Participants’ reactions to the inclusion of sexual orientation and gender identity measures in an established large-scale cohort: the California Teachers Study

Sexual and gender minority (SGM) populations are more likely than non-SGM populations to experience poor health outcomes but are underrepresented in research. The California Teachers Study (CTS) is a large prospective observational cohort that, in its 2017-2019 survey, included sexual orientation and gender identity (SOGI) measures and also asked participants to provide feedback on the questionnaire. We conducted an inductive content analysis of participants' feedback responses and used these qualitative codes to a) identify which participants commented on SOGI and b) establish whether these participants had a positive, negative, or ambiguous reaction to the measures. We used Chi-square tests and multivariable logistic regression to evaluate whether demographic factors were associated with reaction type. A total of 373(2%) of 19,496 respondents commented on the SOGI questions. Of these, 41% had negative reactions, 35% had ambiguous reactions, and 25% had positive reactions. Younger age (<65 years) was positively associated with positive reaction (OR=2.30; 95%CI, 1.23-4.32). Non-white participants had lower adjusted odds of having a negative reaction to the SOGI measures compared to white participants (OR=0.38; 95%CI, 0.17-0.87). In this large established study of older adults, feedback on SOGI measures was rare but differed in frequency and content by participants' demographics.