Adopted by Council of Representatives in February 2016. Amended by Council of Representatives in August 2016. (Suggested citation is included with references.)
Research Summary
Scientific knowledge about the health, mental health, and social status of people in the United States frequently comes from survey data. As such, survey data are particularly important for assessing the need for public policies that address group disparities in mental health, health, and social outcomes, and data are necessary to evaluate the impact of these policies. In particular, U.S. national health outcomes outlined in the Healthy People documents every decade by the Health and Human Services Department rely on research to determine important health goals and unmet health needs. Researchers have noted the special methodological difficulties associated with empirical work targeting lesbian, gay, bisexual, and transgender (LGBT) populations, particularly concerns with anonymity (Cochran, 2001; Solarz, 1999). Herek (1996) has suggested that population-based surveys offer lesbian, gay, bisexual, and transgender (LGBT) participants a relatively greater level of anonymity than other methodologies, which may be important in terms of avoiding the potential for discrimination. Additionally, population-based surveys that document economic and social conditions of the population also have tremendous potential to provide needed foundational data to psychological researchers examining contextual factors related to mental and physical health. It is not always possible to predict in advance whether the inclusion of sexual orientation and gender identity is relevant on either an empirical or theoretical basis. However, as in the case of other under-researched minority populations, the relevancy of the finding is often revealed once the results have been obtained. For example, with the introduction of items to the 2000 U.S. Census which allowed for documentation of same-sex coupled households, the country has benefited from a dramatic increase in understanding of the lives and conditions of people who are in a same-sex couple, many of whom identify as gay, lesbian, bisexual, and/or transgender (see, e.g. Ash & Badgett, 2006; Gates, 2008; UCLA School of Law Williams Institute, 2008). Unfortunately, in addition to the relatively minor presence of LGBT-related items in population-based surveys within the U.S., there is also a looming threat that those few surveys that recently collected these data may not continue do so in the near future. Without these vital data, polices may be enacted without an understanding of the needs of LGBT individuals.
In the absence of data regarding sexual orientation and gender identity, population-based surveys that assess behaviors, physical and mental health states, run the risk of promoting stereotypes and myths about the experiences and social situations of LGBT people. The inclusion of sexual orientation and gender identity as demographic variables enables scholars, policymakers, and the general public to interpret and gain a more accurate understanding of how important health and social outcomes vary by sexual orientation and gender identity (Green, Bettinger, & Zacks, 1996; Harkless & Fowers, 2005; Nardi & Sherrod, 1994; Pathela, Blank, Sell, & Schillinger, 2006; Peplau, 1993).
Previous research has demonstrated that there are multiple ways of constructing questions about sexual orientation identity and about gender identity (Austin, Conron, Patel, & Freedner, 2007; GenIUSS Group, 2013; Grant, et al., 2010; Haseldon & Joloza, 2009; Laumann, Gagnon, Michael, & Michaels, 1994; National Resource Center on LGBT Aging & SAGE, 2013; Saewyc, et al., 2004; San Francisco Department of Public Health, 2014; Sausa, Sevelius, Keatley, Iñiguez, & Reyes, 2009; Sell, 2015; Taylor, 2008). Many studies that have included LGBT people within and outside of the field of psychology suggest that sexual orientation and gender identity are associated with health, mental health, and social outcomes (e.g., Almeida, et al., 2009; American Psychological Association, 2015; Bradford, Cahill, Grasso, & Makadon, 2012; Chae, Krieger, Bennett, Stoddard, & Barbeau, 2010; Cochran, 2001; Cochran, Sullivan, & Mays, 2003; Dean, et al., 2000; Diamant, Wold, Spritzer, & Gelberg, 2000; Garofalo, Wolf, Kessel, Palfrey, & Durant, 1998; Grant, et al., 2010; Mays & Cochran, 2001; Mikalson, Pardo, & Green, 2012; Remafedi, 1990; Self & Petrulio, 1996; Simmons & O’Connell, 2003).
Despite the potential benefits associated with gathering data on sexual orientation and gender identity on population-based surveys, it recognized that gathering such data may create discomfort for respondents and as a result, respondents may choose to opt out of such questions which will lead to missing data. Thus any interpretation of data regarding sexual orientation and gender identity must be undertaken with an understanding that these data may not be missing at random, and must be handled accordingly (Little & Rubin, 2002). To minimize such occurrences of missing data, SMART (2009) has documented best practices for the placement, structure, and wording of questions to gather data on sexual orientation such that individuals along the spectrum of development may experiences less discomfort in responding to such items. SMART acknowledges that “Our lack of knowledge about how to identify transgender respondents on general population surveys hinders efforts to improve the health and socioeconomic status of this marginalized community” (p. 33). In addition, given the possibility that the identity of respondents can be compromised in population-based surveys, it is essential that researchers develop safeguards in their methodology to prevent this inadvertent exposure of respondents' identities. For example, when conducting research with adolescents it is recommended that questions regarding sexual orientation not be placed within demographics section because most students may be on the same page when responding to this question, thus potentially violating a sense of privacy and anonymity. Moreover, minors should be notified that in some instances their gender data field cannot be hidden from their guardians. In the event that transgender identity is collected in the clinical setting for minors and is documented in the clinical notes, best practices such as the ones recently approved by the Health Commission of the San Francisco Department of Public Health, are to consider the local Minor Consent Policies in place. See Best Practice for Asking Questions about Sexual Orientation on Surveys by SMART (2009) and the San Francisco Department of Public Health Sex & Gender Guidelines (2014) for additional recommendations for safe guards to ensure privacy and anonymity.
In addition, understanding intersections of cultural identities such as race, ethnicity, and disability status among LGBT people is critical to psychological well-being (Fraley, Mona, & Theodore, 2007; Goldman, 1996; Lee, 1996; Nadal & Corpus, 2012; Parks, Hughes, & Matthews, 2005; Sweeney & Tunaley, 2004). Thus, as SMART (2009) recommends, the measurement of sexual orientation and gender identity in population-based studies must be considered in relation to age, as well as race, ethnicity, SES, and culture, which more accurately may reflect the diversity within the LGBT population (Albelda, Badgett, Schneebaum, & Gates, 2009; Ramos & Gates, 2008a; 2008b). It is also important to ensure the protections of those on whom data are collected, including considering the developmental appropriateness of participants and gaining consent from vulnerable populations.
APA's adoption of a resolution on any given issue clearly needs to be based on the impact that the resolution can make on the advancement of our body of knowledge and the extent to which it can benefit of human welfare. In light of what has been outlined above, it is believed that the following resolution can have far-reaching empirical and policy implications.