摘要：We examined refusal rates for sensitive demographic questions to determine whether questions on sexual orientation are too sensitive for routine use on public health surveys. We compared the percentage of active refusals in New Mexico for a sexual orientation question and 6 other sensitive demographic questions. In 2007 and 2008, refusal rates for sexual orientation questions were similar to rates for questions on race/ethnicity and weight and significantly lower than rates for questions on household income. Perceptions that sexual orientation is too controversial a topic to be included on state surveys may be unfounded. Lesbian, gay, bisexual, and transgender (LGBT) populations have clear disparities in cigarette smoking, 1 , 2 suicidal ideation, 3 violent victimization, 4 – 6 and sexually transmitted infections 7 compared with the general population. Yet demographic questions about sexual orientation (i.e., questions about identity, attraction, or behavior), in addition to those on gender identity, are often not included in routine health surveys. 8 – 11 The Behavioral Risk Factor Surveillance System (BRFSS) survey, Adult Tobacco Survey (ATS), Youth Risk Behavior Survey, and Youth Tobacco Survey make up the backbone of state health surveillance in the United States, providing benchmarks, informing interventions, and allowing for comparisons between states. In 1998, the Centers for Disease Control and Prevention (CDC) chose not to include a question on sexual orientation in the Youth Risk Behavior Survey, leaving the decision to individual states, 12 which collaboratively administer a core survey and state-added modules. This decision has remained in place and covers, in practice, other CDC-run, state-administered surveys such as the BRFSS, ATS, and Youth Tobacco Survey. Over the subsequent 12 years, approximately 13 states have collected information on sexual orientation in the BRFSS 13 ; California does so by using the separate California Health Interview Survey ( http://www.chis.ucla.edu ). Even fewer states collect such data on other statewide surveys. 14 No research has examined why states do not include such questions on their surveys. Several possible explanations exist; public health practitioners may (1) feel that the evidence of health disparities is not enough to warrant inclusion of such questions in state surveys, (2) perceive a lack of expertise and capacity to develop and include questions on sexual orientation and gender identity, or (3) believe sexual orientation questions will yield a high nonresponse rate or cause early survey termination because of respondents' discomfort with the topic. A fourth possibility is that decisionmakers may not support inclusion of such questions because of political or personal biases. Strong evidence and resources are available to address the first 9 and second concerns; technical assistance is available to enhance capacity and cultural competency through the National LGBT Tobacco Control Network ( http://www.lgbttobacco.org ), and the University of California, Los Angeles's (UCLA's) Williams Institute recently released a best-practices guide to asking questions on sexual orientation. 15 We address the third concern—the belief that sexual orientation questions may be too sensitive for use in public surveys—by using New Mexico's experience in including such questions in 2 statewide population-based surveys. Addressing the last concern, regarding political and personal bias, is outside the scope of this report. Early research on sexual orientation questions and refusal rates came from surveys of women and health care professionals 16 – 18 and, recently, from surveys in the Pacific Northwest 19 and Massachusetts. 20 Using 2003 Oregon and Washington BRFSS data, Dilley et al. reported that 3% of those surveyed reported “do not know” or refused to answer sexual orientation questions. 21 Dilley et al. reported refusal rates as low as 1.2% to 1.6% in combined 2003–2006 Washington State BRFSS data. 19 In combined 2001–2006 Massachusetts BRFSS data, 3.6% of respondents refused to answer questions on sexual orientation. 22 We identified no published research that reported refusal rates for sexual orientation questions by year that showed possible trends or compared refusal rates for sexual orientation questions with refusal rates for other sensitive questions. Although survey researchers have established that inquiries about household income are one of the most sensitive—and therefore most often refused—questions, 23 little research has directly addressed concerns that sexual orientation questions may be too sensitive for the public in states outside of the Pacific Northwest and New England. We examined the sensitivity of questions on sexual orientation and other demographic characteristics by using results from New Mexico health surveys between 2003 and 2008.
