title: Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions.
abstract: OBJECTIVE
  To carry out a study using cognitive processing interview methods to explore ways in which adolescents understand sexual orientation questions currently used on epidemiologic surveys.
  
  
  METHODS
  In-depth, individual interviews were conducted to probe cognitive processes involved in answering four self-report survey questions assessing sexual identity, sexual attraction, and sex of sexual partners.A semi-structured interview guide was used to explore variation in question interpretation, information retrieval patterns and problems, item clarity, valence of reactions to items (positive, negative, neutral), respondent burden, and perceived threat associated with the measures. Thirty adolescents aged 15 to 21 of diverse sexual orientations and race/ethnicities participated in the study, including female, male, and transgender youth.
  
  
  RESULTS
  A question on sexual attraction was the most consistently understood and thus was easy for nearly all youth to answer. In contrast, a measure of sexual identity with options heterosexual, bisexual, gay/lesbian, and unsure was the most difficult to answer. Most preferred a sexual identity item that also provided the intermediate options mostly heterosexual and mostly homosexual, which many said reflected their experience of feeling between categories. Participants had varying and inconsistent interpretations of sexual behavior terms, such as sex and sexual intercourse, used in assessing the sex of sexual partners.
  
  
  CONCLUSIONS
  Differences in understanding could affect interpretation of survey data in important ways. Development of valid measures of sexual orientation will be essential to better monitor health disparities.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Children's Hospital, 300 Longwood Ave Boston, MA 02115, USA. bryn.austin@childrens.harvard.edu
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.forename: Kerith
authors.initials: K
authors.lastname: Conron
authors.forename: Aarti
authors.initials: A
authors.lastname: Patel
authors.forename: Naomi
authors.initials: N
authors.lastname: Freedner
mesh_terms: D000293:Adolescent; D000328:Adult; D001727:Bisexuality / Q000523:psychology*; D003071:Cognition; D005260:Female; D005783:Gender Identity; D006306:Health Surveys; D006716:Homosexuality / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009511:New England; D010865:Pilot Projects; D011581:Psychological Tests; D011594:Psychometrics; D036301:Qualitative Research; D012725:Sexual Behavior; D012933:Social Identification