Academic journal article Canadian Journal of Public Health

Understanding Sexual Orientation and Health in Canada: Who Are We Capturing and Who Are We Missing Using the Statistics Canada Sexual Orientation Question?

Academic journal article Canadian Journal of Public Health

Understanding Sexual Orientation and Health in Canada: Who Are We Capturing and Who Are We Missing Using the Statistics Canada Sexual Orientation Question?

Article excerpt

Many population studies have documented significant health inequalities between sexual minorities and heterosexuals, highlighting the importance of including sexual orientation questions.1-5 Statistics Canada, Canada's statistical agency, has been using a single-item sexual orientation question since 2003 for large national surveys such as the Canadian Community Health Survey (CCHS)6 and the General Social Survey (GSS);7 a similar version of this item is replicated in public health surveys such as Ontario's Rapid Risk Factor Surveillance System.8

Researchers have used data from these surveys to highlight health inequalities experienced by sexual minorities,2-5 though no published studies have critically evaluated this single measure. It is well established that one's sexual identity, behaviour and attraction do not always match one another.9 Discordance between these multiple dimensions of sexual orientation has been documented to be an important health determinant itself.10-14 While researchers have interpreted the Statistics Canada question to measure sexual identity,2-5 it is still unclear if respondents actually interpret the question in this way, given that the measure defines these categories behaviourally, e.g., "bisexual (sexual relations with both sexes)". Furthermore, it is unknown how trans and non-binary persons who may not identify as strictly male or female may understand such a question, as the concepts of "opposite sex" or "same sex" may not make sense.

Hence, the current study has two objectives: 1) to evaluate the extent to which this measure captures sexual minorities as defined by multiple dimensions of sexual orientation, and 2) to measure the agreement of the measure with other sexual orientation questions. Together, these analyses will help us better interpret findings from Canadian health studies in the context of a body of research that defines sexual orientation variably.

METHODS_

This analysis was part of a larger mixed methods study to evaluate various demographic questions (including sexual orientation) that are commonly used in population surveys of Canadians across diverse demographic characteristics. The research protocol was approved by the Research Ethics Board at The University of Western Ontario.

Author Affiliations

Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Correspondence: Christoffer Dharma, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1960 Middlesex Dr, London, ON N6G 2V4, Tel: 519-522-1155, ext. 35091, E-mail: cdharma@uwo.ca

Acknowledgements: This research was funded by the Canadian Institutes of Health Research, Institute of Gender and Health (FRN# MOP-130489). The authors thank Jessica Braimoh, Ayden Scheim and Rachel Giblon for assistance in data collection, and Caitlyn Paget and Mostafa Shokoohi for valuable comments on initial drafts of the manuscript.

Conflict of Interest: None to declare.

Recruitment and sampling

Participants were recruited through convenience sampling using Facebook ads and organizational networks in order to both maximize demographic variation and overrecruit sexual and gender minorities. Those living in Canada who were 14 years of age or above and able to complete an English language online survey were eligible to participate. Participants completed a five to ten minute survey of standard demographic questions along with three of six paired question sets (randomly assigned) on sexual orientation, sex/gender and race/ethnicity. To reduce priming effect, participants were followed up to complete the remaining three sets of questions within one to three weeks without incentives. Participants could skip any questions that they did not wish to answer.

Measures

Socio-demographic variables

Demographic variables included age, gender, trans status, ethnoracial background, education, and immigration history. …

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