Among the rare studies that report sexual orientation, most only report a single dimension, which is commonly sexual identity ( Flentje et al., 2015). Challenges to measuring and reporting sexual orientation in research studies include the multidimensionality of the construct of sexual orientation (Sell, 1997), consisting of, at minimum, identity and behavior, and up to seven dimensions ( Klein, Sepekoff, & Wolf, 1985), along with the potential for discordance among these dimensions. While large health research data collection efforts have begun to incorporate measures of sexual orientation ( Baker & Hughes, 2016), very few research studies report or account for participant sexual orientation ( Flentje et al., 2015 Heck et al., 2017). However, the measurement and reporting of sexual orientation in health research studies continues to be neglected ( Flentje, Bacca, & Cochran, 2015 Heck, Mirabito, LeMaire, Livingston, & Flentje, 2017). The Institute of Medicine (2011) has recognized that the measurement of sexual orientation is critical to understanding health.
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Sexual minority individuals (i.e., individuals who are not heterosexual with respect to identity, behavior, or some other component of sexual orientation) are at greater risk for a variety of poor health outcomes including substance use ( McCabe, Hughes, Bostwick, West, & Boyd, 2009), mental health problems ( King et al., 2008), and physical health problems ( Lick, Durso, & Johnson, 2013) and factors that influence health such as homelessness ( Corliss, Goodenow, Nichols, & Austin, 2011) and trauma ( Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). This study found that sexual fluidity is common in unstably housed women, and many sexual minority women would be missed in longitudinal studies with different methods of accounting for sexual orientation.
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Only 24.0%( n=72) were identified through a single measure of sexual identity, 27.0% ( n=81) were identified with a single measure of identity and behavior, 33.0% ( n=99) were identified through annual measures of identity and behavior, and 22.0–22.3% ( n=66–67) were identified through latent class analysis including all identity/behavior measures. Altogether, 39.7%( n=119) could be considered sexual minority at one or more time points based on identity and/or behavior 16.3%( n=49) reported shifts in sexual identity.
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This study examined different methods of accounting for sexual orientation in a cohort study of 300 homeless and unstably-housed women followed every 6 months over 3 years. Sexual orientation has been linked to certain health conditions, yet quantifying sexual orientation in longitudinal studies is challenging.