Suggested improvements to SOGI questions included using gradational questions of femininity and masculinity to reflect gender diversity among all individuals, or using new answer choices to recognize different communities previously categorized under the umbrella term of “transgender” (i.e., those who identify along the gender binary as either men or women versus those who identify outside of the binary such as genderqueer, genderfluid, or non-binary) (Cruz, 2014 Hart et al., 2019 Magliozzi et al., 2016). Specifically, national measurements fail to recognize key concepts for SGM communities: (1) sexual orientation (SO) and gender identity (GI) are independent aspects of identity and both can be dynamic, (2) self-conceptualization of one’s GI is not dependent on biologic sex assigned at birth and both GI and sex assigned at birth should be assessed, and (3) those who have a GI different from their sex assigned at birth are not a homogenous group that can be captured under the umbrella term of “transgender” (Hart, Saperstein, Magliozzi, & Westbrook, 2019 Lombardi & Banik, 2016 Magliozzi, Saperstein, & Westbrook, 2016 Westbrook & Saperstein, 2015). However, this is done without critically examining how existing SOGI questions normalize cisgender and heterosexual identities while marginalizing non-normative SGM identities (Galupo, Davis, Grynkiewicz, & Mitchell, 2014 Westbrook & Saperstein, 2015). Further, recent SOGI questions have primarily added new answer choices to recognize underrepresented SGM identities (e.g., adding “transgender male” and “transgender female” as answer choices).
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Testing and validation of new SOGI questions on a national level has largely focused on the perspectives of non-SGM individuals (Dahlhamer, Galinsky, Joestl, & Ward, 2013 Division of Health Interview Statistics, 2014 Miller & Ryan, 2011 Stern, Michaels, Milsei, Heim Viox, & Morrison, 2016).
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Accurately capturing SGM communities by using inclusive SOGI questions serves to validate and demarginalize their existences in society.Ĭurrent SOGI questions are not sufficiently engaging SGM people. Improved SOGI questions not only have significant implications in data collection but also in bringing visibility to under-recognized communities (Spade, 2015). Recently, increasing national attention has been paid toward improving sexual orientation and gender identity (SOGI) questions in research and clinical settings to better identify SGM individuals (Badgett, 2009 Institute of Medicine, 2011, 2013 The GenIUSS Group, 2014). SGM individuals are understudied and underrepresented in research, and accurate identification and inclusive data collection are critical to improving outcomes and reducing disparities (Cahill et al., 2014 Daniel, Butkus, & Health and Public Policy Committee of American College of Physicians, 2015 Institute of Medicine, 2011 Pérez-Stable, 2016). Sexual and gender minority (SGM) people-including members of lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities-make up approximately 4.5% of the United States population and face discrimination with worse health outcomes when compared to non-SGM populations (Ard & Makadon, 2012 Newport, 2018 The GenIUSS Group, 2014) (see Table 1 for definitions). Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities. We present recommendations for future development and use of SOGI measures.
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To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Template analysis using a priori themes guided analysis. Questions were refined and presented in semi-structured cognitive interviews. We conducted a qualitative study to answer the question, “For SGM people, what are the major limitations with current SOGI questions?” Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation.
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Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research.