Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys

Elizabeth M. Saewyc, Greta R. Bauer, Carol L. Skay, Linda H. Bearinger, Michael D. Resnick, Elizabeth Reis, Aileen Murphy

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225 Scopus citations


To examine the performance of various items measuring sexual orientation within 8 school-based adolescent health surveys in the United States and Canada from 1986 through 1999. Analyses examined nonresponse and unsure responses to sexual orientation items compared with other survey items, demographic differences in responses, tests for response set bias, and congruence of responses to multiple orientation items; analytical methods included frequencies, contingency tables with Chi-square, and ANOVA with least significant differences (LSD)post hoc tests; all analyses were conducted separately by gender. In all surveys, nonresponse rates for orientation questions were similar to other sexual questions, but not higher; younger students, immigrants, and students with learning disabilities were more likely to skip items or select "unsure." Sexual behavior items had the lowest nonresponse, but fewer than half of all students reported sexual behavior, limiting its usefulness for indicating orientation. Item placement in the survey, wording, and response set bias all appeared to influence nonresponse and unsure rates. Specific recommendations include standardizing wording across future surveys, and pilot testing items with diverse ages and ethnic groups of teens before use. All three dimensions of orientation should be assessed where possible; when limited to single items, sexual attraction may be the best choice. Specific wording suggestions are offered for future surveys.

Original languageEnglish (US)
Pages (from-to)345.e1-345.e15
JournalJournal of Adolescent Health
Issue number4
StatePublished - Oct 2004

Bibliographical note

Funding Information:
This study was funded by grant R01 MH6258601 from the National Institute of Mental Health, National Institutes of Health (Saewyc, PI). In addition, during preparation of the manuscript, three authors were supported in part by a nursing training grant, T80MC00021 (Center for Adolescent Nursing; Director: Bearinger) from the Maternal and Child Health Bureau (Title V, Social Security Act) Human Resources and Services Administration, Department of Health and Human Services. Greta Bauer is now with the Department of Health Management and Policy, University of New Hampshire, Durham. We thank the principal investigators and research teams who conducted the original eight surveys, and acknowledge their generosity in making these surveys available for this study: Robert W. Blum, M.D., of the University of Minnesota, for the Minnesota Adolescent Health Survey; Michael D. Resnick, Ph.D., of the University of Minnesota, for the National American Indian Adolescent Health Survey; the Minnesota Division of Child & Family Learning (now the Minnesota Department of Education), for the 1992 and 1998 Minnesota Student Surveys; Pamela Hillard of the Seattle Independent School District, Seattle, WA, for the 1995 and 1999 Seattle Adolescent Health Surveys; and Roger Tonkin, M.D., and Aileen Murphy, M.A., of the McCreary Centre Society, Burnaby, British Columbia, Canada, for the 1992 and 1998 British Columbia Adolescent Health Surveys.


  • Adolescent
  • Bisexuality
  • Health surveys
  • Homosexuality
  • Sexual orientation


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