-

2012 

(D5) Do you consider yourself to be heterosexual or

けstraightげ, Hise┝ual, or hoマose┝ual or ga┞?

け“tヴaight,げ ┘hiIh is also Ialled Heteヴose┝ual

Bi-sexual 

[If R is male] Homosexual or Gay 

[If R is female, DK, Refused] Homosexual, Gay, or 

Lesbian 

Other 

ふDoミげt Kミo┘ぶ

ACASI/PAPI Prison and 

jail inmates, 

age 18 and 

older (except 

in 2011-12, 

which 

included 

inmates age 

16 or older) 

NCVS 

(DOJ/BJS) 

Years asked: 

July 2016-

present 

Which of the following best represents how you think of 

yourself? 

[If R is female then Lesbian or] Gay 

Straight, that is, not [If R is female then Lesbian or] Gay 

Bisexual 

Something else 

I doミげt kミo┘ the aミs┘eヴ 

Interviewer 

administered, 

CAPI, in-person 

and telephone 

interviewing 

U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 16 and 

older 
8 

Table III.a Current Measures of Sexual Identity in Federal Surveys 

Survey Name Current Question Mode Population 

(Refused) 

NSOAAP 

(DHHS/ACL) 

Years asked: 

2014-2016 

(ACISIM/F) Which of the following best represents how

you think of yourself? 

[If R is female then Lesbian or] Gay 

Straight, that is, not [If R is female then Lesbian or] Gay

Bisexual 

Something else 

Refused 

Doミげt Kミo┘

If R aミswers さ“oマethiミg elseざ to ACI“M/F: 

(ACISMELS/FELS) What do you mean by something 

else? 

You are not straight, but identify with another label 

such as queer, trisexual, omnisexual or pansexual 

You are transgender, transsexual or gender variant 

You have not figured out or are in the process of 

figuring out your sexuality 

You do not think of yourself as having sexuality 

You do not use labels to identify yourself 

You mean something else 

Refused 

Doミげt Kミo┘ 

If R aミswers さDoミ’t kミowざ to ACI“MEL“/FEL“:

(ACISIMDK/FDKぶ What do ┞ou マeaミ H┞ doミげt kミo┘?

You doミげt uミdeヴstaミd the ┘oヴds

You understand the words, but you have not figured out 

or are in the process of figuring out your sexuality 

You mean something else 

Refused 

Doミげt kミo┘ 

If R aミswers さ“oマethiミg elseざ to ACISIMDK/FDK: 

(ACIMSESP/FSESP) What do you mean by something 

else? Open ended 

CATI Administrati

on on Aging 

Title III 

service 

participants. 

Most 

respondents 

are aged 60

and older. 

Respondents 

answering 

questions 

under the 

Caregiver 

module are 

adults age 18 

and over. 

YRBSS 

(DHHS/CDC) 

Years asked: 

2015 

(Q68) Which of the following best describes you? 

Heterosexual (straight) 

Gay or Lesbian 

Bisexual 

Not sure 

School-based, 

selfadministered 

PAPI 

9

th – 12th

graders 
9 

Table III.a Current Measures of Sexual Identity in Federal Surveys 

Survey Name Current Question Mode Population 

BRFSS 

(DHHS/CDC) 

Years asked: 

2014 

(582) Do you consider yourself to be: 

Straight 

Lesbian or Gay 

Bisexual 

CATI 

(Optional 

module) 

U.S. adult 

civilian, 

noninstitutio

nalized 

population 

aged 18 and 

older 

Location in Survey 

In the NHIS, the questions appear in the sample adult core module, where a sample adult responds on 

behalf of his/herself. The NCVS and the NSOAAP also include the questions in the demographic section. 

However, generally, sexual identity questions tend to be placed at the end of ACASI sections and not to 

be placed with other demographic questions. In NHANES, NSDUH, NSFG, and PATH, the sexual identity 

question appears in the ACASI module, often as the last question. In NATS, it is asked as the closing 

question in computer assisted interviewing, in the NIS, the sexual identity question is asked as the last 

question asked of all inmates. In the YRBSS and BRFSS, the sexual identity question appears in optional 

modules, not the core survey. The HCPS includes the questions in the second demographic section, 

amidst questions about education, marital, employment, and veteran status. 

b. Sexual Attraction 

Table III.b presents current measures of sexual attraction used by NSFG and NSDUH; and PATH. 

9

 The 

NSDUH question is slightly different from the NSFG question format. 

Table III.b. Sexual Attraction 

Survey Name Current Question Mode Population 

NSFG 

(DHHS/CDC/NCHS) 

Years asked: 2002, 

2006-2010, 2011-

2013 

(ATTRACT) People are different in their sexual 

attraction to other people. Which best describes 

┞our feeliミgs? Are ┞ou...

[If R is male] 

Only attracted to females 

Mostly attracted to females 

Equally attracted to females and males 

Mostly attracted to males 

Only attracted to males 

Not sure 

[If R is female] 

Only attracted to males 

Mostly attracted to males 

Equally attracted to males and females 

Mostly attracted to females 

ACASI U.S. adult civilian, 

noninstitutionalized 

population aged 

15-44

 

9

 In wave 1 of PATH, different response options were used for males and females; in waves 2 and 3, only one set of 

response options was provided. 
10

Table III.b. Sexual Attraction 

Survey Name Current Question Mode Population 

Only attracted to females 

Not sure 

NSDUH 

(DHHS/ 

SAMHSA/ 

CBHSQ) 

Years asked: 2015-

present 

(QD62) People are different in their sexual 

attraction to other people. Which best describes 

your feelings? 

[If R is male] 

I am only attracted to females 

I am mostly attracted to females 

I am equally attracted to females and males 

I am mostly attracted to males 

I am only attracted to males 

I am not sure 

ふDoミげt Kミo┘ぶ

(Refused) 

 

[If R is female] 

I am only attracted to males 

I am mostly attracted to males 

I am equally attracted to males and females 

I am mostly attracted to females 

I am only attracted to females 

I am not sure 

ふDoミげt kミo┘ぶ

(Refused) 

ACASI U.S. adult civilian, 

noninstitutionaliz

ed population 

aged 18 and 

older 

PATH 

(DHHS/NIH and 

DHHS/FDA) 

Years asked: 2013-

present 

Current Question: 

2015 

(R01_AM0021) The next question asks about your 

level of sexual attraction to BOTH males and 

females. Please consider the response choices 

carefully, as it is important that you understand 

them and are as honest as you can be in your 

answer. 

To whom have you felt sexually attracted, even if 

you did not take any action based on feeling 

attracted? 

Only to females, never to males 

Mostly to females, and at least once to a male 

About equally often to females and to males 

Mostly to males, and at least once to a female 

Only to males, never to females 

I have never felt sexually attracted to anyone at all 

Doミげt Kミo┘

Refused 

ACASI U.S. civilian, 

noninstitutionaliz

ed population 

aged 12 and 

older 
11

Table III.b. Sexual Attraction 

Survey Name Current Question Mode Population 

c. Sexual Behavior 

Four federal surveys currently include questions on sexual behavior: NHANES, NSFG, NIS and YRBSS. 

These questions have different phrasing and have different populations of interest. See Table III.c. 

Table III.c Sexual Behavior 

Survey Name Current Question Mode Population 

NHANES 

(DHHS/CDC/NCHS) 

Years asked: 2001-

Current 

NHANES includes sexual behavior questions 

including age at first sexual intercourse, number of 

sexual partners, and history of sexually 

transmitted disease 

ACASI U.S. adult civilian, 

noninstitutionalized 

population aged 

18-59

NSFG 

(DHHS/CDC/NCHS) 

Years asked: 2002, 

2006-2010, 2011-

2013 

NSFG includes questions on a wider range of 

sexual activities—including oral and anal sex with 

opposite-sex partners and sexual contact with 

same-sex partners 

(See report for sexual behavior questions: 

http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf) 

ACASI U.S. adult civilian, 

noninstitutionalized 

population aged 

15-44

NIS 

(DOJ/BJS) 

Years asked: 2007, 

2008-2009, 2011-

2012 

[IF D3 さミuマHer of partミersざ NE 1 ふミo partミersぶ] 

(D4) Before you entered this facility, had you had 

sex with men only, women only, or both men and 

women? 

Men only 

Women only 

Both men and women 

ACASI, 

PAPI 

Prison and jail 

inmates, age 18 

or older (except 

in 2011-12, which 

included inmates 

16 or older) 

YRBSS 

(DHHS/CDC) 

Years asked: 2015 

(Q67) During your life, with whom have you had 

sexual contact? 

I have never had sexual contact 

Females 

Males 

Females and males 

Schoolbased, 

selfadminist

ered 

PAPI 

9

th – 12th graders 
12

d. Gender Identity 

Six Federal surveys currently feature gender identity questions. PATH and BRFSS ask similar two-part 

questions. NATS and NCVS ask similar two-part questions: sex at birth and current gender. NCVS also 

includes a follow up question to confirm the questions were answered as intended. NIS and HCPS use a 

one question format, asking about gender and providing a response option for transgender in the 

question stem and among response options. See Table III.d. We note that the location of the NATS twostep gender identity measure (Demographics section) is different than the location of its sexual 

orientation questions (Closing section). To improve the response rates of this phone survey, NATS 

strategically placed the series of sexual orientation questions, which might be considered sensitive, in 

the Closing section. 

Table III.d Gender Identity 

Survey 

Name 

Current Question Mode Population 

PATH 

(DHHS/NIH 

and 

DHHS/FDA) 

Years asked: 

2013-

present 

(R02_AM0061/R03_AM0061) 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

Doミげt kミo┘

Refused 

Not Sure 

[If R answers yes to R02_AM0061/R03_AM0061) 

(R02_AM0062/R03_AM0062) 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 

Doミげt kミo┘

Refused 

Not Sure 

ACASI U.S. civilian, 

noninstitutiona

lized 

population 

aged 14 and 

older 

HCPS 

(DHHS/HRSA

/BPHC) 

Year asked: 

2014 

(INT3) What is your gender? 

Male 

Female 

[If age >13]: 

Female to male transgender male/trans male/female to 

male 

CAPI All health 

center patients 

If respondent is 

less than 12 

years old, 
13

Table III.d Gender Identity 

Survey 

Name 

Current Question Mode Population 

Male to female transgender female/trans woman/male to 

female 

Gender queer 

OTHER, specify 

 

(INT3_SPEC) We have entered your gender as [INT3 

RESPONSE: Genderqueer OR INT3_OTH RESPONSE: FILL]. 

In this interview, questions will appear based on gender. 

For example, we only ask questions about mammograms 

to females of a specific age. Since this is a research study 

collecting medical-related data, could you tell us your 

biological sex at birth? 

Male 

Female 

parent/guardia

n response 

NATS 

(DHHS/CDC) 

Years asked: 

2012-2014 

90. What sex were you at birth? 

Male 

Female 

91. Do you currently consider yourself to be: 

Male 

Female 

CATI U.S. adult 

civilian, 

noninstitutiona

lized 

population 

aged 18 and 

older 

NIS 

(DOJ/BJS) 

Years asked: 

2007, 2008-

2009, 2011-

2012 

(D2) Are you male, female, or transgender? 

Male 

Female 

Transgender 

ACASI, 

PAPI 

Prison and jail 

inmates, age 18 

or older 

(except in 

2011-12, which 

included 

inmates 16 or 

older) 

NCVS 

(DOJ/ BJS) 

Years asked: 

July 2016-

present 

What sex were you assigned at birth, on your original 

birth certificate? 

Male 

Female 

(Refused) 

ふDoミげt kミo┘ぶ

Do you currently describe yourself as male, female or 

transgender? 

Interview

er 

administ

ered, 

CAPI, inperson 

and 

telephon

e 

U.S. adult 

civilian, 

noninstitutiona

lized 

population 

aged 16 and 

older 
14

Table III.d Gender Identity 

Survey 

Name 

Current Question Mode Population 

Male 

Female 

Transgender 

None of these 

Just to confirm, you were assigned {FILL} at birth and 

now describe yourself as {FILL}. Is that correct? 

Yes

No

(Refused) 

ふDoミげt kミo┘ぶ

interview

ing 

BRFSS 

(DHHS/CDC) 

Years asked: 

2014 

(583) Do you consider yourself to be transgender? 

If ┞es, ask さDo ┞ou Ioミsider ┞ourself to He 1. Male-tofemale, 2. Female-to-male, or 3. Gender nonconforming? 

1. Yes, Transgender, male-to-female 

2. Yes, Transgender, female to male 

3. Yes, Transgender, gender nonconforming 

CATI 

(Optional 

module) 

U.S. adult 

civilian, 

noninstitutiona

lized 

population 

aged 18 and 

older 

e. Household Relationships 

A previous working paper, Improved Measurement of Household Relationships in Federal Surveys, 

focused on the measurement of same-sex co-residential relationships (MRFHS, 2014). Although not the 

main focus of the current working paper, below we provide a brief summary of Federal measurement of 

same sex households since 2010. 

The 2010 Census was the first decennial census to provide estimates of same-sex married couples 

(Lofquist et al., 2012). Although estimates of same sex-couples were produced by researchers from 

earlier censuses, such estimates were subject to misreporting as well as the statistical challenges of 

obtaining estimates of a small group, such as the SGM population, because of a low rate of random 

error in a large group (Lewis et al., 2015; Black et al., 2007). 

Of the 56 million different-sex married couple households reported in 2010, a small proportion of 

respondents mismarked their responses and indicated being same-sex married couples. When 2010 

Census data were compared to the 2010 ACS, the number of same-sex couple households in the Census 

was 52 percent higher than the ACS estimate ふOげCoミミell aミd Feliz, ヲヰヱヱぶ. Investigation of this 

discrepancy found data capture errors in the sex item on the Census form that inflated the census 

counts of the numbers of same-sex spousal households. Although these cases represented a relatively 

small percentage of all households, the resulting error was still large enough to create a significant error 

in the estimate of same-sex married couple households. 

After conducting focus groups and cognitive testing, the Census Bureau developed a revised relationship 

question. The revision sought to incorporate several goals—to list same-sex married couples specifically, 
15

to treat unmarried partners and spouses equivalently, and to minimize the identified statistical error. To 

address the statistical error specifically, the revised relationship question includes an automated check 

in electronic modes of data collection to help respondents accurately report their household 

characteristics. The automated check pops up if respondents report sex values for spouses or unmarried 

partner couples that do not agree with the specific relationship category they chose. 

The revised question and electronic checks were tested in the 2013 American Housing Survey (AHS), the 

2014 and 2015 Census Tests, and the 2015 National Content Test. In addition, the Census Bureau is 

testing this question on the 2016 Census Test and 2016 American Community Survey (ACS) Content Test. 

This revised question has now been implemented in the AHS and the Survey of Income and Program 

Participation (SIPP). 

Beginning in May 2015, the revised question was implemented in the Current Population Survey (CPS) 

for incoming rotation groups, so that by the time of the 2017 Annual Social and Economic Supplement, 

all cases will receive the revised question. ACS implementation is planned for 2019, after the content 

testing cycle is completed, and the Census Bureau plans to continue to test and work toward inclusion of 

the revised question in the 2020 Census. 

f. Administrative Records and Program Data 

Administrative records – Fielding a probability survey to obtain gender identity may not be feasible or 

affordable. A variety of administrative databases have been used to study alternative ways to identify 

some of the transgender population and to evaluate disparities and health concerns, when direct 

measurement of the SGM population is not possible. 

Social Security Administration (SSA) records have been used to identify individuals likely to be 

transgender by examining name and sex-coding changes (Cerf Harris, 2015). These individuals were 

more likely to change their names than their sex-coding although some individuals changed both items. 

SSA records were linked to Census records and found that transgender individuals identified in the SSA 

files were more likely than non-transgender individuals to leave the Census question on sex blank or to 

IheIk Hoth さMざ aミd さFざ (Cerf Harris, 2015). 

Medicare claims records can be used to identify transgender Medicare beneficiaries (Haffer, 2015). 

Diagnosis, procedure, prescription drug, and billing codes were used to identify beneficiaries who 

sought transgender-related services. This research was able to use other claims information to validate 

the classification of transgender in 87 percent of cases (Haffer, 2015). 

Veterans Health Administration data were used to examine health issues among veterans with gender 

identity disorder (GID). Such veterans were identified from claims data using the GID diagnosis codes 

and older related codes such as transsexualism (Blosnich et al., 2013; Kauth et al., 2014). The GID 

identification could not be independently confirmed and is subject to misclassification bias from 

erroneous diagnosis codes in the patient claims files. In addition, using GID diagnosis codes to identify 

transgender status may miss veterans who self-identify as transgender but do not have a clinical 

diagnosis of GID, or may have included veterans with GID who do not self-identify as transgender 

(Blosnich et al., 2013; Kauth et al., 2014). 

Although these studies demonstrate that identification of some of the transgender population is 

possible using administrative records, such an approach is not currently being routinely used in part due 

to the difficulty in generalizing the results to the entire transgender population. In particular, individuals 
16

who have not yet begun any transgender medical services or who have already fully transitioned may 

not be identified with these methods. 

Program Data - Program data differs from the types of Federal survey and administrative data 

mentioned here but may provide a source of data on SGM. For example, the Uniform Data System (UDS) 

is a core system of information appropriate for reviewing the operation and performance of health 

centers. UDS is a reporting requirement for Health Resources and Services Administration (HRSA) 

grantees, including community health centers, migrant health centers, health care for the homeless 

grantees, and public housing primary care grantees. The data are used to improve health center 

performance and operation and to identify trends over time. UDS data are compared with national data 

to review differences between the U.S population at large and those individuals and families who rely on 

the health care safety net for primary care. Beginning in 2017, health centers will be asked to report 

patieミtげs se┝ at Hiヴth as ┘ell as sexual orientation and gender identity information about the population 

served (see: 2016 Uniform Data System (UDS) Changes, 

http://www.bphc.hrsa.gov/datareporting/reporting/index.html). Similar data are collected by grantees 

of soIial seヴ┗iIe pヴogヴaマs fuミded H┞ the Adマiミistヴatioミ foヴ Coママuミit┞ Li┗iミgげs ふACLぶ Agiミg aミd 

Disability Networks. 

IV. Choosing a Measure 

This section reviews and identifies issues for Federal agencies to consider when choosing SOGI questions 

for inclusion in Federal surveys and administrative databases. These issues will be explored in more 

detail in the forthcoming evaluations working paper. The term SOGI is used broadly to include the 

concepts covered in section II. More specific terms are discussed where necessary. Factors to consider 

when incorporating SOGI questions in data collection efforts include the selection of concept(s) related 

to the suヴ┗e┞げs puヴpose, pre-survey considerations and context, changes in the methods or 

administration of the survey, and post-survey analysis. 

a. Selecting the Concept 

Before incorporating SOGI questions in surveys or administrative databases, Federal agencies need to 

consider the purpose and objectives of the survey or database and the reason to add SOGI questions. 

Several of the SOGI questions discussed in the Current Measures section have undergone extensive 

testing and validation (Dahlhamer et al., 2014; Lombardi and Banik, 2016). Some surveys, like the NSFG, 

include a variety of concepts including sexual orientation, sexual behavior, and sexual attraction 

(Chandra, et al., 2011). If an agency chooses to develop a new question, it should be validated with 

qualitative techniques like cognitive testing, pre-testing, and split samples (OMB, 2016). Even if a 

validated SOGI question is used, additional testing during the design phase may be needed to evaluate 

how the question performs in a new setting with a different audience. 

Cognitive testing is used to ensure data validity and to test question validity, how respondents 

understand the question and whether it measures what is intended (OMB, forthcoming). Although it is 

impossible for a cognitive testing study to include all social and demographic groups represented in each 

survey, having a variety of groups represented is preferred. Previous cognitive testing of SOGI questions 

found that in some cases the non-SOGI population misinterpreted the question and response categories 

(Miller and Ryan, 2011; Ridolfo et al., 2012). Therefore, it is important that question validation efforts 

include both the SOGI and non-SOGI groups. 

Some early efforts to measure SOGI included a question or series of questions intended to measure both 

sexual orientation and gender identity. For example, a sexual orientation question with a けsomething 
17

elseげ response category led to a question on gender identification. Attempts to measure both sexual 

orientation and gender identity with one question or a series of questions tend to conflate the concepts 

and reduce resulting information quality. These two concepts are distinct and should be measured by 

separate questions. In some cases, agencies may choose to measure only one of these concepts, 

depending on the goals of the survey and feasibility of measurement (Westbrook and Saperstein, 2015). 

b. Considerations and Context 

Additional considerations when incorporating SOGI questions include the context and characteristics of 

the respondent population. 

Age – Teenagers may be in the midst of developing their sexual orientation, experiencing sexual 

attraction, and beginning to engage in sexual behavior, and therefore they may be unsure of how to 

respond to SOGI questions (IOM, 2011; Chandra et al., 2011; SMART, 2009; Saewyc et al., 2004). 

Adolescents may use different terms for SOGI concepts than adults use; therefore, questions developed 

and validated for adults should be reevaluated before being applied to adolescent populations. SOGIヴelated Hull┞iミg, iミIludiミg the use of the teヴマs さlesHiaミざ aミd さga┞ざ as sluヴs, is マoヴe Ioママoミ duヴiミg 

adolescence. Such harassment may cause some teenagers to be reluctant to identify themselves with 

those terms and emphasizes the importance that respondents are confident that their responses are 

private, anonymous, and confidential (Saewyc et al., 2004; SMART, 2009).

Some surveys, such as NSFG, developed SOGI questions for young and middle-aged adults. These 

questions may not be suitable for other age groups (SMART, 2009).There has not been much research 

focused on measuring SOGI among older adults. Older adults may have a different understanding of the 

meaning of SOGI terms than younger adults, leading to more missing responses or misidentification 

(IOM, 2011; SMART, 2009). The Medicare Current Beneficiary Survey (MCBS) evaluated issues with 

adding SOGI questions (Reed-Gillette, 2015). One concern was the generational differences in 

terminology and self-identification; therefore, MCBS used cognitive testing to evaluate the 

appropriateness of SOGI questions. 

Cultural or racial/ethnic considerations – SOGI questions should be culturally appropriate and 

IoマpatiHle ┘ith the ヴespoミdeミtげs uミdeヴstaミdiミg of the IoミIept that is Heiミg マeasuヴed ふSMART, 2009; 

Ridolfo et al., 2012). Differences in SOGI concepts across racial and ethnic groups may affect the 

robustness of the questions. To improve SOGI measurement within racial and ethnic minority groups, 

additional response terms commonly used by these groups should be added (SMART, 2009). For 

e┝aマple, soマe AマeヴiIaミ Iミdiaミ iミdi┗iduals マa┞ ideミtif┞ theマsel┗es as さt┘o-spiヴitざ ヴatheヴ thaミ さga┞ざ oヴ 

さHise┝ualざ as a ┘a┞ to ヴeIoミミeIt ┘ith tヴiHal Iustoマs aミd a┗oid usiミg teヴマs iマposed oミ theマ (Simoni et 

al., 2006). However, including specific cultural terms in probability surveys of the U.S. population might 

be difficult due to the diversity of cultural and racial and ethnic groups. 

Geography – There is some evidence that reported prevalence of SOGI populations is lower in 

Midwestern states and nonmetropolitan areas (IOM, 2011). There may also be regional differences in 

iミteヴ┗ie┘eヴsげ aミd ヴespoミdeミtsげ Ioマfoヴt ┘ith “OGI ケuestioミs.

Language – Careful attention must be paid to the translation of SOGI questions because other languages 

may not have terms for the SOGI concepts or only have terms that are offensive. For example, Spanish 

does ミot ha┗e a IoマpaヴaHle ┘oヴd foヴ けstヴaightげ ふMiller and Ryan, 2011). In addition, nonresponse rates 

to the SOGI questions have been found to be higher among respondents to the Spanish-language 

surveys. In the course of the development of a SO question for NHIS, the NCHS Questionnaire Design 
18

Research Laboratory conducted cognitive interviews to assess several versions of the SO question, 

including the questions from the 2002 and 2006 NSFG. Some Spanish-language speakers reported 

confusion with the response category wording. While the iミIlusioミ of the teヴマ けheteヴose┝ualげ oミ the 

English-language version of the survey was found to cause confusion among some respondents, the 

absence of this term in the Spanish-laミguage suヴ┗e┞ Iaused Ioミfusioミ HeIause the teヴマ けga┞げ does ミot 

have a direct translation in Spanish. Therefore the decision was made to use different wording in the 

Spanish-language response categories. In particular, the respoミse Iategoヴ┞ けHeterosexual, o sea no gayげ 

[けHeteヴose┝ual, that is, ミot ga┞げ] was used iミstead of け“tヴaight, that is, ミot ga┞げ ┘hiIh is used foヴ the 

English-language question. This change is believed to have reduced confusion and misclassification and 

improved measurement of sexual orientation (Miller and Ryan, 2011; Ridolfo et al., 2012).

Response categories – The use of nonresponse categories ふDoミげt Know/Refused/Other/Something else) 

may reduce the number of SOGI respondents who identify themselves as such, without yielding usable 

data (SMART, 2009; Ridolfo et al., 2012; NCHS, 2014; Chandra et al., 2011; Ward et al., 2014). These 

response categories may be especially problematic for SOGI questions because there are many different 

terms for these concepts. These categories may also indicate confusion with the question or response 

category wording, rather than the SOGI status of respondents (SMART, 2009). In the case of adolescents, 

┘ho マa┞ ミot ┞et He suヴe of theiヴ “OGI status, けDoミげt kミo┘げ oヴ siマilaヴ Iategoヴies マa┞ He マoヴe fitting, 

although the ヴespoミse Iategoヴ┞ けI aマ ミot suヴe ┞etげ is マoヴe iミfoヴマati┗e ふSMART, 2009). In addition to 

nonresponse categories, survey specialists should be cautious about the order of the response 

categories. For example, the NSDUH uses the same sexual orientation question and response categories 

as the NHIS, but the response categories are presented in a different order. This difference may affect 

responses, response rates, and the comparability between estimates from the two surveys. 

Terminology – Non-SGM respondents may be confused by technical terms such as けheterosexualげ and 

けbisexualげ and either misidentify themselves or select a nonresponse category. For example, in the 2002 

NSFG, 6.2 percent of respondents selected けsomething elseげ, けdon't knowげ, or けrefusedげ. When the sexual 

orientation question added common terms to the response categories (けheterosexual or straightげ, 

けhomosexual or gayげ) in the 2006-2008 NSFG, the percentage selecting these nonresponse categories fell 

to 1.6 percent. The selection of these nonresponse categories was higher among respondents with 

lower educational attainment (Miller and Ryan, 2011). In addition to higher missing response rates with 

the technical terms, it is not possible to know the extent of misclassification due to confusion over the 

terms. 

Incarcerated populations – Surveying the incarcerated population can be challenging. The incarcerated 

SGM population is at higher risk for victimization than the non-SGM population (Beck et al., 2013), 

making identification of the SOGI population to evaluate victimization rates and other factors vital. 

However, the higher victimization rates that the SGM incarcerated population experiences, both from 

other inmates and from the prison staff, may make members of the SGM population especially reluctant 

to reveal their sexual orientation or gender identity. 

Other factors that influence the identification of the incarcerated SOGI population include their lower 

educational attainment and higher rates of illiteracy. The incarcerated population has poorer reading, 

writing, and oral communication skills than the general population, dimensions which must be 

considered when drafting SOGI-related questions (Haigler et al., 1994; Spangenberg, 2004; Harlow, 

2003). The Buヴeau of JustiIe “tatistiIsげ National Inmate Survey (NIS) found a higher prevalence of 

gay/lesbian/bisexual persons among the incarcerated population (Beck et al., 2013). However, blacks 

and Hispanics are disproportionately represented in prison and jail populations; therefore, findings 
19

about the incarcerated SGM population are not generalizable to the U.S. noninstitutionalized 

population. 

c. Methods Considerations 

Mode of interview – Agencies interested in capturing SOGI data may consider changing the mode of 

administration used for data collection efforts for SOGI-related items. ACASI (audio computer-assisted 

self-interviewing) allows respondent to hear questions through headphones or read them from laptop 

screens and enter answers directly into a computer. ACASI is considered the preferred mode of 

administration for questions which may be considered sensitive and/or personal. The Bureau of Justice 

Statistics uses ACASI for the SOGI questions in its surveys of the incarcerated population to afford more 

privacy. NSFG has used ACASI for sensitive questions about sexual behavior and activity; the SO question 

was incorporated into the ACASI portion of the survey (Chandra et al., 2011). NHIS tested the use of 

ACASI for the collection of SO data, compared to CAPI (computer-assisted personal interviewing) and 

found similar results (Dahlhamer et al., 2014). There were no significant differences in the percentage of 

adults identifying as gay/lesbian or bisexual (ACASI = 2.2 percent, CAPI = 2.4 percent) by mode; item 

nonresponse to the sexual orientation question also did not differ significantly by mode (ACASI = 2.7 

percent, CAPI = 2.3 percent). Therefore, NHIS has chosen not to add an ACASI component to its survey 

and instead will continue to ask the SO question using CAPI (Dahlhamer et al., 2014).

Placement of the question – The location of SOGI questions may affect responses and therefore should 

be carefully considered and evaluated in the design phase of any survey. SOGI questions are considered 

sensitive and generally items that are sensitive should not be included in the beginning or end of a 

survey. If SOGI questions are going to be asked using a certain mode (such as ACASI) in a multi-mode 

survey, then they will be placed in that section of the questionnaire. In some surveys, SOGI questions 

may be considered demographic indicators and therefore are included amidst other demographic 

questions (Ward et al., 2014). SOGI questions should not be placed near questions on abuse to avoid 

implying a connection between these concepts (SMART, 2009).

Proxy measurement – Many surveys ask one person to provide basic demographic information for other 

members of the household. This approach is commonly used to reduce respondent burden and cost of 

surveys. However, agreement between proxy and self-report varies based on the indicator and 

relationship between the proxy and individual (Kojetin and Mullin, 1995). In the case of a sensitive topic 

such as SOGI, using a proxy is of concern because of both data quality and privacy protection. Surveys in 

New Zealand and the United Kingdom do not permit proxy reporting for SOGI items because of concerns 

about accuracy and confidentiality (Joloza et al., 2010). Due to similar concerns, some surveys do not ask 

SOGI questions of a respondent receiving assistance from a family member acting as an interpreter. The 

Bureau of Labor Statistics has begun work to evaluate proxy response on the CPS (See Pascale, 2016). 

Census is sponsoring the 2016 JPSM Practicum, which will be testing proxy response in an internet 

survey (Bates and Ortman, 2016). Surveys with both proxy and self-report portions may choose to place 

SOGI questions in the self-reported portion to avoid proxy responses. 

Some surveys may have the interviewer enter responses based on observation for items, such as sex, 

that are considered obvious. This indirect assessment may result in errors, especially in the case of 

gender identity (Westbrook and Saperstein, 2015). 

Sample size – Because of the small size of SGM populations, it is labor-intensive and costly to recruit a 

large enough sample in general population surveys for meaningful analysis of these populations and 

their subgroups (IOM, 2011; Devers et al., 2013). SOGI questions may not be feasible in all Federal 
20

surveys, particularly smaller ones. Surveys generally have established rules about estimate reliability and 

population thresholds to release the data. For example, ACS releases 1-year estimates for groups of 

65,000 or more, 3-year estimates for groups of 20,000 or more, and 5-year estimates for groups less 

than 20,000 (Census, 2014).

Small errors among very large populations lead to big errors among small populations. As noted in 

section III.e. Household Relationships, even a very small percentage of false positive errors can have a 

significant impact on the overall estimate of same-sex couples. An estimated 28 percent of all same-sex 

couple households in 2010 Census tabulations were likely to be different-sex couple households 

ふOげCoミミell aミd Feliz, 2011). 

d. Post-Survey Analysis 

Cross-survey comparisons – Post-survey analysis includes comparing estimates to the findings from 

other analyses and previous rounds of the survey of interest (OMB, 2016; Chandra et al., 2011). In 

addition to comparing overall estimates, estimates by subgroups (such as gender, age, education level) 

can help evaluate if the estimates are biased. Table IV.A presents a variety of national probability 

estimates of the LGB population. 

Table IV.a. Prevalence of Sexual Orientation among Adults in Selected National Federal Surveys 

Survey Age Data 

Collection 

Year 

Percent 

gay or 

lesbian 

Percent 

bisexual 

Percent 

gay 

(men) 

Percent 

lesbian 

(women) 

National Health Interview Survey 18 and 

over 

2013 1.6 0.7 1.8 1.4 

National Survey on Drug Use and 

Health 

18-44 2013 1.9 3.4 1.9 1.9 

National Adult Tobacco Survey 18 and 

over 

2012-2013 2.0 1.7 2.7 1.3 

National Health and Nutrition 

Examination Survey 

18-59 2009-2012 1.8 2.6 2.3 1.3 

National Survey of Family Growth 18-44 2006-2010 1.5 2.6 1.8 1.2 

There are few national estimates of the prevalence of the transgender population. Several published 

estimates are from convenience samples and therefore are not generalizable to the U.S. population 

(Conron et al., 2012). Some earlier efforts to measure the transgender population in probability samples 

conflated sexual orientation and gender identity in one question with a けsomething elseげ response 

category to the sexual orientation question which led to a question on transgender (Dahlhamer et al., 

2014). Other probability surveys, like NATS, do not yield reliable estimates of the transgender 

population due to the small size of this population. The 2007-2009 Massachusetts Behavioral Risk Factor 

Surveillance System (MA-BRFSS) asked adults aged 18-64 if they were transgender and estimated that 

0.5 percent of the noninstitutionalized Massachusetts adult population was transgender (Conron et al., 

2012). One review which evaluated a variety of sub-national survey estimates of the transgender 

population, including the MA-BRFSS and the California Health Interview Survey, concluded that the U.S. 

transgender population was approximately 0.3 percent (Gates, 2011).

Item non-response – The proportion of respondents who did not know the answer or refused to answer 

should be evaluated and compared to other questions (OMB, forthcoming; Dahlhamer et al., 2014; NRC, 
21

2013). High nonresponse levels (that is, higher than other sensitive questions) may indicate respondent 

confusion about the meaning of the question. Variation in nonresponse by other characteristics (such as 

education level) may indicate bias. Most surveys incorporating SOGI items have not found higher 

nonresponse rates thaミ otheヴ けseミsiti┗eげ ケuestioミs, such as personal or household income (Dahlhamer 

et al., 2014; Joloza et al., 2010). In addition to examining item non-response rates, evaluation of longer 

response times to SOGI questions may reveal respondent confusion or uncertainty. Longer response 

times or pauses are evaluated during qualitative testing prior to fielding the survey but also can reveal 

issues post survey. 

Unit nonresponse – Not all potential respondents will participate in a given survey. Low response rates 

are of concern, especially if the nonrespondents differ in their characteristics, because the findings may 

no longer be representative of the target population. If unit response rates indicate potential bias, 

nonresponse bias analyses should be conducted and weighting adjustments and other techniques used 

as needed (OMB, 2016; NRC, 2013). 

Data checks – Comparing responses for consistency can identify errors. For example, marital status and 

the sex of the couple could be compared to sexual orientation responses for consistency. Same-sex 

couples would be likely to identify as gay, lesbian, or bisexual on sexual orientation questions. If not, 

then additional investigation to check whether there are response errors should be undertaken. When 

feasible, surveys should incorporate data checks into the interview process to capture and correct data 

eヴヴoヴs at the tiマe of IolleItioミ ふOげCoミミell aミd Feliz, 2011).

V. Conclusion 

Federal agencies have expressed interest and enthusiasm for improving the measurement of sexual 

orientation and gender identity (SOGI). The U.S. Federal Government is interested in better 

understanding the sexual and gender minority community in order to better serve their needs. This 

cannot be accomplished without better data on the population. This working paper describes the key 

concepts, current data measures being utilized, as well as important considerations when choosing a 

measure for inclusion in a survey. A forthcoming working paper will describe what is known about the 

reliability and validity of the currently available measures and highlight the methodological questions 

that remain to be answered. 

 
22

References 

American Psychiatric Association (APA). 2013. Diagnostic and Statistical Manual of Mental Disorders 5th

ed. Washington, DC: APA. Available from: http://www.dsm5.org/about/pages/default.aspx.

Bates, N. & Ortman, J. 2016. Optimizing Self and Proxy Response to Survey Questions on Sexual 

Orientation and Gender Identity (SOGI). 2016 JPSM Practicum Proposal Submitted by the Census Bureau. 

Beck, A. J., Berzofsky, M., Caspar, R., & Krebs, C. 2013. Sexual Victimization in Prisons and Jails Reported 

by Inmates, 2011–12: National Inmate Survey, 2011–12. Washington, DC: Department of Justice, Bureau 

of Justice Statistics, NCJ 241399. Available from: http://www.bjs.gov/content/pub/pdf/svpjri1112.pdf.

Black, D., Gates, G. J., Sanders, S. G. & Taylor, L. 2007. The Measureマeミt Error of “aマe‐“e┝ Uミマarried

Partner Couples in the U.S. Census, s.l.: California Center for Population Research. Available from: 

http://papers.ccpr.ucla.edu/papers/PWP-CCPR-2007-023/PWP-CCPR-2007-023.pdf. 

Blosnich J. R., Brown G. R., Shipherd J. C., Kauth M., Piegari R. I., & Bossarte R. M. 2013. Prevalence of 

Gender Identity Disorder and Suicide Risk among Transgender Veterans utilizing Veterans Health 

Administration Care. American Journal of Public Health. 103(10):e27-32. 

Census Bureau. 2014. American Community Survey Design and Methodology (January 2014). 

Available from: http://www2.census.gov/programssurveys/acs/methodology/design_and_methodology/acs_design_methodology_report_2014.pdf.

Cerf Harris, B. 2015. Likely Transgender Individuals in U.S. Federal Administrative Records and the 2010 

Census. Center for Administrative Records Research and Applications (CARRA) Working Paper Series. 

Working Paper #2015-03. Available from: 

https://www.census.gov/srd/carra/15_03_Likely_Transgender_Individuals_in_ARs_and_2010Census.pd

f. 

Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. 2011. Sexual Behavior, Sexual Attraction, and 

Sexual Identity in the United States: Data from the 2006–2008 National Survey of Family Growth. 

Hyattsville, MD: NCHS, National Health Statistics Report, no. 36. Available from:

http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf.

Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. 2012. Transgender Health in Massachusetts: 

Results from a Household Probability Sample of Adults. American Journal of Public Health. 102(1):118-

22.

Dahlhamer, J. M., Galinsky, A. M., Joestl, S. S., & Ward, B. W. 2014. Sexual Orientation in the 2013 

National Health Interview Survey: A Quality Assessment. Hyattsville, MD: NCHS, Vital Health Stat 2(169). 

Available from: http://www.cdc.gov/nchs/data/series/sr_02/sr02_169.pdf.

Devers, K., Gray, B., Ramos, C., Shah, A., Blavin, F., & Waidmann, T. 2013. The Feasibility of Using 

Electronic Health Records (EHRs) and Other Electronic Health Data for Research on Small Populations. 

Washington, DC: The Urban Institute, Submitted to the Assistant Secretary for Planning and Evaluation. 

Available from: https://aspe.hhs.gov/sites/default/files/pdf/107231/rpt_ehealthdata.pdf.
23

Gates, G.J. 2011. How Many People are Lesbian, Gay, Bisexual and Transgender? Los Angeles, CA: The 

Williams Institute, UCLA School of Law. Available from: http://williamsinstitute.law.ucla.edu/wpcontent/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf.

Haffer, S. C. 2015. Using Health Care Claims Data to Identify the Transgender Population in the Medicare 

Program. Hollywood, FL, Presented at the Annual Conference of the American Association for Public 

Opinion Research. 

Haigleヴ, K. O., Haヴlo┘, C., OげCoミミoヴ, P., & CaマpHell, A. ヱ99ヴ. Literacy behind Prison Walls: Profiles of the 

Prison Population from the National Adult Literacy Survey. Washington, DC: Department of Education, 

National Center for Education Statistics, NCES 1994-102. Available from: 

http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=94102.

Harlow, C. W. 2003. Education and Correctional Populations. Washington, DC: Department of Justice, 

Bureau of Justice Statistics Special Report, NCJ 195670. Available from: 

http://www.bjs.gov/content/pub/pdf/ecp.pdf.

Interagency Working Group on Measuring Relationships in Federal Household Surveys (MRFHS). 2014. 

Improved Measurement of Household Relationships in Federal Surveys. Washington, DC. Available from: 

http://fcsm.sites.usa.gov/files/2014/04/MRFHS_StatisticalPolicyWorkingPaper201408.pdf.

Institute of Medicine (IOM). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: 

Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. 

Available from: http://www.nationalacademies.org/hmd/Reports/2011/The-Health-of-Lesbian-GayBisexual-and-Transgender-People.aspx.

Joloza, T., E┗aミs, J., OげBヴieミ, ‘., & Potteヴ-Collins, A. 2010. Measuring Sexual Identity: An Evaluation 

Report. Office of National Statistics. United Kingdom. 

Kauth, M. R., Shipherd, J. C., Lindsay, J., Blosnich, J. R., Brown, G. R., & Jones, K. T. 2014. Access to Care 

for Transgender Veterans in the Veterans Health Administration: 2006–2013. American Journal of Public 

Health. 104(Suppl 4):S532–S534. 

Kelly, M. 2016. Sex versus Gender Categorization. In N. Naples (Ed.). The Wiley Blackwell Encyclopedia of 

Gender and Sexuality Studies. 

Kojetin, B. A., Mullin, P. 1995. The Quality of Proxy Reports in the Current Population Survey (CPS). Fort 

Lauderdale, FL, Presented at the Annual Conference of the American Association for Public Opinion 

Research. 

Lev, A. 2016. Gender Dysphoria. In N. Naples (Ed.). The Wiley Blackwell Encyclopedia of Gender and 

Sexuality Studies. 

Lewis, J. M., Bates, N., & Streeter, M. 2015. Measuring Same-Sex Couples: The What and Who of 

Misreporting on Relationships and Sex. Washington, DC: Census Bureau, Social, Economic, & Housing 

Statistics Division Working Paper. Available from:

https://www.census.gov/content/dam/Census/library/working-papers/2015/demo/SEHSD-WP2015-

12.pdf.
24

Lombardi, E., & Banik, S. 2016. The Utility of the Two-Step Gender Measure within Trans and Cis 

Populations. Sexuality Research and Social Policy. 13(1):288-96.

Lofケuist, D., Lugaila, T., OげCoミミell, M., & Feliz, “. ヲヰヱヲ. Households and Families: 2010. Washington, DC: 

Census Bureau, 2010 Census Briefs No. C2010BR-14. Available from: 

https://www.census.gov/prod/cen2010/briefs/c2010br-14.pdf.

Miller, K., & Ryan, J. M. 2011. Design, Development and Testing of the NHIS Sexual Identity Question. 

Hyattsville, MD: NCHS, Questionnaire Design Research Laboratory, Office of Research and Methodology. 

Available from: 

http://wwwn.cdc.gov/qbank/report/Miller_NCHS_2011_NHIS%20Sexual%20Identity.pdf.

National Research Council. Nonresponse in Social Science Surveys: A Research Agenda. Roger 

Tourangeau and Thomas J. Plewes, (Eds.). 2013. Panel on a Research Agenda for the Future of Social 

Science Data Collection, Committee on National Statistics. Division of Behavioral and Social Sciences and 

Education. Washington, DC: The National Academies Press. Available from: 

http://www.nap.edu/catalog/18293/nonresponse-in-social-science-surveys-a-research-agenda. 

National Center for Health Statistics (NCHS). 2014. A Brief Quality Assessment of the NHIS Sexual 

Orientation Data. Hyattsville, MD: NCHS. Available from: 

https://www.cdc.gov/nchs/data/nhis/qualityso2013508.pdf.

O'Connell, M. & Feliz S. 2011. Same-Sex Couple Household Statistics from the 2010 Census. Washington, 

DC: Census Bureau. SEHSD Working Paper Number 2011-26. 

Office of Management and Budget. 2016. Evaluating Survey Questions: An Inventory of Methods. 

Washington, DC: OMB, Statistical Policy Working Paper 47, Statistical and Science Policy Office, Office of 

Information and Regulatory Affairs. Prepared by Subcommittee on Questionnaire Evaluation Methods. 

Available from: http://fcsm.sites.usa.gov/files/2014/04/spwp47.pdf.

Office of Management and Budget. forthcoming. Statistical Policy Directive No. 2: Standards and 

Guidelines for Statistical Surveys. Addendum. Washington, DC: OMB, Statistical and Science Policy Office, 

Office of Information and Regulatory Affairs. Will be available from: 

https://www.whitehouse.gov/omb/inforeg_statpolicy. 

Pascale, J. 2016. Modernizing a Major Federal Government Survey: A Review of the Redesign of the 

Current Population Survey Health Insurance Questions. Journal of Official Statistics. 32(2):461-86.

Reed-Gillette, D. S. 2015. Testing Sexual Orientation & Gender Identity Items in the Medicare Current 

Beneficiary Survey. Washington, DC, Presented at the Interagency Working Group on the Measurement 

of Sexual Orientation and Gender Identity. 

Ridolfo, H., Miller, K., & Maitland, A. 2012. Measuring Sexual Identity Using Survey Questionnaires: How 

Valid Are Our Measures? Sexuality Research and Social Policy. 9(2):113–24. 
25

Saewyc, E. M., Bauer, G. R., Skay, C. L., Bearinger, L. H., Resnick, M. D., Reis, E., & Murphy, A. 2004. 

Measuring Sexual Orientation in Adolescent Health Surveys: Evaluation of Eight School-Based Surveys. 

Journal of Adolescent Health. 35(4):e1-e15. 

Sexual Minority Assessment Research Team (SMART). 2009. Best Practices for Asking Questions about 

Sexual Orientation on Surveys. Los Angeles, CA: The Williams Institute, UCLA School of Law. 

Available from: http://williamsinstitute.law.ucla.edu/wp-content/uploads/SMART-FINAL-Nov-2009.pdf.

Simoni, J. M., Walters, K. L., Balsam, K. F., & Meyers, S. B. 2006. Victimization, Substance Use, and HIV 

Risk Behaviors among Gay/Bisexual/Two-Spirit and Heterosexual American Indian Men in New York City. 

American Journal of Public Health. 96(12):2240–5. 

Spade D. 2008. Documenting Gender. Hastings Law Journal. 59:731-842. Available from: 

http://williamsinstitute.law.ucla.edu/wp-content/uploads/Spade-Documenting-Gender-Apr-2008.pdf

Spangenberg, G. 2004. Current Issues in Correctional Education: A Compilation & Discussion. New York, 

NY: Council for Advancement of Adult Literacy. Available from: 

http://www.caalusa.org/correct_ed_paper.pdf.

Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. 2014. Sexual Orientation and Health 

among U.S. Adults: National Health Interview Survey, 2013. Hyattsville, MD: NCHS, National Health 

Statistics Report, no. 77. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf. 

Westbrook, L., & Saperstein, A. 2015. New Categories Are Not Enough: Rethinking the Measurement of 

Sex and Gender in Social Surveys. Gender & Society. 29(4):534-60. 

World Health Organization (WHO). 2014. What Do We Meaミ b┞ さ“e┝ざ Aミd さGeミderざ? 

Available from: http://www.who.int/gender-equity-rights/understanding/gender-definition/en/.

 
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Appendix A: Acronyms 

Acronym Term 

ACL Administration for Community Living 

ACS American Community Survey 

AHS American Housing Survey 

ACASI Audio computer-assisted self-interviewing 

BRFSS Behavioral Risk Factor Surveillance System 

BJS Bureau of Justice Statistics 

BLS Bureau of Labor Statistics 

BPHC Bureau of Primary Health Care 

CHIS California Health Interview Survey 

CBHSQ Center for Behavioral Health Statistics and Quality 

CDC Centers for Disease Control and Prevention 

CAPI Computer-assisted personal interview 

CATI Computer-assisted telephone interview 

CPS Current Population Survey 

DHHS Department of Health and Human Services 

DOJ Department of Justice 

FDA Food and Drug Administration 

GI Gender identity 

GID Gender identity disorder 

HCPS Health Center Patient Survey 

HRSA Health Resources and Services Administration 

JPSM Joint Program in Survey Methodology 

LGB Lesbian, gay, bisexual 

LGBT Lesbian, gay, bisexual, and transgender 

MCBS Medicare Current Beneficiary Survey 

NATS National Adult Tobacco Survey 

NCHS National Center for Health Statistics 

NHANES National Health and Nutrition Examination Survey 

NHIS National Health Interview Survey 

NIS National Inmate Survey 

NIH National Institutes of Health 

NSFG National Survey of Family Growth 

NSOAAP National Survey of Older Americans Act Participants 

NSDUH National Survey on Drug Use and Health 

OMB Office of Management and Budget 

PAPI Paper and pencil interview 

PATH Population Assessment of Tobacco and Health 

SGM Sexual and gender minority 

SO Sexual orientation 

SOGI Sexual orientation and gender identity 

SSA Social Security Administration 

SAMHSA Substance Abuse and Mental Health Services Administration 

SIPP Survey of Income and Program Participation 
27

UDS Uniform Data System 

YRBSS Youth Risk Behavior Surveillance System