Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question?

Dharma, Christoffer; Bauer, Greta R.

doi:10.17269/cjph.108.5848

Cited by 27LGBTQ Health, Identity, and PolicyGender and Feminist StudiesHIV/AIDS Research and Interventions

Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question?

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Dharma, Christoffer, Bauer, Greta R.·2017·Canadian Journal of Public Health

DOI 10.17269/cjph.108.5848PMC PMC6972415

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Abstract

Objective Public health research on inequalities in Canada depends heavily on population data sets such as the Canadian Community Health Survey. While sexual orientation has three dimensions - identity, behaviour and attraction - Statistics Canada and public health agencies assess sexual orientation with a single questionnaire item on identity, defined behaviourally. This study aims to evaluate this item, to allow for clearer interpretation of sexual orientation frequencies and inequalities. Methods Through an online convenience sampling of Canadians ≥14 years of age, participants (n = 311) completed the Statistics Canada question and a second set of sexual orientation questions. Results The single-item question had an 85.8% sensitivity in capturing sexual minorities, broadly defined by their sexual identity, lifetime behaviour and attraction. Kappa statistic for agreement between the single item and sexual identity was 0.89; with past year, lifetime behaviour and attraction were 0.39, 0.48 and 0.57 respectively. The item captured 99.3% of those with a sexual minority identity, 84.2% of those with any lifetime same-sex partners, 98.4% with a past-year same-sex partner, and 97.8% who indicated at least equal attraction to same-sex persons. Conclusion Findings from Statistics Canada surveys can be best interpreted as applying to those who identify as sexual minorities. Analyses using this measure will underidentify those with same-sex partners or attractions who do not identify as a sexual minority, and should be interpreted accordingly. To understand patterns of sexual minority health in Canada, there is a need to incorporate other dimensions of sexual orientation.

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Dharma and Bauer (2017) estimated that 16% of individuals who had ever engaged in same-sex sexual behaviour would be classified as heterosexual by Statistics Canada's single-item sexual identity question.
“Dharma and Bauer (2017) estimated that 16% of individuals who had ever engaged in same-sex sexual behaviour would be classified as heterosexual by Statistics Canada’s single-item sexual identity question.”
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The social organization of sexuality: sexual practices in the United States
(1995) · Choice Reviews Online · doi:10.5860/choice.32-4802a · Cited by 2,888 · see citing works
Laumann (E.O), Gagnon (J.H), Michael (R.T), Michaels (S) — The Social Organization of Sexuality. Sexual Practices in the United States; Michael (R.), Gagnon (J.), Laumann (E.), Kolata (G.) — Sex in America. A Definitive Survey
Giami, A., Laumann, E. O., Gagnon, J. H., Michael, R. T., Michaels, S., Michael, R. T., Laumann, E. O., & Kolata, G. B. (1997) · Population · doi:10.2307/1534637 · Cited by 1,563 · see citing works
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Authors: Dharma, C., & Bauer, G. R.
Affiliations: Western University (CA)
Corresponding author: Dharma, Christoffer
ORCID: Dharma, Christoffer
Bauer, Greta R.
Venue: Canadian Journal of Public Health
Publisher: Springer Science and Business Media LLC
Published: 2017-01
Volume: 108
Issue: 1
Pages: e21-e26
ISSN: 0008-4263 (ISSN-L)
1920-7476
DOI: 10.17269/cjph.108.5848
PMC: PMC6972415
OpenAlex: W2605393996
Cited by: 25
References: 21
Citations by year: 2026: 1 · 2025: 3 · 2024: 1 · 2023: 9 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 1
FWCI: 2.95
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Canadian Journal of Public Health (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research (130489, 130489_1)
Institute of Gender and Health (MOP-130489)
Topics: Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Social Sciences › Gender Studies › Gender and Feminist Studies
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords: sexual orientation, sexual minority health, sexual identity, sexual behavior, sexual attraction, same-sex couples, measurement sensitivity, underidentification, health disparities, Canadian Community Health Survey
MeSH terms: Adolescent, Adult, Aged, Canada, Female, Health Surveys, Humans, Male, Middle Aged, Sexual Behavior, Reproducibility of Results, Health Status Disparities, Young Adult

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Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question?

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