Meeting the methodological challenges of LGBT population health research

bricolage, noun
Etymology: French, from bricoler to putter about
: construction (as of a sculpture or a structure of ideas) achieved by using whatever comes to hand
(Source: Merriam-Webster.com)

Over the past several decades, LGBT health researchers have acted as bricoleurs, combining and adapting a variety of scientific methods and theoretical perspectives to learn about the health of sexual and gender minority people and communities.  They have been creative, appropriating and modifying traditional scientific techniques and theories not originally designed with the uniqueness of LGBT communities in mind.  They have been resourceful, working to pull together limited funds for projects to help us better understand and improve LGBT health.  They have been determined, overcoming political challenges to fight for recognition of the importance and value of research in LGBT health. 

LGBT health researchers have also been remarkably successful.  Their work over the past several decades has built an evidence base that documents the existence of LGBT health disparities and highlights the unique health needs of LGBT people and communities. 

Methodological challenges in LGBT health research remain.  LGBT people are a relatively small and sometimes hidden or hard-to-reach segment of the overall population.  While scientists have had great successes in working with LGBT communities and in recruiting LGBT people for research studies, they face the challenge of assessing the “representativeness” of their research samples.  Representativeness refers to the degree to which the people who are recruited and selected to be included in a study resemble the broader population as a whole. 

Traditional demographic science has a methodological solution to the question of representativeness: the large scale probability survey.  In large scale probability surveys, researchers select a large sample of the population to be included in the research study.  Researchers select the sample carefully so that they are able to estimate the chance that any one member of the population will be included in the study.  Using statistics and probability theory, researchers are then able to make claims about the representativeness of the sample.  In the simplest probability survey, every member of the population has an equal chance of selection (a random sample). With a large enough sample size, the sample characteristics can thus be expected to represent the population as a whole.

But because LGBT people make up a relatively small proportion of the population as a whole, large-scale probability surveys of the population are not a great way to study LGBT people.  Even large surveys of the population as a whole will yield small sample sizes of LGBT people and even smaller sample sizes of subgroups of interest, such as LGBT people of color.  Further complicating matters, many of the existing large scale federal health surveys don’t ask about sexual orientation, making the use of large scale probability surveys for the study of LGBT health even more difficult.

LGBT health researchers—those creative, resourceful, determined bricoleurs—have not been stymied by these methodological challenges.  They meet these challenges by working with a host of alternative methodological strategies to account for representativeness in their samples.  Some of these alternative methodological strategies include: using the Census data that measures same-sex partner households; community and venue-based sampling; social network sampling; innovative internet-based sampling; random-digit dial sampling in high density LGBT neighborhoods; community based participatory research; and pooling data from across several probability surveys to create larger sample sizes of LGBT people.

At the Center for Population Research in LGBT Health, we support the work of researchers as they make use of these alternative methodological strategies in concert with the more traditional use of large scale probability surveys.   Most recently, the Center has been working with researchers to explore how to expand secondary analyses of existing large-scale probability surveys that include sexual orientation measures.  For example, the Center’s LGBTQ Youth Working Group has been heading up the YRBS Pooling Project to merge data from several state and local-level probability surveys into a pooled data set.  The pool will contain sufficient sample sizes to allow for comparison of health outcomes for sexual minority and heterosexual adolescents. 

The YRBS Pooling Project combines data from the Youth Risk Behavior Surveys (YRBS).  YRBS are conducted every two years by state, territorial, and local education and health agencies in conjunction with Center for Disease Control (CDC).  These probability surveys are representative of public high school students for the jurisdiction in which they are conducted.  The surveys cover six categories of health-risk behaviors: behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity. 

The YRBS are of particular interest to LGBT health researchers who study adolescents.   While the CDC’s core questionnaire does not contain any measures related to sexual orientation, states and districts have the option of adding additional questions to the CDC core questionnaire.  Several states and districts add sexual orientation measures among their additional questions.  LGBT health researchers have analyzed state and district-level YRBS data in a number of these states and districts.  They have uncovered patterns of health disparities for sexual minority adolescents.  However, the power of these previous analyses of YRBS state and district level data has been limited by the small sample sizes of sexual minority youth in any one state or district. 

The YRBS Pooling Project will address the challenge of small sample sizes by merging the data from several states and districts to create a larger pooled sample of sexual minority youth.  The eventual pool will contain data from survey years 2005 and 2007 in fourteen states and districts that included one or more sexual orientation measures in their version of the YRBS questionnaire.  The pooled data set will be made available to Center researchers for collaborative analysis.

This project is an exciting one for the Center.  We expect it will allow LGBT health researchers to make use of the YRBS probability surveys for analysis of LGBTQ youth in a new way.  We hope the project will spur new research collaborations and projects and that analysis of this new data set will further build the growing evidence base in LGBT health.  We plan to use what we learn from the YRBS pooling project experience to explore pooled analyses of other probability surveys, including the CDC’s Behavioral Risk Factor Surveillance System (BRFSS).  BRFSS is very similar to YRBS, but surveys adults. 

For more information about YRBS: www.cdc.gov/HealthyYouth/yrbs/index.htm

For more information about BRFSS:
www.cdc.gov/BRFSS/