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Assessment of Health Disparities and Sexual Orientation Response Choices Used in Two US National Population-Based
Nicole F Kahn1, Carolyn T Halpern1, Dana R Burshell1
1Nicole F. Kahn is with the Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of Washington, Seattle; Center for Child Health, Behavior and Development, Seattle Children's Research Institute; and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Carolyn T. Halpern is with the Department of Maternal and Child Health, Gillings School of Global Public Health; and Carolina Population Center, University of North Carolina at Chapel Hill. Dana R. Burshell is with the Carolina Population Center. Stephanie M. Hernandez is with the Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Maternal and Child Health, Gillings School of Global Public Health; and Carolina Population Center. Kerith J. Conron is with the Williams Institute, School of Law, University of California Los Angeles, and Carolina Population Center.
Abstract:
Objectives. To (1) compare responses to 2 survey questions designed to measure sexual orientation and (2) understand how variation in responses is associated with mental health. Methods. Data were from the National Longitudinal Study of Adolescent to Adult Health (Add Health) Sexual Orientation/Gender Identity, Socioeconomic Status, and Health Across the Life Course (SOGI-SES) study (2020-2021) in the United States. We used the adjusted Wald test to compare proportions of respondents who were (1) categorized as heterosexual or straight and sexual minorities using the sexual orientation questions designed for the Add Health study and the National Health Interview Survey (NHIS) and (2) diagnosed with depression or anxiety or panic disorder. Results. The Add Health question detected more than twice as many sexual minority respondents as the NHIS question. Those who responded as sexual minorities to the Add Health question but as heterosexual or straight to the NHIS question, primarily "mostly heterosexuals," had mental health outcomes that were more like those who were consistently classified as sexual minorities versus those consistently classified as heterosexual or straight. Conclusions. Current measures of sexual orientation in national-level surveys may underestimate the sexual minority population and sexual orientation‒related health disparities. Public Health Implications. Results illustrate the need for further research to expand measurement of sexual orientation on population-based health surveys. (Am J Public Health. 2024;114(12):1375-1383. https://doi.org/10.2105/AJPH.2024.307839).
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