Out of the Closet and Into Our Data: An Analysis of LGBTQIA+ Inclusion Questions in National Health Surveys 

Out of the Closet and Into Our Data: An Analysis of LGBTQIA+ Inclusion Questions in National Health Surveys | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Out of the Closet and Into Our Data: An Analysis of LGBTQIA+ Inclusion Questions in National Health Surveys Iris Olson, Emma Mairson, Jacqueline Ellison, Marian Jarlenski This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7781272/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : To assess the extent to which federal survey questionnaires include items pertaining to LGBTQIA + identities and experiences, and identify the domains covered by relevant survey items. Methods : Survey questionnaires were included for review if they were federally administered, related to health, provided in English, cited at least 300 times in PubMed, and fielded at least once every five years. We reviewed the most recent iteration of questionnaires. We deductively coded each questionnaire to ascertain whether they included questions about Sex, Gender Identity, Gender Expression, Sexual Attraction/Orientation, Romantic Attraction/Orientation, Partnership, and Sexual Activities/Behaviors. Results : We identified 11 survey instruments from 2022 for inclusion in our analysis. The most prevalent domains included in surveys were Sex (n = 9) and Partnership (n = 9). No surveys included items about Gender Expression, Romantic Attraction, or Romantic Orientation. Other domains were inconsistently captured, including Gender Identity (n = 6), Sexual Attraction (n = 3), Sexual Orientation (n = 7), and Sexual Activities/Behaviors (n = 2). Conclusion : Federally sponsored U.S. health surveys in 2022 did not include the full range of items pertaining to LGBTQIA + identities and experiences. This limits the ability of researchers and policymakers to understand health experiences, outcomes, and disparities of LGBTQIA + peoples. Out of the Closet and Into Our Data: An Analysis of LGBTQIA + Inclusion Questions in National Health Surveys Introduction Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic (LGBTQIA+) inclusion in healthcare research and public health initiatives is essential to advancing overall health equity. (Graham et al., 2025; Guidance on Adding Sexual Orientation and Gender Identity Questions to State Medicaid and CHIP Applications for Health Coverage , 2023) LGBTQIA + identifying peoples are an expanding population in the U.S. In 2024, an estimated 7.6% of the U.S. population identified as LGBTQIA+, increasing from 3.5% in 2012, with LGBTQIA + identification being higher for younger generations (e.g., millennials and generation Z). (Jones, 2024; Munz, 2024) This same study points to 0.9% of people in the U.S. identifying as transgender.(Jones, 2024) This change over generations may be due to a combination of the impacts of the HIV epidemic, suicidality rates amongst LGBTQIA + peoples, as well as the historical lack of acceptance.(Bitterman & Hess, 2021 ; Herman et al., 2022) However, there is a lack of nationally representative information about the health and wellness of LGBTQIA + populations in the US, overall and within subgroups.(Jones, 2022) Inconsistent or insufficient data collection on the health and wellbeing of LGBTQIA + populations has allowed for ongoing knowledge gaps, limiting public health and medical professionals’ ability to address health needs, and has led to difficulties in addressing disparities. (Dawson et al., 2023 ; Munz, 2024; State Health Access Data Assistance Center, 2021) In 2011, Health and Human Services (HHS) considered including sexual orientation and gender identity (SOGI) in standardized federal data collection alongside race, ethnicity, sex, primary language, and disability. (HHS Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, 2011) At the time, SOGI questions were not included across surveys, and sex was redefined a ‘biological sex,’ separating from gender identity and sexual orientation.(HHS Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, 2011) Shortly after this, HHS conducted a Data Progression Plan Around Sexual Orientation and Gender Identity inclusion which resulted in the first sexual orientation question being included in a federal survey, the National Health Interview Survey. However, no questions were added that pertained to gender identity or transgender status.(Grennlee, 2017; LGBT Policy Coordinating Committee, 2016; Miller & Ryan, 2011; Sexual Orientation Information Background , 2016; State Health Access Data Assistance Center, 2021) Later in 2016, the Office of Management and Budget’s (OMB) Federal Interagency Working Group on Measuring Sexual Orientation and Gender Identity released multiple documents addressing the lack of data on SOGI populations. (State Health Access Data Assistance Center, 2021) These reports 12 cover federal survey’s inclusion of sexual identity (n = 12), sexual attraction (n = 3), sexual behavior (n = 4), and gender identity (n = 6).(Current Measures of Sexual Orientation and Gender Identity in Federal Surveys, 2016; Evaluations of Sexual Orientation and Gender Identity Survey Measures: What Have We Learned?, 2016; Toward a Research Agenda for Measuring Sexual Orientation and Gender Identity in Federal Surveys: Findings, Recommendations, and next Steps, 2016; State Health Access Data Assistance Center, 2021) Also in 2016, the Centers for Medicare & Medicaid Services (CMS) added a requirement that electronic health records would allow users to record SOGI data, though this was not a requirement for providers to collect SOGI data from every patient.( Standards for the Electronic Health Record Technology Incentive Program , 2010, p. 495) Additionally, the Health Resources and Services Administration (HRSA) also began requiring SOGI data as part of standard demographics reporting for patients age. ( Program Assistance Letter , 2016) To address this issue of inconsistent SOGI inclusion in federal surveys, in 2022, President Biden issued an executive order for federal agencies which included a mandate for OMB to “publish a report with recommendations for agencies on the best practices for the collection of [SOGI] data on Federal statistical surveys”.(Exec. Order No. 14075, 3 C.F.R., 2022) This executive order both acknowledged that LGBTQI + experiences around systemic discrimination as well as directed heads of federal agencies to review internal policies and use their authority to expand access to comprehensive healthcare; prevent and address homelessness and housing instability; protect LGBTQI + identifying students and educators in educational institutions; explicitly combat conversion therapy; and ensure that LGBTQI + identifying children did not face discrimination in the child welfare or juvenile justice systems. This was followed by a report on equitable data collection in 2023 by the Subcommittee on Sexual Orientation, Gender Identity, and Variations in Sex Characteristics Data.(Federal Evidence Agenda on LGBTQI + Equity, 2023) While both reports point to the need for more data collection on sexual orientation, gender identity, and sex characteristics, these efforts centered only on some aspects of LGBTQIA + identity.(Exec. Order No. 14075, 3 C.F.R., 2022; Federal Evidence Agenda on LGBTQI + Equity, 2023) Measurement of LGBTQIA + identities and experiences helps public health professionals better understand the behaviors, disparities, experiences, and health of LGBTQIA + peoples and therefore their ability to improve health for the public at large. Since the beginning of 2025, the landscape around LGBTQIA + measurement and inclusion in federal health surveys has drastically changed. Numerous executive actions have occurred that impact the functionality and effectiveness around LGBTQIA + populations and their inclusion in health programming, services, funding, and research.(Dawson & Kates, 2025; Gerstein, 2025; Todd, 2025) Additionally, data sets have been impacted by the new administration through federal level data manipulation. (Dawson & Kates, 2025; Freilich & Kesselheim, 2025 ; Gerstein, 2025; Todd, 2025) These anti-LGBTQIA + actions not only impact the present systems and policies that support LGBTQIA + peoples today, but will have negative impacts on LGBTQIA + populations for years to come.(How State Policy Affects the Well-Being and Relocation of LGBTQ + Young People, 2025; Tran & Gonzales, 2025) In this study, our team aimed to quantify the extent to which federal health surveys fielded prior to current anti-LGBTQIA actions in the federal government included items pertaining to LGBTQIA + identities and experiences. Drawing on queer theory, we defined nine domains for which inclusion was identified: Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors. Queer theory examines and critiques structures and systems that define the societal norms around gender and sexuality, allowing researchers and advocates to look outside traditional sexuality and gender binaries. This lens is essential when looking at the inclusion of LGBTQIA + identifying peoples to see who is included outside of cis- hetero-normative structures. Methods Survey Selection We sought to include health surveys that are commonly accessed and used by researchers to study the health of the U.S. population. U.S. health surveys were identified through federalinstitutions such as Health and Human Services, the National Institutes of Health, the United States Census Bureau, the National Center for Health Statistics, the Centers for Medicaid and Medicare Services, the Substance Abuse and Mental Health Services Administration, the Food and Drug Administration, the Bureau of Justice Statistics, the Bureau of Labor Statistics, the National Science Foundation, and the Centers for Disease Control. The initial list of surveys was developed by coauthors from these institutions to ensure comprehensiveness since our team could not find a list of all federal health-oriented surveys. After discussion of the surveys, the research team created the following criteria for survey questionnaires’ inclusion in the study: 1) federally administered, 2) available in English, 3) cited at least 300 times in PubMed as of July 12, 2022, 4) used the word “health”, “medicine”, or “medical” in the title or objective statement of the survey, 5) administered every five years or more frequently, 6) fielded nationally or across multiple states (i.e., provided national or state representative results), and 7) contained items that measure person-reported health status, history, or behaviors. The survey questionnaires reviewed were the most recent publicly available iteration as of July 12, 2022, with survey years ranging from 2017–2022. Domain Development Domains were developed based on queer theory peer-reviewed literature in the effort to create an inclusive series of domains that captured the varying experiences and identities of individuals under the LGBTQIA + umbrella. Many studies point to the need for differentiation between sex assigned at birth in relation and gender identity, creating the ‘Sex’ and ‘Gender’ domains. Additionally, gender expression is distinct from gender identity and is a way one can communicate to others about their gender, leading to the creation of the ‘Gender Expression’ domain.( Glossary of Terms , 2025; “Understanding Transgender People, Gender Identity and Gender Expression,” 2024; Malatino & Stoltzfus-Brown, 2020; Moseson et al., 2024) The split attraction model differentiates between sexual and romantic attraction.(Winer, 2024) Additionally, literature about sexual fluidity makes a clear distinction between attraction and orientation.(Katz-Wise & Hyde, 2017) As such, we define four distinct domains: ‘Sexual Attraction,’ ‘Sexual Orientation,’ ‘Romantic Attraction,’ and ‘Romantic Orientation’ domains. Sexual fluidity literature also parses how attraction and orientation differ from behaviors, which informed our definitions of the ‘Partnership’ and ‘Sexual Activities/Behaviors’ domains.(Katz-Wise & Hyde, 2017) Survey Item coding Survey items included in the questionnaires were coded by two study members (XX and XX). The coders utilized deductive coding using the Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors domains, which are based on LGBTQIA + research and queer theory (Table 1 ). ( Glossary of Terms , 2025; Resources for Improving Demographic Data Quality , 2024) Each survey item was assigned to one domain (Appendix A). To be included, items had to explicitly and directly measure one of the specified domains. Domains pertaining to demographics and those pertaining behaviors were distinguished. For example, an item about the respondent’s sexual experiences with people of other genders would be coded as Sexual Activities/ Behaviors, rather than Sexual Orientation. [Table ] This team excluded introductory statements, items that were used to collect identifiable information that are not included in the available data and questions verifying previous responses. If a question was repeated based on a response to a previous item (e.g. At the time you began living together, were you and he engaged to be married or did you have definite plans to get married? (N TH HUSBAND) ), it was counted only once. Questions that did not directly ask about the survey respondent – such as those about partners, family, or household members – were also excluded. In surveys where alternate versions of the same question were tested, the different question versions were treated as a single item because the respondent would only ever be prompted to answer one version. Further, if the same or equivalent question was asked across several versions of a survey, it would only be coded once (e.g. the ‘male’ and ‘female’ National Survey of Family Growth (NSFG) questionnaires; age-specific National Immunization Survey (NIS) questionnaires). Team members (XX and XX) met biweekly to rectify coding differences and discuss individual findings. Questions were included based on mutual agreement that they belong under the defined domains to be included in this analysis. While coding disagreements rarely occurred, when coding differences persisted after discussion, reviewers consulted with the other coauthors (XX and XX) for additional feedback and perspectives. Results Survey Identification We identified 11 federal health surveys that met inclusion criteria ( Table 2 ) , which included the National Survey of Children's Health 2021 (NSCH), National Health Interview Survey 2022 (NHIS), National Health and Nutrition Examination Survey 2021–2022 (NHANES), National Survey of Family Growth 2017–2019 (NSFG), Pregnancy Risk Assessment Monitoring System 2017 (PRAMS), National Survey on Drug Use and Health 2019 (NSDUH), Medicare Current Beneficiary Survey 2022 (MCBS), Youth Risk Behavior Surveillance System 2019 (YRBSS), Behavioral Risk Factor Surveillance System 2021 (BRFSS), Population Assessment of Tobacco and Health Waves 1–7 (PATH), and the National Immunization Survey 2021 (NIS). [Table ] No survey questionnaire included items from all domains, and none measured Gender Expression, Romantic Attraction, or Romantic Orientation. NSFG and PATH had items pertaining to the greatest number of domains (n domains = 5). The most represented domains were Sex (n surveys = 9) and Partnership (n surveys = 9). Federal surveys missing the most domains include PRAMS and NSDUH, which did not have questions about Sex, as well as NSCH and NIS which did not have questions about Partnership. NSCH, MCBS, and PRAMS did not include Sexual Orientation or Gender Identity items. NHANES did not include a Sexual Orientation item, but did include an item about Gender Identity. Conversely, NSFG and YRBSS included an item about Gender Identity, but not Sexual Orientation. [Table ] Discussion Our findings show that before 2025, many national health surveys incompletely capture constructs like Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors. These changes to federal data collection and dissemination will impact our future understanding of LGBTQIA + health at the federal level. Our data shows that LGBTQIA + identifiers were incorporated into data collection processes amongst most reviewed surveys. However, based on the current administrations attacks on LGBTQIA + populations, we will likely miss these mechanisms of understanding LGBTQIA + populations moving forward. (Dawson & Kates, 2025; Gerstein, 2025; How State Policy Affects the Well-Being and Relocation of LGBTQ + Young People, 2025; Todd, 2025; Tran & Gonzales, 2025) This not only impacts our ability to understand many aspects of LGBTQIA + population health but also impacts future research investigation and funding opportunities for LGBTQIA + focused researchers. However, Biden-era recommendations for greater inclusion of LGBTQIA + identities and populations are under active attach under the Trump Administration. (Dawson & Kates, 2025; Gerstein, 2025; How State Policy Affects the Well-Being and Relocation of LGBTQ + Young People, 2025; Todd, 2025; Tran & Gonzales, 2025) Executive orders, administrative changes, and funding cuts have already begun to impact federal research and development across topics and communities, with LGBTQIA + populations being disproportionally impacted. (Cahill & DiBlasi, 2024 ; Cox et al., 2025 ; Dawson & Kates, 2025; Freilich & Kesselheim, 2025 ; Tran & Gonzales, 2025) A study of government data set manipulation between January 20, 2025 and March 25, 2025 found that data manipulation is occurring on the federal level.(Freilich & Kesselheim, 2025 ) Of the 232 datasets reviewed 49% of the data sets had been “substantially altered”. (Freilich & Kesselheim, 2025 ) Of the 114 identified altered data sets, 93% had the word “gender” switched to “sex”.(Freilich & Kesselheim, 2025 ) Even if federally disseminated surveys were to capture Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors moving forward, LGBTQIA + identifying peoples may choose not to participate or disclose their identities. Beyond cuts to research funding or interference with national survey data, the Trump administration has targeted “promotion of gender ideology” through elimination of nondiscrimination protections in education and healthcare, bans on gender-affirming care, and attempts to erase entire LGBTQIA + populations. These actions have already had consequences on lives and well-being of LGBTQIA + identifying people and may dissuade this population from being honest moving forward as a method of keeping themselves safe, potentially impacting accurate data collection moving forward. It is thus incumbent upon researchers in the field to implement best practices around LGBTQIA + inclusion.(Keuroghlian et al., 2024) Entire federal data sets are being taken offline and federal employees are making undocumented changes in survey constructs. Researchers at academic, philanthropic, and community-based institutions have the opportunity to ask questions around constructs pertaining to LGBTQIA + populations, going beyond just SOGI. It is even more important now to collect data on LGBTQIA + populations in an expansive, culturally competent way, especially since the federal government cannot be relied on for this research. Health researchers should consider using these domains to guide question and survey development to better understand LGBTQIA + peoples’ health and wellbeing in relation to their research question and aims. Designing survey mechanisms to be inclusive of LGBTQIA + experiences and identities can help ensure future discoveries and interventions that are inclusive of and/or tailored to LGBTQIA + peoples. Our team acknowledges that not all domains may be pertinent for all surveys; each survey may have specific considerations related to the population or subject matter. Nonetheless, each domain should be considered in relation to the purposes and objectives of the survey and understanding subpopulations who may experience additional health disparities and outcomes. There may be concerns that it is not appropriate to ask youth about LGBTQIA + identification, however, asking questions around sexual attraction can help identify health disparities. For example, several studies have now identified differences in cigarette and e-cigarette use among sexual and gender minority youth.(Kierstead et al., 2024; Park-Lee et al., 2022) There may also be objections related to participants not understanding the concepts when asked about them, but looking to prior research and cognitive interview testing, studies show that a majority of participants understand with minimal distress, no matter their sexuality and age.(Austin et al., 2007 ; Meyer & Elias, 2022; Rullo et al., 2018; Suen et al., 2022) Additionally, researchers may be concerned about LGBTQIA + peoples uneasiness to respond due to the sensitive nature of the questions, however, sensitive topics are often included in surveys around interpersonal violence, substance use, and sexual activity. In instances of asking questions that are considered sensitive, utilizing techniques to support comfort, honesty, and reducing question avoidance are helpful across topic areas and should be considered.(Brown, 2024; Caltabiano & Dalla-Zuanna, 2013 ; Hart et al., 2021) There may even push back around how knowing LGBTQIA + identification is not relevant to health, however a study that looked at family formation among polyamorous parents found that polyamorous families were more deliberative and had more positive experiences around family planning, which had been underrepresented in the literature before publication.(Landy et al., 2021) Another study on intersex health found a high prevalence of mental health diagnoses this population.(Rosenwohl-Mack et al., 202 C.E.) While these concerns around LGBTQIA + inclusion may come up, these studies point to the need for research on these specific populations and aspects of identity to better understand the strengths and challenges experienced in the context of health and healthcare. By not asking questions in relation to LGBTQIA + people and the domains reviewed, understanding of these identities and experiences will continue to go un-measured, resulting in exclusion and erasure.(Human Rights Campaign Foundation, 2021; Kastanis et al., 2019; New Household Pulse Survey Data Reveal Differences between LGBT and Non-LGBT Respondents during COVID-19 Pandemic., 2024) Previous efforts were implemented to include LGBTQIA + identities and experiences through federal SOGI recommendation efforts in the previous administrations. (Dawson et al., 2023 ; Exec. Order No. 14075, 3 C.F.R., 2022; Federal Evidence Agenda on LGBTQI + Equity, 2023; New Household Pulse Survey Data Reveal Differences between LGBT and Non-LGBT Respondents during COVID-19 Pandemic., 2024) However, these efforts did not fully encapsulate the range of LGBTQIA + identities and experiences, limiting researchers’ current ability to analyze and understand LGBTQIA + populations. Conclusion The federal survey mechanisms studied here point to gaps in understanding this population, individual researchers and their labs should consider LGBTQIA + inclusion in their research programs. Through the consideration and implementation of questions under Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors constructions, this can fill in gaps in understanding LGBTQIA + population health that government systems can no longer. While the dismantling of this form of inclusion is prevalent at the federal level, individual researchers and their labs can make changes to keep LGBTQIA + population health at the forefront. Declarations Author Contribution IO and MJ conceived of the paper. IO and EM reviewed all included surveys. All authors discussed the results and contributed to the final manuscript. IO wrote the manuscript with support from EM, JE, and MJ. EM, JE, and MJ supplied feedback on the manuscript and provided insights needed manuscript edits. MJ supervised the project. References Austin, S. B., Conron, K., Patel, A., & Freedner, N. (2007). Making sense of sexual orientation measures: Findings from a cognitive processing study with adolescents on health survey questions. Focus on Adolescent Health , 3 (1), 55–65. https://doi.org/10.1300/J463v03n01_07 Bitterman, A., & Hess, D. (2021). Understanding generation gaps in LGBTQ + communities: Perspectives about gay neighborhoods among heteronormative and homonormative generational cohorts . Springer. https://link.springer.com/chapter/ 10.1007/978-3-030-66073-4_14 Brown, M. (2024, August 9). Handling sensitive questions in surveys and screeners . Nielsen Norman Group. https://www.nngroup.com/articles/sensitive-questions/ Cahill, S., & DiBlasi, C. (2024). Project 2025’s threat to LGBTQI + equality, safety, and health, racial and gender equity, and sexual and reproductive health . The Fenway Institute. https://fenwayhealth.org/wp-content/uploads/Project-2025-Brief_FINAL_7_30_24.pdf Caltabiano, M., & Dalla-Zuanna, G. (2013). A comparison of survey techniques on sensitive sexual behavior in Italy. Journal of Sex Research , 50 (6), 537–547. https://doi.org/10.1080/00224499.2012.674573 Cox, C., Rae, M., Kates, J., Wager, E., Ortaliza, J., & Dawson, L. (2025). February 2). A look at federal health data taken offline. Kaiser Family Foundation . https://www.kff.org/hiv-aids/a-look-at-federal-health-data-taken-offline/ Current measures of sexual orientation and gender identity in federal surveys . (2016). Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. https://nces.ed.gov/FCSM/pdf/buda5.pdf Dawson, L., & Kates, J. (2025, August 15). Overview of president Trump’s executive actions impacting LGBTQ + health . https://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/ Dawson, L., Long, M., & Frederiksen, B. (2023). LGBT + people’s health status and access to care [Issue Brief]. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/lgbt-peoples-health-status-and-access-to-care/#4247e403-4e09-437b-89fc-810dabd97ad7 Evaluations of sexual orientation and gender identity survey measures: What have we learned? (2016). Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/242/2014/04/Evaluations_of_SOGI_Questions_20160923.pdf Exec, O. (2022). No. 14075 , 3 C.F.R. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/ Federal (2023). evidence agenda on LGBTQI + equity . [Subcommittee Report]. Subcommittee on Sexual Orientation, Gender Identity, and Variations in Sex Characteristics (SOGI) Data Subcommittee on Equitable Data of the National Science and Technology Council. https://bidenwhitehouse.archives.gov/wp-content/uploads/2023/01/Federal-Evidence-Agenda-on-LGBTQI-Equity.pdf Freilich, J., & Kesselheim, A. (2025). Data manipulation within the US federal government. The Lancet , 406 (10500), 227–228. https://doi.org/10.1016/S0140-6736(25)01249-8 Gerstein, J. (2025, August 21). Supreme court lets Trump admin cut off health grants it says advance DEI or ‘gender ideology extremism.’ Politico . https://www.politico.com/news/2025/08/21/supreme-court-nih-funding-grants-00518782 Tables Table 1: Inclusion Domains and Criteria Inclusion Domain Definition of Construct Definition of Inclusion Domain Response Options (Not exhaustive) Sex 9 Based on reproductive organs, hormones, and genetics. Often determined by a medical professional based on genital makeup at birth. The Sex questions are a demographic domain that may include language around assigned sex at birth or biological sex. Question Format: If it was unclear whether the item was written to measure Sex or Gender Identity, but the item or response options used terms like “male” or “female,” then the Sex code was applied. Male Female Intersex Gender Identity 9 One’s innermost concept and perception of the self in relation to masculinity, femininity, both, or neither. This can be the same or different from one’s sex. The Gender Identity questions are a demographic domain that may encompass language around identity, concept, or perception of one’s gender. Question Format: If it was unclear whether the item was written to measure Sex or Gender Identity, but the item or response options used terms like “male” or “female,” then the Sex code was applied. Woman Man Nonbinary Genderqueer Agender Genderfluid Gender Expression 9 The way someone signals their gender to the world through behavior, mannerisms, appearance, and expressions. May be culturally specific. The Gender Expression questions are a behavior domain that may encompass: 1) visual presentation, 2) pronouns, 3) alignment of gender and outward expression (e.g., vocal changes, hormone therapy) Question Format: N/A Feminine Masculine Androgynous Butch Sexual Attraction 9 A form of attraction concerning who, if anyone, someone is interested in sexually; often based around physical arousal. The Sexual Attraction questions are a behavior domain that may use language about attraction and have clarifications in the surrounding text about the sexual nature of the experienced attraction. Question Format: If it was unclear whether the item was written to measure Sexual Attraction or Sexual Orientation, but the item or response options use terminology related to evoking interest, pleasure, or liking, and do not focus on the respondent’s identity, then the Sexual Attraction code was applied. Sexual attraction to men Sexual attraction to women Sexual attraction to feminine people Sexual attraction to masculine people Sexual attraction to androgynous people Sex repulsed Sex averse Sex indifferent Sex favorable Sexual Orientation 9, 16 The sexual identity someone uses to describe themself. For individuals who experience Sexual Attraction, their Sexual Orientation and Romantic Orientation can be aligned, but do not necessarily overlap. The Sexual Orientation questions are a demographic domain that may encompass language around orientation and identity. Questions should focus on the respondent’s self-described pattern of attraction. Question Format: If it was unclear whether the item was written to measure Sexual Attraction or Sexual Orientation, but the item or response options referenced identity or understanding of the self, then the Sexual Orientation code was applied. Gay Bisexual Lesbian Pansexual Demisexual Asexual Allosexual Graysexual Heterosexual Romantic Attraction 9 A form of attraction concerning who, if anyone, someone is interested in romantically, often based around the bond, shared values, beliefs, and similar interests with another individual. The Romantic Attraction questions are a behavior domain that may use language about attraction and have clarifications in the surrounding text about the romantic nature of the experienced attraction. Question Format: If it was unclear whether the item was written to measure Romantic Attraction or Romantic Orientation, but the item or response options referenced evoking interest, pleasure, or liking, and do not focus on identity, then the Romantic Attraction code was applied. Attraction to men Attraction to women Attraction to feminine people Attraction to masculine people Attraction to androgynous people Romantic repulsed Romantic averse Romantic indifferent Romantic favorable Romantic Orientation 9, 16 The romantic identity someone uses to describe themself with. For individuals who experience Romantic Attraction, their Romantic Orientation and Sexual Orientation can be aligned, but do not necessarily overlap. The Romantic Orientation questions are a demographic domain that may encompass language around orientation and identity. Questions should focus on the respondent’s self-described pattern of attraction. Question Format: If it was unclear whether the item was written to measure Romantic Attraction or Romantic Orientation, but the item or response options used terminology in relation to identity or understanding of the self, then this code was applied to Romantic Orientation. Heteroromantic Homoromantic Femmeromantic Androromantic Polyromantic Aromantic Biromantic Demiromanitc Alloromantic Partnership 9 Sexual, romantic, and/or intimate relationship dynamic(s) someone takes part in. The partnership questions are a demographic domain that may encompass: 1) relationship status (formal and informal), 2) relationship dynamics (e.g., polyamorous, monogamous), and 3) the nature of one’s relationship agreement(s). Question Format: Items that measure current or past partnerships may be included. Single Dating Married Divorced Separated Monogamous Non-Monogamous Polyamorous Open Relationship Sexual Activities/ Behaviors 9 The activities an individual participates in during or as part of sex. The Sexual Activities/Behaviors questions are a behavior domain that may encompass: 1) whether the respondent is sexually active or 2) what Sexual Activities/Behaviors the respondent engages in. Question Format: Items that measure sexual assault, “non-voluntary” intercourse, transactional sex, and coercive sex are excluded. Items about contraceptive use, sexual health behaviors, and sex education are also excluded. None Oral Penetration Manual Stimulation Vaginal/Front Hole Ana/Back Hole Kink* (*can be sexual, but is not inherently sexual) Top/Topping Bottom/Bottoming Switch/Vers Table 2: Survey instruments included in analysis Survey Title Survey Description/ Objective Statement Frequency Survey Year Collected Conducted By Scope Respondents National Survey of Children's Health 2021 (NSCH) 17 To provide national and state-level estimates on key indicators of health and well-being of children, their families and communities, and information about the prevalence and impact of special health care needs. Yearly 2021 HHS and HRSA National and State 95,000 Children National Health Interview Survey 2022 (NHIS) 18 To monitor the health of the U.S. population through the collection and analysis of data on a broad range of health topics. Yearly 2022 CDC National 87,500 noninstitutionalized U.S. adults ages 18 and older National Health and Nutrition Examination Survey 2021-2022 (NHANES) 19 To assess the health and nutritional status of adults and children in the U.S. Yearly 2021-2022 CDC National Nationally representative sample of 5,000 persons National Survey of Family Growth 2017-2019 (NSFG) 20 To gather information on pregnancy and births, marriage and cohabitation, infertility, use of contraception, family life, and general and reproductive health. Every 5 years 2017-2019 CDC National 11,347 respondents aged 15-49 (6,141 women and 5,206 men) Pregnancy Risk Assessment Monitoring System 2017 (PRAMS) 21 To reduce infant morbidity and mortality by influencing programs and policies aimed at reducing health problems among mothers and infants. Every 3-5 years 2017 CDC National 1,000 – 3,000 women who had a recent live birth National Survey on Drug Use and Health 2019 (NSDUH) 22 To provide accurate data on the level and patterns of alcohol, tobacco and illegal substance use and abuse, track trends in the use of alcohol, tobacco and various types of drugs, assess the consequences of substance use and abuse and identify those groups at high risk for substance abuse. Yearly 2019 SAMHSA and HHS National 67,625 Participants (16,894 adolescents aged 12–17 years and 50,731 adults aged 18 and over) Medicare Current Beneficiary Survey 2022 (MCBS) 23 To aid CMS in administering, monitoring, and evaluating the Medicare program. To provide important information on Medicare beneficiaries that is not available in CMS administrative data. Three times a year 2022 Centers for Medicaid and Medicare Services National 1,200,000 Medicare beneficiaries Youth Risk Behavior Surveillance System 2019 (YRBSS) 24 To measure health-related behaviors and experiences that can lead to death and disability among youth and adults. Every 2 years 2019 CDC and NCHS National, State, Territorial, Tribal 13,677 High school students in 136 public and private schools in the U.S. Behavioral Risk Factor Surveillance System 2021 (BRFSS) 25 To collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Yearly 2021 CDC and NCHS National 438,693 noninstitutionalized U.S. adults ages 18 and older Population Assessment of Tobacco and Health Waves 1-7 (PATH) 26 To study tobacco use and how it affects the health of people in the U.S. Every 1-2 years 2013-2021 NIH and FDA National Wave 1 (2013): 53,178 adults and youth Wave 7 (2021): 46,169 adults and youth National Immunization Survey 2021 (NIS) 27 To monitor vaccination coverage among children, teens, and adults. Yearly 2021 CDC National 29,142 adults ages 19 and older Table 3: Domain coverage across included surveys Survey Sex Gender Identity Gender Expression Sexual Attraction Sexual Orientation Romantic Attraction Romantic Orientation Partnership Sexual Activities/ Behaviors NSCH X - - - - - - - - NHIS X X - - X - - X - NHANES X X - - - - - X - NSFG X - - X X - - X X PRAMS - - - - - - - X - NSDUH - X - X X - - X - MCBS X - - - - - - X - YRBSS X - - - X - - X X BRFSS X X - - X - - X - PATH X X - X X - - X - NIS X X - - X - - - - * X indicates that at least one question is asked ** See Appendix A for list of items from each federal survey mechanism. Additional Declarations No competing interests reported. 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17:23:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":778402,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7781272/v1/56560981-20ed-42b3-af94-1d7309f3dcc2.pdf"},{"id":96214200,"identity":"d77a036d-6899-46f5-b0f5-743b478209b9","added_by":"auto","created_at":"2025-11-18 19:38:33","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33597,"visible":true,"origin":"","legend":"","description":"","filename":"OutoftheClosetAppendixSexualityResearchandSocialPolicy.docx","url":"https://assets-eu.researchsquare.com/files/rs-7781272/v1/c90e349eb19f0dab8de2edbe.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Out of the Closet and Into Our Data: An Analysis of LGBTQIA+ Inclusion Questions in National Health Surveys ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic (LGBTQIA+) inclusion in healthcare research and public health initiatives is essential to advancing overall health equity. (Graham et al., 2025; \u003cem\u003eGuidance on Adding Sexual Orientation and Gender Identity Questions to State Medicaid and CHIP Applications for Health Coverage\u003c/em\u003e, 2023) LGBTQIA\u0026thinsp;+\u0026thinsp;identifying peoples are an expanding population in the U.S. In 2024, an estimated 7.6% of the U.S. population identified as LGBTQIA+, increasing from 3.5% in 2012, with LGBTQIA\u0026thinsp;+\u0026thinsp;identification being higher for younger generations (e.g., millennials and generation Z). (Jones, 2024; Munz, 2024) This same study points to 0.9% of people in the U.S. identifying as transgender.(Jones, 2024) This change over generations may be due to a combination of the impacts of the HIV epidemic, suicidality rates amongst LGBTQIA\u0026thinsp;+\u0026thinsp;peoples, as well as the historical lack of acceptance.(Bitterman \u0026amp; Hess, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Herman et al., 2022)\u003c/p\u003e\u003cp\u003eHowever, there is a lack of nationally representative information about the health and wellness of LGBTQIA\u0026thinsp;+\u0026thinsp;populations in the US, overall and within subgroups.(Jones, 2022) Inconsistent or insufficient data collection on the health and wellbeing of LGBTQIA\u0026thinsp;+\u0026thinsp;populations has allowed for ongoing knowledge gaps, limiting public health and medical professionals\u0026rsquo; ability to address health needs, and has led to difficulties in addressing disparities. (Dawson et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Munz, 2024; State Health Access Data Assistance Center, 2021)\u003c/p\u003e\u003cp\u003eIn 2011, Health and Human Services (HHS) considered including sexual orientation and gender identity (SOGI) in standardized federal data collection alongside race, ethnicity, sex, primary language, and disability. (HHS Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, 2011) At the time, SOGI questions were not included across surveys, and sex was redefined a \u0026lsquo;biological sex,\u0026rsquo; separating from gender identity and sexual orientation.(HHS Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, 2011) Shortly after this, HHS conducted a Data Progression Plan Around Sexual Orientation and Gender Identity inclusion which resulted in the first sexual orientation question being included in a federal survey, the National Health Interview Survey. However, no questions were added that pertained to gender identity or transgender status.(Grennlee, 2017; LGBT Policy Coordinating Committee, 2016; Miller \u0026amp; Ryan, 2011; \u003cem\u003eSexual Orientation Information Background\u003c/em\u003e, 2016; State Health Access Data Assistance Center, 2021) Later in 2016, the Office of Management and Budget\u0026rsquo;s (OMB) Federal Interagency Working Group on Measuring Sexual Orientation and Gender Identity released multiple documents addressing the lack of data on SOGI populations. (State Health Access Data Assistance Center, 2021) These reports 12 cover federal survey\u0026rsquo;s inclusion of sexual identity (n\u0026thinsp;=\u0026thinsp;12), sexual attraction (n\u0026thinsp;=\u0026thinsp;3), sexual behavior (n\u0026thinsp;=\u0026thinsp;4), and gender identity (n\u0026thinsp;=\u0026thinsp;6).(Current Measures of Sexual Orientation and Gender Identity in Federal Surveys, 2016; Evaluations of Sexual Orientation and Gender Identity Survey Measures: What Have We Learned?, 2016; Toward a Research Agenda for Measuring Sexual Orientation and Gender Identity in Federal Surveys: Findings, Recommendations, and next Steps, 2016; State Health Access Data Assistance Center, 2021) Also in 2016, the Centers for Medicare \u0026amp; Medicaid Services (CMS) added a requirement that electronic health records would allow users to record SOGI data, though this was not a requirement for providers to collect SOGI data from every patient.(\u003cem\u003eStandards for the Electronic Health Record Technology Incentive Program\u003c/em\u003e, 2010, p. 495) Additionally, the Health Resources and Services Administration (HRSA) also began requiring SOGI data as part of standard demographics reporting for patients age. (\u003cem\u003eProgram Assistance Letter\u003c/em\u003e, 2016)\u003c/p\u003e\u003cp\u003eTo address this issue of inconsistent SOGI inclusion in federal surveys, in 2022, President Biden issued an executive order for federal agencies which included a mandate for OMB to \u0026ldquo;publish a report with recommendations for agencies on the best practices for the collection of [SOGI] data on Federal statistical surveys\u0026rdquo;.(Exec. Order No. 14075, 3 C.F.R., 2022) This executive order both acknowledged that LGBTQI\u0026thinsp;+\u0026thinsp;experiences around systemic discrimination as well as directed heads of federal agencies to review internal policies and use their authority to expand access to comprehensive healthcare; prevent and address homelessness and housing instability; protect LGBTQI\u0026thinsp;+\u0026thinsp;identifying students and educators in educational institutions; explicitly combat conversion therapy; and ensure that LGBTQI\u0026thinsp;+\u0026thinsp;identifying children did not face discrimination in the child welfare or juvenile justice systems. This was followed by a report on equitable data collection in 2023 by the Subcommittee on Sexual Orientation, Gender Identity, and Variations in Sex Characteristics Data.(Federal Evidence Agenda on LGBTQI\u0026thinsp;+\u0026thinsp;Equity, 2023) While both reports point to the need for more data collection on sexual orientation, gender identity, and sex characteristics, these efforts centered only on some aspects of LGBTQIA\u0026thinsp;+\u0026thinsp;identity.(Exec. Order No. 14075, 3 C.F.R., 2022; Federal Evidence Agenda on LGBTQI\u0026thinsp;+\u0026thinsp;Equity, 2023) Measurement of LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences helps public health professionals better understand the behaviors, disparities, experiences, and health of LGBTQIA\u0026thinsp;+\u0026thinsp;peoples and therefore their ability to improve health for the public at large.\u003c/p\u003e\u003cp\u003eSince the beginning of 2025, the landscape around LGBTQIA\u0026thinsp;+\u0026thinsp;measurement and inclusion in federal health surveys has drastically changed. Numerous executive actions have occurred that impact the functionality and effectiveness around LGBTQIA\u0026thinsp;+\u0026thinsp;populations and their inclusion in health programming, services, funding, and research.(Dawson \u0026amp; Kates, 2025; Gerstein, 2025; Todd, 2025) Additionally, data sets have been impacted by the new administration through federal level data manipulation. (Dawson \u0026amp; Kates, 2025; Freilich \u0026amp; Kesselheim, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Gerstein, 2025; Todd, 2025) These anti-LGBTQIA\u0026thinsp;+\u0026thinsp;actions not only impact the present systems and policies that support LGBTQIA\u0026thinsp;+\u0026thinsp;peoples today, but will have negative impacts on LGBTQIA\u0026thinsp;+\u0026thinsp;populations for years to come.(How State Policy Affects the Well-Being and Relocation of LGBTQ\u0026thinsp;+\u0026thinsp;Young People, 2025; Tran \u0026amp; Gonzales, 2025)\u003c/p\u003e\u003cp\u003eIn this study, our team aimed to quantify the extent to which federal health surveys fielded prior to current anti-LGBTQIA actions in the federal government included items pertaining to LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences. Drawing on queer theory, we defined nine domains for which inclusion was identified: Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors. Queer theory examines and critiques structures and systems that define the societal norms around gender and sexuality, allowing researchers and advocates to look outside traditional sexuality and gender binaries. This lens is essential when looking at the inclusion of LGBTQIA\u0026thinsp;+\u0026thinsp;identifying peoples to see who is included outside of cis- hetero-normative structures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eSurvey Selection\u003c/h2\u003e\u003cp\u003eWe sought to include health surveys that are commonly accessed and used by researchers to study the health of the U.S. population. U.S. health surveys were identified through federalinstitutions such as Health and Human Services, the National Institutes of Health, the United States Census Bureau, the National Center for Health Statistics, the Centers for Medicaid and Medicare Services, the Substance Abuse and Mental Health Services Administration, the Food and Drug Administration, the Bureau of Justice Statistics, the Bureau of Labor Statistics, the National Science Foundation, and the Centers for Disease Control. The initial list of surveys was developed by coauthors from these institutions to ensure comprehensiveness since our team could not find a list of all federal health-oriented surveys. After discussion of the surveys, the research team created the following criteria for survey questionnaires\u0026rsquo; inclusion in the study: 1) federally administered, 2) available in English, 3) cited at least 300 times in PubMed as of July 12, 2022, 4) used the word \u0026ldquo;health\u0026rdquo;, \u0026ldquo;medicine\u0026rdquo;, or \u0026ldquo;medical\u0026rdquo; in the title or objective statement of the survey, 5) administered every five years or more frequently, 6) fielded nationally or across multiple states (i.e., provided national or state representative results), and 7) contained items that measure person-reported health status, history, or behaviors. The survey questionnaires reviewed were the most recent publicly available iteration as of July 12, 2022, with survey years ranging from 2017\u0026ndash;2022.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDomain Development\u003c/h3\u003e\n\u003cp\u003eDomains were developed based on queer theory peer-reviewed literature in the effort to create an inclusive series of domains that captured the varying experiences and identities of individuals under the LGBTQIA\u0026thinsp;+\u0026thinsp;umbrella. Many studies point to the need for differentiation between sex assigned at birth in relation and gender identity, creating the \u0026lsquo;Sex\u0026rsquo; and \u0026lsquo;Gender\u0026rsquo; domains. Additionally, gender expression is distinct from gender identity and is a way one can communicate to others about their gender, leading to the creation of the \u0026lsquo;Gender Expression\u0026rsquo; domain.(\u003cem\u003eGlossary of Terms\u003c/em\u003e, 2025; \u0026ldquo;Understanding Transgender People, Gender Identity and Gender Expression,\u0026rdquo; 2024; Malatino \u0026amp; Stoltzfus-Brown, 2020; Moseson et al., 2024) The split attraction model differentiates between sexual and romantic attraction.(Winer, 2024) Additionally, literature about sexual fluidity makes a clear distinction between attraction and orientation.(Katz-Wise \u0026amp; Hyde, 2017) As such, we define four distinct domains: \u0026lsquo;Sexual Attraction,\u0026rsquo; \u0026lsquo;Sexual Orientation,\u0026rsquo; \u0026lsquo;Romantic Attraction,\u0026rsquo; and \u0026lsquo;Romantic Orientation\u0026rsquo; domains. Sexual fluidity literature also parses how attraction and orientation differ from behaviors, which informed our definitions of the \u0026lsquo;Partnership\u0026rsquo; and \u0026lsquo;Sexual Activities/Behaviors\u0026rsquo; domains.(Katz-Wise \u0026amp; Hyde, 2017)\u003c/p\u003e\n\u003ch3\u003eSurvey Item coding\u003c/h3\u003e\n\u003cp\u003eSurvey items included in the questionnaires were coded by two study members (XX and XX). The coders utilized deductive coding using the Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors domains, which are based on LGBTQIA\u0026thinsp;+\u0026thinsp;research and queer theory (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e(\u003cem\u003eGlossary of Terms\u003c/em\u003e, 2025; \u003cem\u003eResources for Improving Demographic Data Quality\u003c/em\u003e, 2024) Each survey item was assigned to one domain \u003cem\u003e(Appendix A).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo be included, items had to explicitly and directly measure one of the specified domains. Domains pertaining to demographics and those pertaining behaviors were distinguished. For example, an item about the respondent\u0026rsquo;s sexual experiences with people of other genders would be coded as Sexual Activities/ Behaviors, rather than Sexual Orientation.\u003c/p\u003e\n\u003ch3\u003e[Table ]\u003c/h3\u003e\n\u003cp\u003eThis team excluded introductory statements, items that were used to collect identifiable information that are not included in the available data and questions verifying previous responses. If a question was repeated based on a response to a previous item (e.g. \u003cem\u003eAt the time you began living together, were you and he engaged to be married or did you have definite plans to get married? (N\u003c/em\u003e\u003csup\u003e\u003cem\u003eTH\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eHUSBAND)\u003c/em\u003e), it was counted only once. Questions that did not directly ask about the survey respondent \u0026ndash; such as those about partners, family, or household members \u0026ndash; were also excluded. In surveys where alternate versions of the same question were tested, the different question versions were treated as a single item because the respondent would only ever be prompted to answer one version. Further, if the same or equivalent question was asked across several versions of a survey, it would only be coded once (e.g. the \u0026lsquo;male\u0026rsquo; and \u0026lsquo;female\u0026rsquo; National Survey of Family Growth (NSFG) questionnaires; age-specific National Immunization Survey (NIS) questionnaires).\u003c/p\u003e\u003cp\u003eTeam members (XX and XX) met biweekly to rectify coding differences and discuss individual findings. Questions were included based on mutual agreement that they belong under the defined domains to be included in this analysis. While coding disagreements rarely occurred, when coding differences persisted after discussion, reviewers consulted with the other coauthors (XX and XX) for additional feedback and perspectives.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eSurvey Identification\u003c/h2\u003e\u003cp\u003eWe identified 11 federal health surveys that met inclusion criteria \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e, which included the National Survey of Children's Health 2021 (NSCH), National Health Interview Survey 2022 (NHIS), National Health and Nutrition Examination Survey 2021\u0026ndash;2022 (NHANES), National Survey of Family Growth 2017\u0026ndash;2019 (NSFG), Pregnancy Risk Assessment Monitoring System 2017 (PRAMS), National Survey on Drug Use and Health 2019 (NSDUH), Medicare Current Beneficiary Survey 2022 (MCBS), Youth Risk Behavior Surveillance System 2019 (YRBSS), Behavioral Risk Factor Surveillance System 2021 (BRFSS), Population Assessment of Tobacco and Health Waves 1\u0026ndash;7 (PATH), and the National Immunization Survey 2021 (NIS).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e[Table ]\u003c/h3\u003e\n\u003cp\u003eNo survey questionnaire included items from all domains, and none measured Gender Expression, Romantic Attraction, or Romantic Orientation. NSFG and PATH had items pertaining to the greatest number of domains (n\u003csub\u003edomains\u003c/sub\u003e = 5). The most represented domains were Sex (n\u003csub\u003esurveys\u003c/sub\u003e = 9) and Partnership (n\u003csub\u003esurveys\u003c/sub\u003e = 9). Federal surveys missing the most domains include PRAMS and NSDUH, which did not have questions about Sex, as well as NSCH and NIS which did not have questions about Partnership.\u003c/p\u003e\u003cp\u003eNSCH, MCBS, and PRAMS did not include Sexual Orientation or Gender Identity items. NHANES did not include a Sexual Orientation item, but did include an item about Gender Identity. Conversely, NSFG and YRBSS included an item about Gender Identity, but not Sexual Orientation.\u003c/p\u003e\n\u003ch3\u003e[Table ]\u003c/h3\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eOur findings show that before 2025, many national health surveys incompletely capture constructs like Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors. These changes to federal data collection and dissemination will impact our future understanding of LGBTQIA\u0026thinsp;+\u0026thinsp;health at the federal level. Our data shows that LGBTQIA\u0026thinsp;+\u0026thinsp;identifiers were incorporated into data collection processes amongst most reviewed surveys. However, based on the current administrations attacks on LGBTQIA\u0026thinsp;+\u0026thinsp;populations, we will likely miss these mechanisms of understanding LGBTQIA\u0026thinsp;+\u0026thinsp;populations moving forward. (Dawson \u0026amp; Kates, 2025; Gerstein, 2025; How State Policy Affects the Well-Being and Relocation of LGBTQ\u0026thinsp;+\u0026thinsp;Young People, 2025; Todd, 2025; Tran \u0026amp; Gonzales, 2025) This not only impacts our ability to understand many aspects of LGBTQIA\u0026thinsp;+\u0026thinsp;population health but also impacts future research investigation and funding opportunities for LGBTQIA\u0026thinsp;+\u0026thinsp;focused researchers.\u003c/p\u003e\u003cp\u003eHowever, Biden-era recommendations for greater inclusion of LGBTQIA\u0026thinsp;+\u0026thinsp;identities and populations are under active attach under the Trump Administration. (Dawson \u0026amp; Kates, 2025; Gerstein, 2025; How State Policy Affects the Well-Being and Relocation of LGBTQ\u0026thinsp;+\u0026thinsp;Young People, 2025; Todd, 2025; Tran \u0026amp; Gonzales, 2025) Executive orders, administrative changes, and funding cuts have already begun to impact federal research and development across topics and communities, with LGBTQIA\u0026thinsp;+\u0026thinsp;populations being disproportionally impacted. (Cahill \u0026amp; DiBlasi, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Cox et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Dawson \u0026amp; Kates, 2025; Freilich \u0026amp; Kesselheim, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Tran \u0026amp; Gonzales, 2025) A study of government data set manipulation between January 20, 2025 and March 25, 2025 found that data manipulation is occurring on the federal level.(Freilich \u0026amp; Kesselheim, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Of the 232 datasets reviewed 49% of the data sets had been \u0026ldquo;substantially altered\u0026rdquo;. (Freilich \u0026amp; Kesselheim, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) Of the 114 identified altered data sets, 93% had the word \u0026ldquo;gender\u0026rdquo; switched to \u0026ldquo;sex\u0026rdquo;.(Freilich \u0026amp; Kesselheim, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eEven if federally disseminated surveys were to capture Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors moving forward, LGBTQIA\u0026thinsp;+\u0026thinsp;identifying peoples may choose not to participate or disclose their identities. Beyond cuts to research funding or interference with national survey data, the Trump administration has targeted \u0026ldquo;promotion of gender ideology\u0026rdquo; through elimination of nondiscrimination protections in education and healthcare, bans on gender-affirming care, and attempts to erase entire LGBTQIA\u0026thinsp;+\u0026thinsp;populations. These actions have already had consequences on lives and well-being of LGBTQIA\u0026thinsp;+\u0026thinsp;identifying people and may dissuade this population from being honest moving forward as a method of keeping themselves safe, potentially impacting accurate data collection moving forward.\u003c/p\u003e\u003cp\u003eIt is thus incumbent upon researchers in the field to implement best practices around LGBTQIA\u0026thinsp;+\u0026thinsp;inclusion.(Keuroghlian et al., 2024) Entire federal data sets are being taken offline and federal employees are making undocumented changes in survey constructs. Researchers at academic, philanthropic, and community-based institutions have the opportunity to ask questions around constructs pertaining to LGBTQIA\u0026thinsp;+\u0026thinsp;populations, going beyond just SOGI. It is even more important now to collect data on LGBTQIA\u0026thinsp;+\u0026thinsp;populations in an expansive, culturally competent way, especially since the federal government cannot be relied on for this research. Health researchers should consider using these domains to guide question and survey development to better understand LGBTQIA\u0026thinsp;+\u0026thinsp;peoples\u0026rsquo; health and wellbeing in relation to their research question and aims. Designing survey mechanisms to be inclusive of LGBTQIA\u0026thinsp;+\u0026thinsp;experiences and identities can help ensure future discoveries and interventions that are inclusive of and/or tailored to LGBTQIA\u0026thinsp;+\u0026thinsp;peoples.\u003c/p\u003e\u003cp\u003eOur team acknowledges that not all domains may be pertinent for all surveys; each survey may have specific considerations related to the population or subject matter. Nonetheless, each domain should be considered in relation to the purposes and objectives of the survey and understanding subpopulations who may experience additional health disparities and outcomes. There may be concerns that it is not appropriate to ask youth about LGBTQIA\u0026thinsp;+\u0026thinsp;identification, however, asking questions around sexual attraction can help identify health disparities. For example, several studies have now identified differences in cigarette and e-cigarette use among sexual and gender minority youth.(Kierstead et al., 2024; Park-Lee et al., 2022) There may also be objections related to participants not understanding the concepts when asked about them, but looking to prior research and cognitive interview testing, studies show that a majority of participants understand with minimal distress, no matter their sexuality and age.(Austin et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Meyer \u0026amp; Elias, 2022; Rullo et al., 2018; Suen et al., 2022) Additionally, researchers may be concerned about LGBTQIA\u0026thinsp;+\u0026thinsp;peoples uneasiness to respond due to the sensitive nature of the questions, however, sensitive topics are often included in surveys around interpersonal violence, substance use, and sexual activity. In instances of asking questions that are considered sensitive, utilizing techniques to support comfort, honesty, and reducing question avoidance are helpful across topic areas and should be considered.(Brown, 2024; Caltabiano \u0026amp; Dalla-Zuanna, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Hart et al., 2021) There may even push back around how knowing LGBTQIA\u0026thinsp;+\u0026thinsp;identification is not relevant to health, however a study that looked at family formation among polyamorous parents found that polyamorous families were more deliberative and had more positive experiences around family planning, which had been underrepresented in the literature before publication.(Landy et al., 2021) Another study on intersex health found a high prevalence of mental health diagnoses this population.(Rosenwohl-Mack et al., 202 C.E.) While these concerns around LGBTQIA\u0026thinsp;+\u0026thinsp;inclusion may come up, these studies point to the need for research on these specific populations and aspects of identity to better understand the strengths and challenges experienced in the context of health and healthcare.\u003c/p\u003e\u003cp\u003eBy not asking questions in relation to LGBTQIA\u0026thinsp;+\u0026thinsp;people and the domains reviewed, understanding of these identities and experiences will continue to go un-measured, resulting in exclusion and erasure.(Human Rights Campaign Foundation, 2021; Kastanis et al., 2019; New Household Pulse Survey Data Reveal Differences between LGBT and Non-LGBT Respondents during COVID-19 Pandemic., 2024) Previous efforts were implemented to include LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences through federal SOGI recommendation efforts in the previous administrations. (Dawson et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Exec. Order No. 14075, 3 C.F.R., 2022; Federal Evidence Agenda on LGBTQI\u0026thinsp;+\u0026thinsp;Equity, 2023; New Household Pulse Survey Data Reveal Differences between LGBT and Non-LGBT Respondents during COVID-19 Pandemic., 2024) However, these efforts did not fully encapsulate the range of LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences, limiting researchers\u0026rsquo; current ability to analyze and understand LGBTQIA\u0026thinsp;+\u0026thinsp;populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe federal survey mechanisms studied here point to gaps in understanding this population, individual researchers and their labs should consider LGBTQIA\u0026thinsp;+\u0026thinsp;inclusion in their research programs. Through the consideration and implementation of questions under Sex, Gender Identity, Gender Expression, Sexual Attraction, Sexual Orientation, Romantic Attraction, Romantic Orientation, Partnership, and Sexual Activities/Behaviors constructions, this can fill in gaps in understanding LGBTQIA\u0026thinsp;+\u0026thinsp;population health that government systems can no longer. While the dismantling of this form of inclusion is prevalent at the federal level, individual researchers and their labs can make changes to keep LGBTQIA\u0026thinsp;+\u0026thinsp;population health at the forefront.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIO and MJ conceived of the paper. IO and EM reviewed all included surveys. All authors discussed the results and contributed to the final manuscript. IO wrote the manuscript with support from EM, JE, and MJ. EM, JE, and MJ supplied feedback on the manuscript and provided insights needed manuscript edits. MJ supervised the project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAustin, S. B., Conron, K., Patel, A., \u0026amp; Freedner, N. (2007). Making sense of sexual orientation measures: Findings from a cognitive processing study with adolescents on health survey questions. \u003cem\u003eFocus on Adolescent Health\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 55\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1300/J463v03n01_07\u003c/span\u003e\u003cspan address=\"10.1300/J463v03n01_07\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBitterman, A., \u0026amp; Hess, D. (2021). \u003cem\u003eUnderstanding generation gaps in LGBTQ\u0026thinsp;+\u0026thinsp;communities: Perspectives about gay neighborhoods among heteronormative and homonormative generational cohorts\u003c/em\u003e. Springer. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/chapter/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/chapter/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-3-030-66073-4_14\u003c/span\u003e\u003cspan address=\"10.1007/978-3-030-66073-4_14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown, M. (2024, August 9). \u003cem\u003eHandling sensitive questions in surveys and screeners\u003c/em\u003e. Nielsen Norman Group. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nngroup.com/articles/sensitive-questions/\u003c/span\u003e\u003cspan address=\"https://www.nngroup.com/articles/sensitive-questions/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCahill, S., \u0026amp; DiBlasi, C. (2024). \u003cem\u003eProject 2025\u0026rsquo;s threat to LGBTQI\u0026thinsp;+\u0026thinsp;equality, safety, and health, racial and gender equity, and sexual and reproductive health\u003c/em\u003e. The Fenway Institute. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://fenwayhealth.org/wp-content/uploads/Project-2025-Brief_FINAL_7_30_24.pdf\u003c/span\u003e\u003cspan address=\"https://fenwayhealth.org/wp-content/uploads/Project-2025-Brief_FINAL_7_30_24.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaltabiano, M., \u0026amp; Dalla-Zuanna, G. (2013). A comparison of survey techniques on sensitive sexual behavior in Italy. \u003cem\u003eJournal of Sex Research\u003c/em\u003e, \u003cem\u003e50\u003c/em\u003e(6), 537\u0026ndash;547. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00224499.2012.674573\u003c/span\u003e\u003cspan address=\"10.1080/00224499.2012.674573\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCox, C., Rae, M., Kates, J., Wager, E., Ortaliza, J., \u0026amp; Dawson, L. (2025). February 2). A look at federal health data taken offline. \u003cem\u003eKaiser Family Foundation\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kff.org/hiv-aids/a-look-at-federal-health-data-taken-offline/\u003c/span\u003e\u003cspan address=\"https://www.kff.org/hiv-aids/a-look-at-federal-health-data-taken-offline/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eCurrent measures of sexual orientation and gender identity in federal surveys\u003c/em\u003e. (2016). Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nces.ed.gov/FCSM/pdf/buda5.pdf\u003c/span\u003e\u003cspan address=\"https://nces.ed.gov/FCSM/pdf/buda5.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDawson, L., \u0026amp; Kates, J. (2025, August 15). \u003cem\u003eOverview of president Trump\u0026rsquo;s executive actions impacting LGBTQ\u0026thinsp;+\u0026thinsp;health\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/\u003c/span\u003e\u003cspan address=\"https://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDawson, L., Long, M., \u0026amp; Frederiksen, B. (2023). \u003cem\u003eLGBT\u0026thinsp;+\u0026thinsp;people\u0026rsquo;s health status and access to care\u003c/em\u003e [Issue Brief]. Kaiser Family Foundation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kff.org/womens-health-policy/lgbt-peoples-health-status-and-access-to-care/#4247e403-4e09-437b-89fc-810dabd97ad7\u003c/span\u003e\u003cspan address=\"https://www.kff.org/womens-health-policy/lgbt-peoples-health-status-and-access-to-care/#4247e403-4e09-437b-89fc-810dabd97ad7\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eEvaluations of sexual orientation and gender identity survey measures: What have we learned?\u003c/em\u003e (2016). Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/242/2014/04/Evaluations_of_SOGI_Questions_20160923.pdf\u003c/span\u003e\u003cspan address=\"https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/242/2014/04/Evaluations_of_SOGI_Questions_20160923.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eExec, O. (2022). \u003cem\u003eNo. 14075\u003c/em\u003e, 3 \u003cem\u003eC.F.R.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/\u003c/span\u003e\u003cspan address=\"https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFederal (2023). \u003cem\u003eevidence agenda on LGBTQI\u0026thinsp;+\u0026thinsp;equity\u003c/em\u003e. [Subcommittee Report]. Subcommittee on Sexual Orientation, Gender Identity, and Variations in Sex Characteristics (SOGI) Data Subcommittee on Equitable Data of the National Science and Technology Council. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bidenwhitehouse.archives.gov/wp-content/uploads/2023/01/Federal-Evidence-Agenda-on-LGBTQI-Equity.pdf\u003c/span\u003e\u003cspan address=\"https://bidenwhitehouse.archives.gov/wp-content/uploads/2023/01/Federal-Evidence-Agenda-on-LGBTQI-Equity.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFreilich, J., \u0026amp; Kesselheim, A. (2025). Data manipulation within the US federal government. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e406\u003c/em\u003e(10500), 227\u0026ndash;228. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(25)01249-8\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(25)01249-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGerstein, J. (2025, August 21). Supreme court lets Trump admin cut off health grants it says advance DEI or \u0026lsquo;gender ideology extremism.\u0026rsquo; \u003cem\u003ePolitico\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.politico.com/news/2025/08/21/supreme-court-nih-funding-grants-00518782\u003c/span\u003e\u003cspan address=\"https://www.politico.com/news/2025/08/21/supreme-court-nih-funding-grants-00518782\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Inclusion Domains and Criteria\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition of Construct\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition of Inclusion Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse Options \u003cem\u003e(Not exhaustive)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eSex\u003csup\u003e9\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eBased on reproductive organs, hormones, and genetics.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOften determined by a medical professional based on genital makeup at birth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Sex questions are a demographic domain that may include language around assigned sex at birth or biological sex.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u003c/strong\u003e If it was unclear whether the item was written to measure Sex or Gender Identity, but the item or response options used terms like \u0026ldquo;male\u0026rdquo; or \u0026ldquo;female,\u0026rdquo; then the Sex code was applied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003cbr\u003e\u0026nbsp;Female\u003cbr\u003e\u0026nbsp;Intersex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eGender Identity\u003csup\u003e\u0026nbsp;9\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eOne\u0026rsquo;s innermost concept and perception of the self in relation to masculinity, femininity, both, or neither. This can be the same or different from one\u0026rsquo;s sex.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Gender Identity questions are a demographic domain that may encompass language around identity, concept, or perception of one\u0026rsquo;s gender.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u003c/strong\u003e If it was unclear whether the item was written to measure Sex or Gender Identity, but the item or response options used terms like \u0026ldquo;male\u0026rdquo; or \u0026ldquo;female,\u0026rdquo; then the Sex code was applied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eWoman\u003cbr\u003e\u0026nbsp;Man\u003cbr\u003e\u0026nbsp;Nonbinary\u003cbr\u003e\u0026nbsp;Genderqueer\u003cbr\u003e\u0026nbsp;Agender\u003cbr\u003e\u0026nbsp;Genderfluid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eGender Expression\u003csup\u003e\u0026nbsp;9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eThe way someone signals their gender to the world through behavior, mannerisms, appearance, and expressions. May be culturally specific.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Gender Expression questions are a behavior domain that may encompass: 1) visual presentation, 2) pronouns, 3) alignment of gender and outward expression (e.g., vocal changes, hormone therapy)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u003c/strong\u003e N/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eFeminine\u003cbr\u003e\u0026nbsp;Masculine\u003cbr\u003e\u0026nbsp;Androgynous\u003cbr\u003e\u0026nbsp;Butch\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eSexual Attraction\u003csup\u003e\u0026nbsp;9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eA form of attraction concerning who, if anyone, someone is interested in sexually; often based around physical arousal.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Sexual Attraction questions are a behavior domain that may use language about attraction and have clarifications in the surrounding text about the sexual nature of the experienced attraction.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eIf it was unclear whether the item was written to measure Sexual Attraction or Sexual Orientation, but the item or response options use terminology related to evoking interest, pleasure, or liking, and do not focus on the respondent\u0026rsquo;s identity, then the Sexual Attraction code was applied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eSexual attraction to men\u003cbr\u003e\u0026nbsp;Sexual attraction to women\u003c/p\u003e\n \u003cp\u003eSexual attraction to feminine people\u003cbr\u003e\u0026nbsp;Sexual attraction to masculine people\u003cbr\u003e\u0026nbsp;Sexual attraction to androgynous people\u003c/p\u003e\n \u003cp\u003eSex repulsed\u003c/p\u003e\n \u003cp\u003eSex averse\u003c/p\u003e\n \u003cp\u003eSex indifferent\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSex favorable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eSexual Orientation\u003csup\u003e\u0026nbsp;9, 16\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eThe sexual identity someone uses to describe themself. For individuals who experience Sexual Attraction, their Sexual Orientation and Romantic Orientation can be aligned, but do not necessarily overlap.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Sexual Orientation questions are a demographic domain that may encompass language around orientation and identity. Questions should focus on the respondent\u0026rsquo;s self-described pattern of attraction.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eIf it was unclear whether the item was written to measure Sexual Attraction or Sexual Orientation, but the item or response options referenced identity or understanding of the self, then the Sexual Orientation code was applied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eGay\u003cbr\u003e\u0026nbsp;Bisexual\u003cbr\u003e\u0026nbsp;Lesbian\u003cbr\u003e\u0026nbsp;Pansexual\u003cbr\u003e\u0026nbsp;Demisexual\u0026nbsp;\u003cbr\u003e\u0026nbsp;Asexual\u003c/p\u003e\n \u003cp\u003eAllosexual\u003cbr\u003e\u0026nbsp;Graysexual\u0026nbsp;\u003cbr\u003e\u0026nbsp;Heterosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRomantic Attraction\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eA form of attraction concerning who, if anyone, someone is interested in romantically, often based around the bond, shared values, beliefs, and similar interests with another individual.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Romantic Attraction questions are a behavior domain that may use language about attraction and have clarifications in the surrounding text about the romantic nature of the experienced attraction.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eIf it was unclear whether the item was written to measure Romantic Attraction or Romantic Orientation, but the item or response options referenced evoking interest, pleasure, or liking, and do not focus on identity, then the Romantic Attraction code was applied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eAttraction to men\u003cbr\u003e\u0026nbsp;Attraction to women\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAttraction to feminine people\u003cbr\u003e\u0026nbsp;Attraction to masculine people\u003cbr\u003e\u0026nbsp;Attraction to androgynous people\u003c/p\u003e\n \u003cp\u003eRomantic repulsed\u003c/p\u003e\n \u003cp\u003eRomantic averse\u003c/p\u003e\n \u003cp\u003eRomantic indifferent\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRomantic favorable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eRomantic Orientation\u003csup\u003e\u0026nbsp;9, 16\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eThe romantic identity someone uses to describe themself with. For individuals who experience Romantic Attraction, their Romantic Orientation and Sexual Orientation can be aligned, but do not necessarily overlap.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Romantic Orientation questions are a demographic domain that may encompass language around orientation and identity. \u0026nbsp; \u0026nbsp; Questions should focus on the respondent\u0026rsquo;s self-described pattern of attraction.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eIf it was unclear whether the item was written to measure Romantic Attraction or Romantic Orientation, but the item or response options used terminology in relation to identity or understanding of the self, then this code was applied to Romantic Orientation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eHeteroromantic\u003cbr\u003e\u0026nbsp;Homoromantic\u003cbr\u003e\u0026nbsp;Femmeromantic\u003cbr\u003e\u0026nbsp;Androromantic\u003cbr\u003e\u0026nbsp;Polyromantic\u003cbr\u003e\u0026nbsp;Aromantic\u003cbr\u003e\u0026nbsp;Biromantic\u003cbr\u003e\u0026nbsp;Demiromanitc\u003c/p\u003e\n \u003cp\u003eAlloromantic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003ePartnership \u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eSexual, romantic, and/or intimate relationship dynamic(s) someone takes part in. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe partnership questions are a demographic domain that may encompass: 1) relationship status (formal and informal), 2) relationship dynamics (e.g., polyamorous, monogamous), and 3) the nature of one\u0026rsquo;s relationship agreement(s).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eItems that measure current or past partnerships may be included.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eSingle\u003cbr\u003e\u0026nbsp;Dating\u003cbr\u003e\u0026nbsp;Married\u003cbr\u003e\u0026nbsp;Divorced\u003cbr\u003e\u0026nbsp;Separated\u003cbr\u003e\u0026nbsp;Monogamous\u003cbr\u003e\u0026nbsp;Non-Monogamous\u003cbr\u003e\u0026nbsp;Polyamorous\u003cbr\u003e\u0026nbsp;Open Relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eSexual Activities/ Behaviors\u003csup\u003e\u0026nbsp;9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eThe activities an individual participates in during or as part of sex.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eThe Sexual Activities/Behaviors questions are a behavior domain that may encompass: 1) whether the respondent is sexually active or 2) what Sexual Activities/Behaviors the respondent engages in.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Format:\u0026nbsp;\u003c/strong\u003eItems that measure sexual assault, \u0026ldquo;non-voluntary\u0026rdquo; intercourse, transactional sex, and coercive sex are excluded. Items about contraceptive use, sexual health behaviors, and sex education are also excluded.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNone\u003cbr\u003e\u0026nbsp;Oral\u003cbr\u003e\u0026nbsp;Penetration\u003cbr\u003e\u0026nbsp;Manual Stimulation\u003cbr\u003e\u0026nbsp;Vaginal/Front Hole\u003cbr\u003e\u0026nbsp;Ana/Back Hole\u003c/p\u003e\n \u003cp\u003eKink* (*can be sexual, but is not inherently sexual)\u003c/p\u003e\n \u003cp\u003eTop/Topping\u003cbr\u003e\u0026nbsp;Bottom/Bottoming\u003cbr\u003e\u0026nbsp;Switch/Vers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eSurvey instruments included in analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTitle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey Description/ Objective Statement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey Year Collected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConducted By\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScope\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Survey of Children\u0026apos;s Health 2021 (NSCH)\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo provide national and state-level estimates on key indicators of health and well-being of children, their families and communities, and information about the prevalence and impact of special health care needs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eHHS and HRSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational and State\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e95,000 Children\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Health Interview Survey 2022 (NHIS)\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo monitor the health of the U.S. population through the collection and analysis of data on a broad range of health topics.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e87,500 noninstitutionalized U.S. adults ages 18 and older\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Health and Nutrition Examination Survey 2021-2022 (NHANES) \u003csup\u003e19\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo assess the health and nutritional status of adults and children in the U.S.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2021-2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eNationally representative sample of 5,000 persons\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Survey of Family Growth 2017-2019 (NSFG)\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo gather information on pregnancy and births, marriage and cohabitation, infertility, use of contraception, family life, and general and reproductive health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eEvery 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2017-2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e11,347 respondents aged 15-49 (6,141 women and 5,206 men)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePregnancy Risk Assessment Monitoring System 2017 (PRAMS)\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo reduce infant morbidity and mortality by influencing programs and policies aimed at reducing health problems among mothers and infants.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eEvery 3-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1,000 \u0026ndash; 3,000 women who had a recent live birth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Survey on Drug Use and Health 2019 (NSDUH)\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo provide accurate data on the level and patterns of alcohol, tobacco and illegal substance use and abuse, track trends in the use of alcohol, tobacco and various types of drugs, assess the consequences of substance use and abuse and identify those groups at high risk for substance abuse.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eSAMHSA and HHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e67,625 Participants (16,894 adolescents aged 12\u0026ndash;17 years and 50,731 adults aged 18 and over)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eMedicare Current Beneficiary Survey 2022 (MCBS)\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo aid CMS in administering, monitoring, and evaluating the Medicare program. To provide important information on Medicare beneficiaries that is not available in CMS administrative data.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eThree times a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCenters for Medicaid and Medicare Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1,200,000 Medicare beneficiaries\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eYouth Risk Behavior Surveillance System 2019 (YRBSS)\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo measure health-related behaviors and experiences that can lead to death and disability among youth and adults.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eEvery 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC and NCHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational, State, Territorial, Tribal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e13,677 High school students in 136 public and private schools in the U.S.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eBehavioral Risk Factor Surveillance System 2021 (BRFSS)\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC and NCHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e438,693 noninstitutionalized U.S. adults ages 18 and older\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ePopulation Assessment of Tobacco and Health Waves 1-7 (PATH)\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo study tobacco use and how it affects the health of people in the U.S.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eEvery 1-2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2013-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eNIH and FDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eWave 1 (2013): 53,178 adults and youth\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWave 7 (2021): 46,169 adults and youth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNational Immunization Survey 2021 (NIS)\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTo monitor vaccination coverage among children, teens, and adults.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eYearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eNational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e29,142 adults ages\u003c/p\u003e\n \u003cp\u003e19 and older\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eDomain coverage across included surveys\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender Identity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender Expression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Attraction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Orientation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRomantic Attraction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRomantic Orientation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartnership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Activities/ Behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSCH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNHIS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNHANES\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n 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\u003cp\u003e\u003cstrong\u003eNIS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e* X indicates that at least one question is asked\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e** See Appendix A for list of items from each federal survey mechanism.\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7781272/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7781272/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIntroduction\u003c/span\u003e: To assess the extent to which federal survey questionnaires include items pertaining to LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences, and identify the domains covered by relevant survey items.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMethods\u003c/span\u003e: Survey questionnaires were included for review if they were federally administered, related to health, provided in English, cited at least 300 times in PubMed, and fielded at least once every five years. We reviewed the most recent iteration of questionnaires. We deductively coded each questionnaire to ascertain whether they included questions about Sex, Gender Identity, Gender Expression, Sexual Attraction/Orientation, Romantic Attraction/Orientation, Partnership, and Sexual Activities/Behaviors.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eResults\u003c/span\u003e: We identified 11 survey instruments from 2022 for inclusion in our analysis. The most prevalent domains included in surveys were Sex (n\u0026thinsp;=\u0026thinsp;9) and Partnership (n\u0026thinsp;=\u0026thinsp;9). No surveys included items about Gender Expression, Romantic Attraction, or Romantic Orientation. Other domains were inconsistently captured, including Gender Identity (n\u0026thinsp;=\u0026thinsp;6), Sexual Attraction (n\u0026thinsp;=\u0026thinsp;3), Sexual Orientation (n\u0026thinsp;=\u0026thinsp;7), and Sexual Activities/Behaviors (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConclusion\u003c/span\u003e: Federally sponsored U.S. health surveys in 2022 did not include the full range of items pertaining to LGBTQIA\u0026thinsp;+\u0026thinsp;identities and experiences. This limits the ability of researchers and policymakers to understand health experiences, outcomes, and disparities of LGBTQIA\u0026thinsp;+\u0026thinsp;peoples.\u003c/p\u003e\u003cp\u003eOut of the Closet and Into Our Data: An Analysis of LGBTQIA\u0026thinsp;+\u0026thinsp;Inclusion Questions in National Health Surveys\u003c/p\u003e","manuscriptTitle":"Out of the Closet and Into Our Data: An Analysis of LGBTQIA+ Inclusion Questions in National Health Surveys ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 19:38:12","doi":"10.21203/rs.3.rs-7781272/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1e9651d-eb9c-40f5-bbbe-8c9988e1c152","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T17:23:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 19:38:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7781272","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7781272","identity":"rs-7781272","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}