When asked by Jessica Xavier from HRSA why the NHIS includes a question about gender identity rather than behavior, Miller answered that the NHIS is a vehicle for collecting basic health data and including questions about sexual behavior would not be appropriate in the survey. She added that the National Survey of Family Growth (NSFG) and the National Health and Nutrition Examination Survey (NHANES) are more appropriate venues for asking sexual behavior questions. Clinton Anderson of the American Psychological Association asked Miller about the significance of the placement of the sexual identity and the sexual behavior questions. Miller explained that the placement of questions is important because respondents get cued in to certain topics. For example, if a question focusing on reproduction is asked after a number of behavioral questions, a respondent may be cued up to provide a sexual behavior answer. In contrast, asking the question as part of a demographic section may cue respondents to indicate sexual identity rather than behavior. Aaron Tax asked Grant if he had been able to identify questions that worked better with older adults who do not always understand terms like “bisexual” and Grant indicated that he hopes to add a question developed by Miller and her colleagues to the CHIS in 2013 that would be easier for older adults to understand. He added that moving away from the terms heterosexual and homosexual may help better identify bisexual older adults.

There was some discussion around the term “sexual orientation.” While Miller asserted during her talk that the term is not a measurable concept, Harvey Makadon pointed out that the term is commonplace and any attempt to substitute “sexual identity” or another term for it would be challenging. Miller responded that “sexual orientation” is a catchall phrase and does not provide constructs around which scientific questions can be developed. Makadon, however, said that he thought of orientation and identity as the same thing and questioned the need to abandon “sexual orientation.”

In response to questions from Bates and John Knudsen, Keatley discussed the two-question approach. She explained that the CDC’s one-question approach provided the following response options:

  • male
  • female
  • transgender male to female
  • transgender female to male

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