Conducting Research on the Measurement of Sexuality and Gender: Where Do We Go from Here?

Background and Purpose: Existing research illustrates systematic health disparities by sexuality, gender, and age. Yet to date it is difficult to obtain quality data to address these disparities and identify modifiable factors to improve health outcomes. Furthermore, increasing diversity and rapidly evolving sociopolitical context are changing how sexuality and gender are experienced and expressed in contemporary America and around the globe. In this paper, we will explore how historical, contemporary, and cultural contexts influence both the dimensions and measurement of sexual and gender identities. Based on the Health Equity Promotion Model, we will explore the intersectional, psychological, social/community, biological and behavioral components and measurement of both sexuality and gender.

Methods: Using longitudinal survey data from Aging with Pride: The National Health, Aging, and Sexuality/Gender Study, in this presentation we assess the measurement of multiple components of sexuality, sex and gender (e.g., sexual identity, desire, behavior, and romantic relationships as well as sex, gender identity and expression) using a national sample of LGBTQ+ midlife and older adults (N=2,450). We delineate both time invariant and time variant measures as they relate to sex, gender and sexuality and compare binary response categories to those that incorporate a continuum. We also examine the associations between dimensions of sexual and gender identity (e.g., intersectionality, centrality, valence, and transformation) and the health and well-being of LGBTQ+ midlife and older adults.

Results: Measures incorporating a continuum as opposed to binary response categories better capture the experiences of bisexuals, sexually diverse and transgender participants as compared to lesbians and gay men. Yet, even among midlife and older lesbians and gay men more than 10% report their sexual identities using a continuum as opposed to a single sexual identity category. The findings also document important differences in the congruency in sexual behavior and romantic relationship by sexuality and gender. When examining sexual and gender identity transformations over time, about 7% reported changes to their sexual identity, and 3% to their gender over 4 years. Those who reported changes to their identity over time showed a higher level of identity stigma and poorer physical and psychological health-related quality of life. Sexual and gender identity affirmation is positively associated with better health and quality of life.

Conclusions and Implications: The study of sexuality and gender is dynamic with multiple dimensions that shift over time. Our findings reveal heterogeneity and intersectionality are critical to understanding sexuality and gender, and identify important aspects of sexuality (e.g., romantic relationships) that are often not included in sexuality or gender research. Furthermore, research on identity transformation in later life is needed as well as the study of the process and implications of such transitions. The findings in this study support the integration of holistic measures of sexuality and gender in public health, social welfare, and aging-related surveys. In order to respond to the growing needs of our increasingly diverse population it is imperative that quality data be collecting using up-to-date measures. We outline important directions and next steps for future research, practices, and policies.