Using Ancillary Sociodemographic Data to Identify Sexual Minority Adults among Those Responding “Something Else” or “Don’t Know” to Sexual Orientation Questions

Background: General population surveys are increasingly offering broader response options for questions on sexual orientation—e.g., not only gay or lesbian, but also “something else” (SE) and “don’t know” (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories. Objectives: Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare three increasingly-inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority. Methods: We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013-2014 NHIS to generate predicted probabilities of identifying as a sexual minority adult. Results: 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and healthcare disparity estimates. Conclusions: Predicted probabilities of sexual minority orientation may be used in this and other surveys potentially to improve representation and categorization of those who identify as a sexual minority adult