Sexual Orientation Information Frequently Asked Questions

1. Why does the National Health Interview Survey (NHIS) include a question about sexual orientation?

The sexual orientation question was added to the NHIS questionnaire to maintain the survey’s timeliness and status as the gold standard for providing nationally-representative health data. Its inclusion allows for the NHIS is to fill the gaps that exist in the state of knowledge about the general health behaviors, health status, and health care utilization of LGB persons, and to monitor changes over time.

2. Why does the NHIS measure sexual orientation with a question about sexual identity, rather than asking about sexual attraction or sexual behavior?

These three constructs – sexual attraction, behavior and identity – are inter-related but distinct. Selection of the appropriate construct depends on the goals of a particular research study. Given the NHIS goal of monitoring population health and health disparities, sexual identity was deemed to be the most appropriate construct. Behavior does not define a demographic group or population, and same-sex sexual behavior does not necessarily coincide with a gay, lesbian or bisexual identity. Because identities are instrumental in organizing peoples’ lives within their social contexts, they have important implications for individuals’ actions and interactions with others. Sexual identity is related to a range of issues under examination in the NHIS, including, but not limited to: health care access and utilization, quality of care, and risk factors such as diet, exercise, and smoking.

For additional details and information, please consult the Coordinating Center for Questionnaire Design and Evaluation Research (CQDER) report Design, development and testing of the NHIS sexual identity question.

3. Does the NHIS have a question measuring gender identity?

Currently the NHIS asks about sexual orientation, but does not ask adults about their gender identity, or whether they identify as transgender.

4. Why do the response categories use the terms “gay” and “straight” instead of “homosexual” and “heterosexual”?

The response categories for the NHIS sexual orientation question use these plain-language terms to minimize response error and measurement problems. The adoption of these terms was the result of extensive cognitive testing by the National Center for Health Statistics (NCHS) CQDER. This testing was carried out over an 11-year period to better understand the interpretive and response process patterns people use to answer questions on sexual identity. Among other findings, it was discovered that respondents (especially those from racial/ethnic minority groups and non-lesbian, gay, bisexual, and transgender [LGBT] individuals) are not consistent in their interpretation of the terms “heterosexual” and “homosexual;” some did not understand the terms at all, whereas others confused the meaning of the two terms. Replacing those terms with the plain-language terms “straight,” ”lesbian,” and “gay” improved respondent understanding and question performance.

For additional details and information, please consult the CQDER report Design, development and testing of the NHIS sexual identity question.

5. How was the order of response options chosen for the NHIS sexual orientation question?

The order of response options is based on findings from extensive cognitive testing carried out by the NCHS CQDER. It was found that that the concept of sexual identity holds different relevance and meaning for people who identify as gay/lesbian or bisexual than it does for those who identify as straight. Respondents who identified as gay/lesbian or bisexual could answer questions about their sexual identity with relative ease, because their sexual identity was a central component of their sense of self. In contrast, respondents who identified as straight often did not find the concept of a sexual identity salient. In other words, they did not have a clear “heterosexual” or “straight” sexual identity beyond knowing that they were decidedly not gay, lesbian, or bisexual. Thus, to help these respondents (who comprise the majority of the population) select the optimal response category, the “straight” response option includes the phrase “that is, not gay.” Given this addition of wording, it was necessary to maintain logical cohesiveness by having the “straight, that is, not gay” response option follow after the “gay/lesbian” response option.

For additional details and information, please consult the CQDRL report Design, development and testing of the NHIS Sexual Identity Question.

6. Some might consider sexual orientation to be a sensitive topic. Why is the question asked by the interviewer instead of self-administered by the respondent?

The decision to keep the sexual orientation question as part of the interviewer-administered questionnaire was made based on the results of field testing that was carried out in 2012 to examine this very issue. A randomized split-ballot experiment assigned 60% of sample adults to the audio computer-assisted self-interviewing (ACASI) condition, in which they self-administered the sexual orientation question, and assigned the remaining 40% to the computer-assisted personal interviewing (CAPI) condition, in which they were administered the question via the standard NHIS protocol of CAPI. Results from the experiment showed no significant differences in the percentage of adults who identified as gay/lesbian or bisexual by mode of administration. Nor did item nonresponse (i.e., responses of “something else,” “I don’t know the answer,” or refusing to answer) differ significantly by mode. On the basis of these results, it was decided that the NHIS sexual orientation question does not require special accommodations for its administration.

For additional details and information, please consult the slides from the presentation Sexual orientation results from the National Health Interview Survey.

7. What happens when respondents feel uncomfortable sharing their sexual orientation with the interviewer?

When respondents feel that they cannot or do not wish to answer the sexual orientation question, they can indicate “I don’t know the answer” as their response, or refuse to answer, as they can for any other question on the survey.

8. Why is the sexual orientation question embedded in the “Adult Selected Items” section of the Sample Adult Core instead of being included alongside other sociodemographic questions?

The sexual orientation question is located within the Adult Selected Items section for two reasons. The first has to do with the structure of the NHIS questionnaire. Sociodemographic information about all members of a family (including the sample adult respondent) is collected at the beginning of the NHIS interview via proxy responses provided by the household respondent. Because of the personal nature of individuals’ sexual orientation, proxy reporting was deemed undesirable for this question.

The second reason is that the question’s location was maintained from the earlier question testing process. For field testing the sexual orientation question, the question was embedded in a newly-created stand-alone module consisting of a mix of potentially sensitive and neutral questions. Because field testing was completed just prior to the start of the 2013 NHIS, there was insufficient time to move questions from that module to other locations within the questionnaire. In the interest of maintaining consistency and allowing direct comparison in sexual orientation-related estimates across survey years, it was decided to keep the question in its current location until at least the next NHIS questionnaire redesign, scheduled for 2018.

9. How does NHIS sexual orientation data relate to Healthy People 2020?

Improving the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals is one of the goals of the Healthy People 2020 initiative. Collection of nationally-representative sexual orientation data places the NHIS at the forefront of meeting Healthy People 2020 objectives LGBT-1.1 and LGBT-1.2. In combination with the wide range of health indicators collected on the NHIS, the sexual orientation data can further be used in advancement of a number of LGBT health-related objectives identified by the Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Topic Area Workgroup.

10. Why did the sexual orientation follow-up questions only appear on the 2013 and 2014 NHIS questionnaires?

The follow-up questions were included only on the 2013 and 2014 questionnaires because analysis of the first two years of data showed that NHIS respondents do not require terms other than those provided on the main sexual orientation question to describe their sexual identity. Furthermore, incorporating the responses to the follow-up questions did not change the estimates of the primary sexual orientation categories.

For additional details and information on why the follow-up questions were initially included on the questionnaire, please consult the CQDER report on the Design, development and testing of the NHIS sexual identity question. For additional details on the analysis of the follow-up questions that informed the decision to remove them from the questionnaire beginning in 2015, please consult the report Sexual orientation in the 2013 National Health Interview Survey: A quality assessment.

11. I am interested in carrying out an analysis that uses the follow-up questions. How can I get access to the data?

You can access the data set containing responses to the follow-up questions through the NCHS Research Data Center.  

12. Are there any other NCHS data systems that collect information on sexual orientation?

Yes. Two other NCHS data systems collect information on sexual orientation: the National Health and Nutrition Examination Survey (NHANES), and the National Survey of Family Growth (NSFG). For a comparison of sexual orientation estimates based on NHIS, NHANES and NSFG data, please consult the report Sexual orientation in the 2013 National Health Interview Survey: A quality assessment.

13. Where can I find more information/publications using the NHIS sexual orientation question?

A list of publications using data from the NHIS sexual orientation question can be found on the Reference section of the NHIS Sexual Orientation Information website.