Blog & News
SHADAC Responds to Proposed American Community Survey (ACS) Sexual Orientation and Gender Identity (SOGI) Test Questions
December 4, 2023:
View the U.S. Census Bureau's full request for comments in the September 19th edition of the Federal Register. |
On September 19, 2023, the U.S. Census Bureau released a request for comments regarding the proposed addition of test questions regarding sexual orientation and gender identity (SOGI) for the American Community Survey (ACS). According to the notice in the Federal Register, the Census Bureau specifically hopes to test question wording, response categories, and placement within the survey itself.
Researchers at SHADAC reviewed the proposed test questions included in the Register proposal, as well as the methodology and reasoning behind the Census Bureau’s choices, and responded with comments regarding the measurement of sex and gender identity. Specifically, researchers discuss the limitations of the two-step gender identity questions, language and inclusivity concerns, and recommendations for a more streamlined and accessible two-step question format.
SHADAC’s Comments on Measuring Sex and Gender Identity
When designing survey questions, the consumer experience is paramount. Maximizing the accessibility and acceptability of question language improves data quality in multiple dimensions, including item non-response, misclassifications, and overall response rates.
In the case of measuring sex and gender identity, context matters. It is important to acknowledge how these questions might differ in various settings - when asked on a survey compared to when asked in an administrative or clinical setting, for example. We are concerned that the ACS is missing a key opportunity to update questions on sex and gender in ways that both enhance user experience and are specific to the survey setting.
The test questions for sex and gender identity as proposed use overly academic language that is better suited for a clinical setting, by asking first ‘what sex was NAME assigned at birth’ followed by ‘current gender identity.’ While such questions have utility, such as for verification of specific health insurance benefits, this approach is not optimal for a population survey such as the ACS.
Unnecessary jargon makes questions less accessible for respondents with lower literacy levels or who are non-English speaking and adds to the cognitive burden for all respondents. Survey language should minimize the respondent burden in order to support data quality and user experience. The limitations of the proposed two-step gender identity question have been described by the National Academies of Sciences, Engineering, and Medicine (NASEM).
Specific concerns worth highlighting are:
1) The proposed response options for ‘current gender’ are not inclusive of transgender experiences because these options imply that transgender is a tertiary or ‘other’ category and mutually exclusive from male or female identities. Allowing for multiple answers (one of the proposed test options) does not address this conceptual limitation.
2) Asking chronologically about ‘sex assigned at birth’ followed by ‘current gender identity’ may be perceived as invasive and/or invalidating for transgender respondents, which could increase item nonresponse for this critical population.
3) Asking a third question for verification of gender status when a respondent’s answers to ‘sex assigned at birth’ and ‘current gender’ don’t match places an undue burden on the transgender and nonbinary population. At minimum, the testing process should assess false positive rates and seek to avoid unnecessarily burdensome questioning of transgender and nonbinary people.
4) ‘Sex assigned at birth’ is not inclusive of intersex or nonbinary designations on infant birth certificates. These situations are increasingly common, and the current wording could lead to false positives for transgender, along with unnecessarily invasive questioning among individuals born with intersex traits.
SHADAC recommends that the Census consider a more streamlined two-step question approach that gathers the same information (sex assigned at birth and current gender) while providing a more inclusive and accessible experience for respondents. Specifically, we recommend asking first ‘what is your gender’ followed by ‘are you transgender.’ This approach was developed in Oregon via extensive stakeholder engagement. Similar language has also been used by administrators to update population survey questions in Minnesota.
The alternative two-step question addresses the limitations described above in the following ways:
1) Response options for ‘gender’ should include male, female, nonbinary, and a write-in response option. Asking about transgender identity in a separate question avoids portraying transgender as mutually exclusive with male or female. For respondents who need an explanation for ‘transgender,’ a hover box or an interviewer can provide a definition as follows: ‘Transgender describes a person whose gender identity differs from their sex assigned at birth.’
2) Asking simply about ‘gender’ first is clear and inclusive. Avoiding the ‘sex assigned at birth’ initial question would be less duplicative and more accessible for many respondents.
3) Asking directly about transgender identity (with ‘yes/no’ response options) prioritizes accessible language to minimize respondent burden and may eliminate the need for additional verification for transgender respondents. Ethically, the ACS should avoid asking all transgender respondents for extra verification without strong data to indicate that doing otherwise would lead to significantly elevated false positive rates.
4) Not asking about ‘sex assigned at birth’ avoids unnecessary collection of personal health data. This supports privacy for all respondents. Additionally, this approach could help reduce item nonresponse and false positives among intersex individuals as well as cisgender respondents who are unfamiliar with and/or dislike the language and concepts in the initially proposed test questions.
Thank you for your consideration. We know that the Census Bureau faces many important decisions and appreciate the chance to share our feedback on this important content test.
Publication
Disparities in Minnesota's COVID-19 Vaccination Rates
Health inequities are nothing new in the U.S., but the COVID pandemic has placed them in a new light. Numerous studies have reported disparities in how COVID-19 affects many vulnerable groups, often placing them at higher risk of infection, hospitalization, and death. And the inequitable effects of the disease itself are not the only cause for alarm. Once COVID-19 vaccines received authorization, equitable vaccination initiatives became a concern, especially as surveys indicated widespread hesitancy and lagging uptake.
Partnering with the Minnesota Electronic Health Record Consortium, SHADAC delved deep into an analysis of COVID-19 vaccination rates in Minnesota, examining not only point-in-time measures of vaccine disparities but also measuring how quickly the state reached vaccination thresholds for different subpopulations. This webinar will present findings from the study, including analysis of disparities in time-to-vaccination by race and ethnicity, age, and other demographic categories.
Attendees learned about:
- Disparities in COVID-19 vaccination rates across demographic groups
- How policymakers' vaccine prioritization approach may have contributed to health inequities
- Ideas for improved metrics for measuring time-sensitive interventions during public health emergencies
Speakers
![]() Colin Planalp, Speaker
SHADAC
Colin Planalp, MPA, senior research fellow at SHADAC and author on the analysis, will present data published in a recent brief. He will be joined by Tyler Winkelman, MD, MSc, past-President of the consortium and co-director of the Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute. Dr. Winkelman will discuss the Minnesota EHR Consortium and its unique data source, which made the study’s time-to-vaccine analysis possible.
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![]() Dr. Tyler Winkelman, Speaker
Hennepin Healthcare Research Institute
Dr. Tyler Winkelman is the Past-President of the Minnesota Electronic Health Record Consortium and co-director of the Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute. Dr. Winkelman is also the General Internal Medicine Division Chief at Hennepin Healthcare. He leads the Consortium’s COVID-19 Project, a statewide collaboration with the Minnesota Department of Health to track COVID-19 prevalence, testing, and vaccination among racial and ethnic groups, as well as people experiencing homelessness and/or incarceration.
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Related Resources
- Webinar slides from SHADAC
- Disparities in Minnesota's COVID-19 Vaccination Rates (Brief)
- Full Transcript