Background and Goal: Federal health surveys are a key source for understanding health needs in the U.S., including the needs of people in LGBTQ+ community. This methodology paper characterized the current landscape of measures capturing sexual orientation, gender identity, and differences of sex development in federal health surveys, detailing when and how the information was collected.
Approach: Researchers scanned 10 large federal health surveys and did a content analysis of each survey's materials. They recorded whether and when surveys included sexual orientation questions, whether gender identity was measured, how stable the items were over time, and whether any survey identified differences of sex development, or intersex status. They highlighted changes that occurred after 2022. The article was submitted in September, 2024.
Main Results:
Sexual orientation questions were asked in nine out of 10 surveys. Several surveys began collecting sexual orientation in the mid-2010s. Unique standouts included the National Health and Nutrition Examination Survey (NHANES) and National Survey of Family Growth (NSFG), which had over 20 years of sexual orientation data collection.
Seven of the ten surveys ask about gender identity, with four adding those questions only within the last two years. Some include a separate sex-assigned-at-birth item, while others do not or ask only whether a person is transgender.
Differences of sex development questions are almost absent. Only one survey, All of Us, included a way to identify people with differences of sex development.
Why It Matters: Having standard, sustained sexual orientation, gender identity, and differences of sex development measures in federal surveys would make it easier to identify and track disparities, plan studies, and evaluate interventions.
Thomas M. Freitag, MPP
Harvard Medical School, Boston, Massachusetts
Yalda Jabbarpour, MD
Robert Graham Center, Washington, DC
Georgetown University School of Medicine, Washington, DC
