**4.1 Limitations**

First, as CHIS is a continuous cross-sectional study, our findings suggest a trend in the populace rather than a change in a discrete set of Californians. Second is that legal partnerships and legal marriage did not convey identical rights and privileges between 2005 and 2008, a period that included concurrent, limited periods of cityand county-based same-sex marriages in California. Moreover, litigation precluded issuance of marriage licenses to same-sex couples between November 2008 and June 2013. Disparate results among legally-partnered, married, and other gay male and lesbian Californians perhaps reflect that uncertainty. Third, we were unable to report results separately by legal same-sex marriage and partnership between 2013 and 2015 though our results nonetheless appear to correspond with the historical events related to this issue during the period. Fourth is the need to exclude bisexually-identified Californians because the survey's order and skip pattern complicate notions of selfidentification and self-report of sexual behavior. For example, a bisexually-identified respondent who reported no sex with a same-sex partner in the last 12 months would not have been asked the question of same-sex legal partnership/marriage. Additionally, the partner's sex/gender and sexual orientation were not reported.

Behavioral and Social Sciences Research (OBSSR), the NIH Office of Research on Women's Health (ORWH), and the National Cancer Institute (NCI) provided financial support for the design and implementation of previous iterations of CHIS. OBSSR and NCI supported access to the dataset created and analyzed for this

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples*

This article represents only the authors' views and perspectives, not the

, Benmei Liu<sup>3</sup>

1 Office of Behavioral and Social Sciences Research, National Institutes of Health,

2 College of Public Health and Human Sciences, Oregon State University, Corvallis,

3 Statistical Research and Applications Branch, National Cancer Institute, National

5 National Institute on Minority Health and Health Disparities, National Institutes

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

4 Information Management Services, Inc., Rockville, MD, United States

, Richard Lee<sup>4</sup>

positions of the National Institutes of Health or the U.S. Government.

\*, Veronica L. Irvin<sup>2</sup>

Institutes of Health, Bethesda, MD, United States

\*Address all correspondence to: william.elwood@nih.gov

of Health, Bethesda, MD, United States

provided the original work is properly cited.

project.

**Disclaimer**

**Author details**

William N. Elwood<sup>1</sup>

Bethesda, MD, United States

and Nancy Breen<sup>5</sup>

OR, United States

**87**

**Author Disclosure Statement**

*DOI: http://dx.doi.org/10.5772/intechopen.90249*

No competing financial interests exist.

This fourth limitation demonstrates that a respondent's reported sexual identity is not necessarily equivalent to that respondent's sexual behavior or to the sex/ gender of that individual's spouse—particularly in our era of increasingly fluid sexual and gender identities [37–39] and growing researcher attention to the intersectionality framework to integrate the complexity of individual lived experiences within efforts to improve care and research in health and well-being [40–42]. For a more comprehensive understanding of the influences of sexual identity, gender identity, and marital status on human health and well-being, survey questions may elicit not only the sex/gender identity of a respondent but also of the respondent's spouse, for example, to help determine the influence of same- or opposite-sex marriage on the health of bisexual or transgender people.

Researchers adapting CHIS to account more precisely for same-sex marriage influences could follow the current question on "now married, living with a partner in a marriage-like relationship, widowed, divorced, separated, or never married" [43] by asking whether the spouse/partner referenced in the previous question is the same or opposite sex as the respondent.

There are thorough conversations across and outside the academy that will lead to comprehensive revisions of survey methodologies to measure the identity and behavior of respondents and their respective spouses. In the interim, the California Health Interview Survey (CHIS) provides a best practice on how to design and adapt questions to collect data that can explain the influence of legal marriage and partnerships on health and well-being, including sex/gender and sexual orientation identities [1]. Research and surveillance methodologies occasionally must respond quickly to provide data-driven public health recommendations. This study demonstrates CHIS's ability to explore the health impact of marriage for same-sex couples, and a need for survey questions to elicit information about marital status and the sex/gender of a respondent's spouse inclusive of sexual identities. Such collection is critical for data-driven health recommendations as sexual and gender identities become increasingly fluid and nuanced.

## **Acknowledgements**

The UCLA Center for Health Policy Research conducts the California Health Interview Survey (CHIS). The National Institutes of Health (NIH) Office of

*Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples DOI: http://dx.doi.org/10.5772/intechopen.90249*

Behavioral and Social Sciences Research (OBSSR), the NIH Office of Research on Women's Health (ORWH), and the National Cancer Institute (NCI) provided financial support for the design and implementation of previous iterations of CHIS. OBSSR and NCI supported access to the dataset created and analyzed for this project.
