New York City study: Was the frequency of the down low overreported?

The September, 2006 Annals of Internal Medicine reported that nearly 10% of heterosexual men surveyed in New York City said they also had sex with men. This study was widely reported.

Now two reports in the April 3 issue of the Annals assert that the format of the survey may have caused a dramatic overreporting of homosexual sex among heterosexual men. Here is that letter:


The article by Pathela and colleagues (1) underemphasized an apparent limitation in the data cited. Self-identified heterosexual male respondents were asked whether they had had sex with a man in the previous 12 months and then were read a definition of sex, including vaginal sex. Respondents who said “yes” were disproportionately foreign-born, had low education, and were married. They also overwhelmingly reported a single sex partner in the previous year and had a very low prevalence of risky sexual behavior. This profile suggests that many may have misunderstood the question and were reporting sex with their wives rather than “vaginal” sex with other men. Persuasive supporting evidence in the article’s Discussion section described a repeated study, as yet unpublished, 2 years later, in which asking men about sex with women before asking them about sex with men produced “a much lower self-reported prevalence of men who report sex with other men.” This marked difference in data, produced by a simple flipping of question order, deserved greater attention. Instead, the only limitation prominently reported was that random digit–dialed samples exclude households without residential telephone numbers—-a triviality in light of the effects of the question wording and question order that were much less prominently disclosed. The press release associated with the report made no mention of these effects, and subsequent press reports described the finding as far more conclusive than the relevant data suggest.

Another article in the April 3 edition provides additional caution about the earlier study. In contrast to the 9.4% reported in September, 2006, these authors estimate that just over 1% of straight-identified men have had sex with men in the past year.

The April 3 issue also allows the authors of the original study, Preeti Pathela et al, to respond to their colleagues.

7 thoughts on “New York City study: Was the frequency of the down low overreported?”

  1. David, you make some good points, especially about the dialect issue. I don’t know that “sex with a man” would be that different region to region, but perhaps it is so.

    I don’t think, however, that we can toss out the study by arguing that it’s all just language.

    I suspect that the 10% number is probably high. But so far, the evidence (little that it is) suggests that the number is significant, whatever the number is. The unpublished follow up with the questions reversed resulted in a large number of men in the category – not 10% but not 1% either.


    I don’t fault the peer research comparisons. That is certainly responsible. And it is important to show that the study appears anomolous.

    However, the letter tries to discredit and belittle Pathela’s study. Take the sentence: This profile suggests that many may have misunderstood the question and were reporting sex with their wives rather than “vaginal” sex with other men.

    There was no suggestion that anyone was having vaginal sex between men. This notion was introduced by the letter writer. Clearly they did not like the conclusions of the study but rather than provide analysis (as did the peers) they instead introduced the ludicrous and tried to imply that this was part of the study. That’s not very responsible.

    The intent of the author of the letter is not to come to the facts of the case, whatever they may be. They simply want the media to tell a different story – one which serves their goals (which we can all guess at).

    Agenda: discredit Pathela’s study.

  2. I spent some time overseas two summers ago with my family in Europe. While in Italy I was reminded by native friends that dialects there are profound and that although every native speaks Italian, Italian sounds very different in different provinces.

    I can only imagine that this may be true for other countries and that there may be difficuties in nuance and meaning and translation…even if the questioner has be trained in a specific language.

    Just some things to consider.

  3. I glanced through the paper.

    And they appear to be saying the following:

    A total of 17 476 men were interviewed, and 13 026 reported having at least 1 sexual partner in the past 12 months. The Table presents weighted results for men who reported having sex with men, women, or both men and women in the past 12 months by self-reported sexual orientation. Among the self-identified straight men, 0.4% reported having sexual intercourse with men (0.3% with men only and 0.1% with both men and women). We found little variation across regions (Los Angeles, 0.4%; San Francisco, 0.5%; San Diego, 0.2%; and Sacramento, 0.2%) or racial or ethnic groups (white, 0.4%; Latino, 0.2%; and African American, 0.3%).”

    They are concerned based upon the above research that Pathela and colleagues research is quite divergent from California data.

    That doesn’t seem to be agenda driven, so much as a reasonable observation to report and explore (time will tell).

    So the assessment is not just with San Franciscans in the paper…although an important piece of the paper is devoted to statistics and inferences drawn solely from San Francisco. And this is definately a population that is not typical of NYC.

  4. Tim,

    do you find this assessment uninteresting?

    “Respondents who said “yes” were disproportionately foreign-born, had low education, and were married.”

    The first two variables suggests some likelihood of misunderstanding, the third variable indicates access to sex.

    Easy way to find out, flip the questions and call again.

  5. …and then were read a definition of sex, including vaginal sex … This profile suggests that many may have misunderstood the question and were reporting sex with their wives rather than “vaginal” sex with other men.

    The author of this letter (whomever that may be) makes some glaring mistakes:

    1. They automatically assume that because vaginal sex was included in the definition of sex, then therefore it must have been vaginal sex that the respondants meant.

    2. They imply that because the respondants were foreign born that therefore they must not have understood the question. They conveniently omit the fact that the questioning was done in their native language.

    3. The concerns of the author of the letter had little to do with providing proper health services or with accurate social services but was fixated solely on media response.

    I smell agenda.

    Further, comparing a NYC study to a San Francisco study is truly comparing apples and oranges. SF has a population of about 750,000 and does not have the same demographic of new immigrants that NYC has. Although there are a large number of foreign-born residents, over 60% of them are from Asia. The largest non-white ethnic block in SF is Chinese – with 30% – but the Chinese community goes back many generations in the city. The immigrants who identified as straight in NYC but also as having sex with another man do not, I believe, exist in the same measure in SF.

    Further, the social structures of SF and NYC are worlds apart. A very significant percentage of SF citizens are gay (probably about 20%) and social stigma for so identifying is dissimilar to that in NYC. Literally every citizen has a gay friend, neighbor, or coworker. Even immigrant communities have long-standing and strong ties (political, social, and cultural) with the gay community there.

    While it’s nice to provide some reality check by using other cities, it’s hard to see how a comparison with San Francisco adds much to the conversation.

    Perhaps Pathela’s original report was inaccurate or overstated. That would not surprise me much. But the objections to her report in the letter are fanciful and based solely on speculation. Because the letter’s author wanted the report to be wrong they made some guesses as to why it must be so.

    And while the objections to her report from her peers do not seem to be agenda driven, they seem to be missing some obvious comparison inequalities.

    Really it isn’t Pathela that copied Cameron’s methodology. But the objections to her work…. maybe a bit.

  6. I think I commented on this study at ex-gay watch…highlighting immigrant status and double marginalization as risks to getting poor information. This study may, in fact, be poor information; but not on the level of Cameron.

    “Given the attention that Pathela and colleagues’ study received by the mass media, and the increasing public health concern surrounding the “down-low” phenomenon, it is important to keep in mind the study’s finding is inconsistent with the rates reported by others and may in fact be an artifact of the methods used in the survey. ”

    Good job keeping track of things, Warren. Bit by bit the reliable facts will assert themselves.

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