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North American Quitline Consortium
Proposed Change to MDS Measure on LGBT Identity – Seeking Member Feedback by April 20

Dear NAQC Members,

NAQC is considering a change to the MDS measure on LGBT identity and would appreciate your feedback on whether the change should be made and the timeline for the change. Instructions for submitting your feedback are provided at the bottom of this bulletin.

The MDS measure on LGBT identity was developed in 2006 by five states and service providers. In 2009, the measure was revised based on new information from the LGBT Network. In late 2014, LGBT HealthLink and National Jewish Health approached NAQC about another revision to the measure. The proposed measure was presented to NAQC members for feedback, revised, and then tested in a 14 state pilot study.

CURRENT MEASURE (Developed in 2009 as an OPTIONAL MDS Intake Question):
Recommended question and scripting:

Several communities have been targeted by the tobacco industry or have higher smoking rates. We have some special materials for people in this community. So we’d like to ask you some demographic questions. Please remember that your answers are completely confidential.

“Do you consider yourself to be one or more of the following” [counselors are instructed to say both the letter and response option so that participants can respond with either]
  • Straight
  • Gay or Lesbian
  • Bisexual
  • Transgender
  • Other [pre-coded responses NOT read aloud include i. Queer, ii. Genderqueer, iii. Dyke, iv. Other]

In FY2013 and FY2015, 20% to 22% of quitline callers refused to answer the question on LGBT identity; indicating some callers may find this question uncomfortable to answer or are unsure of how to respond and therefore refuse to answer the questions.
Feedback from quitline callers shows that some callers want to respond “no”, but the question is not formatted to allow that. In addition, some older callers felt the question was asking about sex life, which it does not.
Finally, there was no adequate follow-up statement to provide to callers that questioned why LGBT identity was being asked.
Proposed Measure:
Do you consider yourself to be gay, lesbian, bisexual, and/or transgender?
  • Yes
  • No
[If No continue. If Yes, prove with the following question.]
[If callers show concern about this question, feel free to add the following sentence: “LGBT people smoke at higher rates than others; we ask this to ensure we're serving all people equally.”]
Thanks, please indicate all of the following which apply to you: [read all response options].
  • Bisexual [yes/no]
  • Gay or (for a woman) lesbian [yes/no]
  • Queer [yes/no]
  • Transgender or gender variant and assigned male at birth [yes/no]
  • Transgender or gender variant and assigned female at birth [yes/no]
The benefits of the proposed new measure allows the vocal minority to respond “no”, provides more options to gather a wider group of trans respondents, eliminates the “other” category which was not providing useful data, reduces administration burden since longer verbage only read if someone is LGBT, reduces measurement error since less understood verbage only read if someone is LGBT, has explanatory sentence to reduce respondent confusion about why the question is being asked.

The question was pilot tested from April through July 2015 with 14 state quitlines and administered during 33,000 quitline intake calls. The question had a 5% yield (meaning 5% of quitline callers identified as being LGBT), indicating it is more sensitive in allowing people to identify as LGBT.

A survey of quitline counselors asking about administration of the propose measure revealed:
  • The measure was gauged to be easier to administer by 79% of intake staff
  • Easier to answer for LGBT respondents by 74% of intake staff, and
  • Less disruptive to people uncomfortable with the topic by 74% of intake staff
NAQC proposes changing the MDS measure on LGBT identity to the version that was pilot tested in 2015 as of July 1, 2016.


NAQC requests your feedback on the adoption of the pilot tested revised measure on LGBT identity into the MDS to replace the current question on LGBT identity. Staff will compile all feedback.

NAQC asks members to please submit your feedback on the proposed change to the MDS measure on LGBT identity. In particular, we are interested in hearing your responses to the questions below:
  1. Do you agree with making the proposed change to the MDS measure on LGBT identity?
  2. Please share any concerns you have with the proposed change.
  3. Does the implementation date of July 1, 2016 seem reasonable to you?
Please submit your feedback by APRIL 20TH to Maria Rudie, NAQC Research Manager, at mrudie@naquitline.org.

A final decision regarding the MDS measure will be made by NAQC and announced via eBulletin on May 2, 2016.

Thank you!

Linda A. Bailey, JD, MHS                                                                              
President and CEO                                                                         
North American Quitline Consortium                                                   
Phoenix, AZ                                                                                      
Ph: 800.398.5489 ext. 706                                                                                                   
Email: lbailey@NAQuitline.org                                                

Maria Rudie, MPH
Research Manager
North American Quitline Consortium                                                   
Phoenix, AZ                                                                                      
Ph: 800.398.5489 ext. 704                                       
Fax: 800.398.5489                                                    
Email: mrudie@NAQuitline.org                                                               

Resources: A webinar will be held on April 6 at 2:00pm to 3:30pm to discuss these issues. If you are interested in attending, please register here.

A recording of this webinar will be available by April 8 and posted to the MDS webpage found here.
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