GOOD AFTERNOON AND WELCOME TO THE JUNE INSTALLMENT OF THE NIH HEALTH DISPARITIES SEMINAR SERIES. I AM DR. JOYCE HUNTER AND I AM THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES. NIMHD SPONSORS THE MONTHLY SEMINARS IN AN ATTEMPT TO DISSEMINATE INFORMATION ON ADVANCES, GAPS, AND CURRENT ISSUES RELATED TO HEALTH DISPARITIES RESEARCH. IT FEATURES NATIONAL AND INTERNATIONAL SPEAKERS, MANY OF WHOM ARE SUPPORTED BY THE NIMHD AND THE NIHIC. EACH SEMINAR GENERALLY FOCUSES ON A SPECIFIC THING. AT THIS TIME I WOULD LIKE TO INVITE DR. JOHN RUFFIN, THE DIRECTOR OF THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES TO BRING IN SOME OPENING REMARKS, THANK YOU. DR. JOHN RUFFIN: THANK YOU, DR. HUNTER. ACTUALLY RATHER THAN OPENING REMARKS I'M GOING TO--I HAVE THE PLEASURE OF INTRODUCING OUR SPEAKER FOR TODAY. AND WE'RE VERY PLEASED TO HAVE HER WITH US AS WE SEEK TO BETTER UNDERSTAND HEALTH DISPARITIES, IN TERMS OF THE UNDERLYING CAUSES, AND SEARCH FOR SOLUTIONS. IT'S ALSO IMPORTANT FOR US TO EXAMINE AND UNDERSTAND THE HEALTH OF DIFFERENT POPULATIONS IN COMMEMORATION OF LESBIAN, GAY, BISEXUAL AND TRANSGENDER LGBT PRIDE MONTH. DURING TODAY'S SEMINAR WE WILL LOOK AT THE HEALTH OF THE LGBT POPULATION. LGBT INDIVIDUALS ARE EXTREMELY DIVERSE, WITH RESPECT TO SEXUAL ORIENTATION, WITH RESPECT TO RACE AND ETHNICITY, WITH THE RESPECT TO SOCIOECONOMIC STATUS AND HISTORICAL EXPERIENCES. DATA ON THE HEALTH OF THE LGBT POPULATION IS SPARSE. AND WHAT WE KNOW IS THAT MORE RESEARCH IS NEEDED TO ENHANCE OUR UNDERSTANDING OF THE HEALTH OF THIS POPULATION. TO GIVE US SOME INSIGHT INTO THE STATE OF AFFAIRS ON THE HEALTH STATUS OF THE LGBT POPULATION, IN MARCH THE INSTITUTE OF MEDICINE, ISSUED A REPORT ENTITLED "THE HEALTH OF LESBIAN, GAY, BISEXUAL AND TRANSGENDER PEOPLE, BUILDING A FOUNDATION FOR BETTER UNDERSTANDING." THE REPORT WAS REQUESTED BY THE NIH IN RECOGNITION OF THE NEED OF A NATIONAL RESEARCH AGENDA ADDRESSING THE HEALTH NEEDS OF LGBT POPULATION. AND ITS AUTHORS, THE AUTHORS OF THAT REPORT, WERE EXPERTS IN MENTAL HEALTH, BIOSTATISTICS, CLINICAL MEDICINE, ADOLESCENT HEALTH AND MANY OTHER AREAS. THEY CAREFULLY REVIEWED THE STATE OF KNOWLEDGE, IDENTIFIED PRIORITIES, AND MADE A SET OF RESEARCH RECOMMENDATIONS FOR THE NATION. DR. JUDITH BRADFORD, OUR SPEAKER TODAY, SERVED ON THE STUDY COMMITTEE, AND WE'RE EAGER TO HEAR ABOUT THE FINDINGS IN THE REPORT AND FOR HER TO SHARE WITH US HER LONG AND VARIED EXPERIENCES IN WORKING TO IMPROVE THE HEALTH OF LGBT INDIVIDUALS. DR. BRADFORD CO CHAIRS THE FENWAY INSTITUTE, A NATIONAL INTERDISCIPLINARY CENTER DEDICATED TO INSURING CULTURAL COMPETENCE AND HEALTHCARE FOR THE LGBT COMMUNITY. THE INSTITUTE, WHICH IS CURRENTLY FUNDED AS A POPULATION RESEARCH CENTER ON LGBT HEALTH BY THE EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE ON CHILD HEALTH AND HUMAN DEVELOPMENT IS PART OF FENWAY COMMUNITY HEALTH, A COMMUNITY BASED ORGANIZATION BASED IN BOSTON INVOLVED IN THE FIGHT AGAINST HIV AIDS. DR. BRADFORD WAS ALSO A FOUNDING MEMBER OF THE NATIONAL COALITION FOR LGBT HEALTH AND IN 2009 SHE SERVED AS CO CHAIR OF THE LESBIAN, BISEXUAL, TRANSGENDER AND INTERSEX WORKING GROUP FOR THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. HER RESEARCH HAS FOCUSED ON ISSUES SUCH AS SURVEY RESEARCH, PROGRAMMING EVALUATION, RESEARCH METHOD FOR HARD-TO-REACH POPULATIONS, HIV/AIDS PREVENTION, LESBIAN AND TRANSGENDER HEALTH, AND ACCESS TO CARE. THE TITLE OF OUR PRESENTATION TODAY IS "ACHIEVING HEALTH EQUITY FOR SEXUAL AND GENDER MINORITIES." PLEASE HELP ME IN WELCOMING DR. BRADFORD. [APPLAUSE] DR. JUDITH BRADFORD: THANK YOU ALL VERY MUCH FOR COMING. THIS IS SUCH AN IMPORTANT TOPIC TO ME AND TO MANY MORE PEOPLE THAN OUR, THAN I, THAN YOU KNOW AND THAT I KNOW. THE NUMBERS ARE GROWING STEADILY THAT IT'S JUST A WONDERFUL OPPORTUNITY ALWAYS TO BE ABLE TO TALK TO PEOPLE ABOUT WHAT THE NEEDS ARE AND WHAT PROGRESS WE'RE MAKING TOWARDS ADDRESSING THOSE NEEDS. SO I'M VERY, VERY HAPPY THAT YOU CAME, THANK YOU. BASICALLY IT ALL BEGAN WITH ED LOWMAN AND NORK. AND "IT ALL" MEANING WHAT DO WE KNOW ABOUT THESE PEOPLE, WHO ARE LGBT PEOPLE, HOW MANY OF US ARE THERE AND HOW DO WE THINK ABOUT COUNTING THEM OR FINDING THEM. SO THE NORK SEX STUDY AS IT'S BEEN REFERRED TO IN THE EARLY 90S, WAS A NATIONAL PROBABILITY STUDY THAT'S WHOLE BASED THAT INCLUDED QUESTIONS AROUND SEXUAL ORIENTATION AND FOR THE FIRST TIME WE HAD A NATIONAL PROBABILITY STUDY. THIS WAS, THIS WAS THEIR PLUSES AND MINUSES TO THIS STUDY, QUESTIONS AROUND PEOPLE WHO DIDN'T RESPOND AND JUST THE USUAL SORT OF CHALLENGES THAT CAN BE MADE TO ANY SURVEY STUDY, BUT THE KEY THING ABOUT THIS AND THE REASON I SAY IT ALL BEGAN WITH ED LOWMAN AND NOERK IS THAT WE UNDERSTOOD OR WE STARTED TO THINK THAT SEXUAL ORIENTATION HAD DIFFERENT CONCEPTS WITHIN IT, THAT IT'S NOT ALL JUST ONE THING, THAT WE'RE NOT ALL ALIKE. IT WAS THE BEGINNING OF THE UNDERSTANDING OF DIVERSITY WITHIN OUR POPULATIONS. AND THIS IS A PART OF A TABLE FROM THAT REPORT THAT I THINK HAS ALSO ALWAYS HELPED ME UNDERSTAND THINGS AND PROVIDE GUIDANCE. THERE'S THE TABLE ITSELF, TABLE 8.2, IT GOES INTO MORE DETAIL, BUT WHAT THIS SAYS WHEN YOU LOOK AT IT IS THAT THERE ARE DIFFERENT RATES OF REPORTING ONESELF ACROSS IDENTITY, DESIRE, ATTRACTION AND SAME SEX BEHAVIOR. AND AS YOU CAN SEE THE SMALLEST YOU PROPORTION ACROSS THE BOARD IS YOU THE IDENTITY VARIABLE. SO THERE ARE MANY PEOPLE WHO DO NOT IDENTIFY SPECIFICALLY AS LGB, TRANSGENDER, WERE NOT MEASURED IN THIS STUDY, WHO DO NOT TAKE ON THAT LABEL, AND THIS IS VERY CRITICAL FOR OUR RECOGNIZING THAT THE PROCESS OF DATA COLLECTION IN LGB HEALTH--AND I'LL SAY MORE ABOUT TRANSGENDER--IS COMPLICATED. WHEN YOU LOOK AT DATA, IT'S VERY IMPORTANT TO SEE WHAT MEASURES ARE THAT HAVE BEEN ASKED AND TO BE ASKED AND TO THINK ABOUT THIS YOU KNOW INITIAL TABLE THAT SHOWS YOU ALSO THAT PEOPLE WHO IDENTIFY MAY BE DIFFERENT BASED ON THEIR RACE ETHNICITY VERY DIFFERENT [ACCORDING] TO WHERE THEY LIVE, YOU CAN SEE--ACCORDING TO THESE DATA--MUCH MORE LIKELY FOR A PERSON TO IDENTIFY AS A SEXUAL MINORITY IF THAT PERSON IS LIVING IN A BIG CITY. THESE THINGS ARE VERY IMPORTANT TO UNDERSTANDING THE CHALLENGES OF RESEARCH WITH THIS POPULATION. SO WHO DO WE COUNT? I HAVE SOME SLIDES HERE THAT WERE GIVEN TO ME OR SHARED WITH ME BY MY GOOD FRIEND AND COLLEAGUE GARY GATES AT THE WILLIAMS INSTITUTE, SO THAT'S WHY I HAVE LITTLE TEXT BOXES THERE. BUT THIS MAKES A POINT HERE THAT HOW YOU ASK THE QUESTIONS VARIES FROM ONE STUDY TO ANOTHER. SO IF YOU LOOK IN THE MIDDLE AT THE HIGH LEVEL NATIONAL SURVEY OF SEXUAL HEALTH AND BEHAVIOR 2009 AND THE UNITED STATES STUDY, YOU SEE A TOTAL OF 5.6 % OF PEOPLE WHO IDENTIFIED AS GAY OR LESBIAN OR BISEXUAL. THE PERCENTAGES VARY ON IDENTITY DEPENDING ON THE STUDY AND WHEN IT WAS CONDUCTED AND THIS IS ONE OF THE NATIONAL CHALLENGES WE HAVE IN AN ONGOING DEBATE. HOW MANY PEOPLE ARE THERE? HOW MANY OF YOU ARE THERE? AND IT SORT OF DEPENDS ON HOW IT'S COUNTED. THE VARIATION ISN'T SO HUGE THAT YOU CAN'T GET BEYOND IT, BUT IT IS A CHALLENGE THAT IS IMPORTANT TO US AS WE'RE MOVING TOWARDS INCLUDING OUR ADVOCATING FOR THE INCLUSION OF SEXUAL ORIENTATION AND GENDER IDENTITY MEASURES IN FEDERAL STUDIES PARTICULAR IN CURRENT STUDIES. GETTING THE MEASURES RIGHT IS CRITICAL, IT'S NOT AS SIMPLE IF THEY ALL SAY 5.6 PERCENT IT WOULD ALL BE EASIER. SO WHO DO WE COUNT IF WE MEASURE ATTRACTION OR BEHAVIOR? WELL, AGAIN THIS VARIES ON THE BASIS OF THE STUDY WHERE IT WAS ASKED AND WHETHER IT'S ATTRACTION OR BEHAVIOR THAT YOU'RE LOOKING AT. SO IN THE NATIONAL SURVEY OF FAMILY GROWTH YOU'LL SEE 11 PERCENT OF PEOPLE OVERALL HAD SAME SEX ATTRACTION, 3.7 PERCENT LGBS. IF YOU LOOK ACROSS YOU'LL SEE THIS NUMBER VARIES AND IF YOU LOOK AT NSFG IN TERMS OF SAME SEX-BEHAVIOR, THE RATE IS DIFFERENT. THE DATA DO TELL US THAT THERE ARE NOW, AGAIN FROM NSFG, OVER FOUR MILLION PEOPLE IN THIS COUNTRY WHO IDENTIFY AS LGB OR T, FOUR THOUSAND AS LGB AND ALMOST A HUNDRED--ALMOST A MILLION AS TRANSGENDER PEOPLE, FOUR MILLION, I'M SORRY AS LGB. MEN, FOUR MILLION IS LGB WOMEN. THESE DATA ALSO TELLS US THAT YOUNGER PEOPLE ARE MORE LIKELY TO BE LESBIAN, GAY OR BISEXUAL ARE MORE LIKELY TO IDENTIFY THAN OLDER PEOPLE OR PEOPLE IN MY AGE COHORT. AND THIS SPEAKS TO WHAT IS APPARENTLY AN INCREASING FLEXIBILITY AND ACCEPTANCE THAT YOUNG PEOPLE FILL OF BEING ABLE TO BE A SEXUAL MINORITY AND NOT SO CLOSETED FOR INSTANCE, AS I WAS WHEN I WAS A YOUNGER PERSON. WE ALL BENEFIT FROM THIS BY THE WAY, ALL MEMBERS OF THE LGBT POPULATION BENEFIT FROM THE STRENGTH AND RESILIENCE THAT YOUNGER PEOPLE ARE FEELING ABOUT THE SAFETY AND COMING OUT AND MUCH OF THAT IS ENVIRONMENTAL AS I'LL BE TALKING ABOUT IN A MINUTE. WHAT ARE THINGS THAT WE KNOW FROM FEDERAL DATA OR IN THIS CASE, THE CALIFORNIA HEALTH INTERVIEW SURVEY, A POPULATION-BASED SURVEY IN CALIFORNIA ARE THAT LGB'S ARE RACIALLY AND ETHNICALLY DIVERSE. YOU CAN SEE THAT WE ARE PERHAPS MORE DIVERSE THAN OTHER POPULATIONS, BUT WE ARE CERTAINLY HAVE ALL OF THE DIFFERENT CHARACTERISTICS WITHIN US, SO THAT YOU SEE IN GSS 70 PERCENT OF THE POPULATION HETEROSEXUAL. SEVENTY PERCENT OF THE LGBT POPULATION ARE WHITE 18, 19 PERCENT AFRICAN AMERICANS, FIVE PERCENT LATINO, SIX OR SEVEN PERCENT OF PEOPLE WHO DIDN'T SELECT ONE OF THOSE OPTIONS. THE PATTERNS ARE A LITTLE DIFFERENT WITH BISEXUAL PEOPLE MORE OF A MIX RACIALLY. SO I'M HOPING THAT YOU SEE THE DIVERSITY WITHIN THIS POPULATION IS NOT JUST ON HOW WE IDENTIFY OR WHETHER WE HAVE BEHAVIOR OR DESIRE OR IDENTITY OR THAT THE DIVERSITY WITHIN US ACCORDING TO OUR DEMOGRAPHIC CHARACTERISTICS. THE DATA ALSO TELL US THAT LESBIAN OR GAY PEOPLE ARE MORE ACTIVE THAN BISEXUAL PEOPLE. SO THE ANSWER TO THE QUESTION OF HOW OLD ARE YOU WHEN YOU FIRST TOLD SOMEBODY YOU WERE LGB OR WHEN YOU STARTED HAVING SAME SEX SEXUAL EXPERIENCES, THIS VARIES BUT LET'S SAY YOU LOOK AT LGB PEOPLE, IS THERE A PERCENT LESS THAN 18 WHEN THEY FIRST TOLD SOMEONE, 12 PERCENT, 18 PERCENT NEVER HAVE. IF YOU BREAK IT OUT BY LESBIAN AND GAY PEOPLE COMPARED TO BISEXUALLY IDENTIFIED PEOPLE THEN YOU SEE DIFFERENT RATES, WITH BISEXUAL PEOPLE HIGHER PERCENTAGE OF THEM NOT TELLING ANYONE. THINK ABOUT THE COMPARISON OR THINK ABOUT WHAT IT MEANS THAT HOW MANY PEOPLE COME OUT TO THEIR COWORKERS. SO LGB PEOPLE 35 PERCENT OF THEM, 34 PERCENT HAVE NEVER COME OUT TO THEIR COWORKERS. BISEXUAL PEOPLE, MUCH HIGHER PERCENTAGE OF THEM, HAVE NOT COME OUT TO THEIR COWORKERS. AGAIN, THESE ARE INDICATIONS OF HOW COMFORTABLE PEOPLE FEEL IN THEIR PERSONAL RELATIONSHIPS AND IN THE PLACES WHERE THEY WORK. SAME-SEX COUPLES--THESE NEXT FEW SLIDES ARE TAKEN FROM THE CENSUS DATA AND AGAIN THESE ARE SLIDES THAT GARY HAD PREPARED, THESE ARE 2000 CENSUS NOT 2010. SO YOU SEE THAT SAME-SEX-COUPLE HEADS OF HOUSEHOLD ARE ALL OVER THE COUNTRY, BUT PRIMARILY WHERE POPULATION DENSITY IS THE GREATEST. YOU SEE THE SAME PATTERN IF YOU LOOK AT AFRICAN AMERICAN SAME-SEX COUPLES. THE BULK OF THE FAMILIES REPORTING THIS [ARE] IN THE SOUTH WHERE YOU HAVE A HIGHER DENSITY OF THIS POPULATION. AND LATINO COUPLES IN THE WESTERN PART OF THE COUNTRY, AGAIN FOLLOWING THE POPULATION TRENDS. IN OTHER WORDS DEPENDING ON WHERE YOU LIVE AND [WHAT] THE OVERALL POPULATION LOOKS LIKE YOU'RE GOING TO FIND PEOPLE WHO ARE SEXUAL MINORITIES, WHO ARE AFRICAN AMERICAN OR LATINO, TO ESSENTIALLY THE SAME LIKELIHOOD OF FINDING THEM THAT YOU WOULD ANYWHERE YOU LIVE. BUT THE CONTEXT IS DIFFERENT. WE THINK THAT IF YOU ARE A SEXUAL MINORITY PERSON AND YOU LIVE IN AN AREA WHERE THE OVERALL DENSITY HAS MORE PEOPLE LIKE YOU, THEN YOU'RE GOING TO BE COMFORTABLE OR MORE LIKELY TO COME OUT. IF YOU HAPPEN TO LIVE IN AN AREA WHERE THERE IS ALMOST NOBODY LIKE YOU, THEN IT COULD BE A DIFFERENT SITUATION. IT MAY NOT BE: LIKE I JUST SAID THESE ARE THE KINDS OF THINGS WE THINK WE KNOW FROM MANY STUDIES WE HAVE DONE, BUT NOT ALL THAT WE NEED TO KNOW. THESE DATA ALSO TELL US THAT MANY OF THE LGB PEOPLE LIVE IN POVERTY. IN THE NSFG IN 2000, 15 PERCENT OF GAY MEN LIVED IN POVERTY AND 24 PERCENT OF LESBIANS AND ONE IN FIVE CHILDREN WHO ARE BEING RAISED BY SAME SEX COUPLES LIVE IN POVERTY. THE DATA ALSO TELL US, THINKING BACK TO THESE MAPS, THAT NOT ALL LGBT PEOPLE ARE URBAN. LGBT LIVE EVERYWHERE JUST LIKE ANYBODY ELSE BUT WITH GREATER OR LESSER DENSITY DEPENDING ON. OR AT LEAST IT SEEMS RELATING, TO THE OVERALL REPRESENTATION THEY ARE OF THE POPULATION AS WHOLE. MANY LGB PEOPLE WANT TO BE PARENTS. THESE DATA [ARE] ON LESBIAN AND GAY MEN. FORTY-ONE PERCENT OF LESBIANS [IN THE] NATIONAL PROBABILITY STUDY SAID THAT THEY WANTED TO HAVE A CHILD. THIRTY-FIVE PERCENT HAVE HAD A CHILD. FIFTY-TWO PERCENT OF GAY MEN SAID THEY WANTED TO HAVE CHILDREN AND THE NUMBER OF THEM ARE LOWER, MUCH LOWER THAN THOSE THAT WANTED TO HAVE [CHILDREN].. SO THEIR QUESTIONS HERE AROUND THE MAKE UP ARE VERY IMPORTANT AROUND WHAT HAPPENS IN HOUSEHOLDS AND FAMILIES. MANY SAME-SEX COUPLES ALSO ARE DISADVANTAGED, ARE RECEIVING PUBLIC ASSISTANCE. MEN AND WOMEN--LET'S SEE THESE--SO, YOU KNOW, RECENTLY THE BIG ISSUE AND ONE THAT HAS SORT OF PUT US ON THE MAP--I'LL LET YOU LOOK AT THIS WHILE I GRAB MY WATER--IS GAY MARRIAGE HAPPENING ALL OVER THE COUNTRY IT SEEMS NOW, ALMOST EVERY, NOT QUITE LIKE THIS UNFORTUNATELY, BUT IT SEEMS LIKE PROBABLY A MONTH GOES BY WHEN WE'RE NOT MAKING PROGRESS IN THAT AREA. SO THIS IS ONE (LAUGHS) ONE OF MY FAVORITE SLIDES, LIKE "WOW, YOU KNOW YOU GET MARRIED, HAVEN'T YOU SUFFERED ENOUGH? WHY DO YOU WANT TO DO (LAUGHS) OTHER THINGS? WHY DO YOU WANT TO--WHY EVEN THINK ABOUT HEALTH CARE. BUT THE TRUTH IS MARRIAGE ISN'T THE ONLY THING WE DON'T SUFFER FROM, AND HOPEFULLY WE DON'T SUFFER. WE SMOKE MORE THAN HETEROSEXUALS DO. GAY MEN SMOKE AT RATES 50 PERCENT HIGHER THAN OTHER MEN, LESBIANS [SMOKE AT RATES] 70 PERCENT HIGHER THAN OTHER WOMEN. LGBT WOMEN AS A GROUP ALL TOGETHER SMOKE AT RATES ALMOST A HUNDRED PERCENT HIGHER. THIS SHOULD BE LBT, SORRY FOR THE G THERE. SEXUAL MINORITY WOMEN SMOKE AT RATES SO MUCH HIGHER THAN OTHER WOMEN. THESE DATA THAT ARE HERE ON THIS CHART ARE TAKEN FROM PROBABILITY STUDIES. THE CALIFORNIA TOBACCO SURVEY, JUST ONE STATE, SO NOT GENERALIZABLE [SPELLED PHONETICALLY] AND THE U.S. BEHAVIOR SURVEY IS ALSO TAKEN FROM A NUMBER OF STATES ACROSS THE COUNTRY, BUT NOT ALL. BUT THIS SORT OF LEADS ME INTO THINGS THAT I WANT TO SAY ABOUT THE CHALLENGES OF DATA, BUT A FEW MORE STATS FIRST. THESE DATA ARE GOOD POPULATION DATA FROM AN AGGREGATED DATA SET IN BOSTON OF THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM AND WHERE SEXUAL ORIENTATION MEASURES HAVE BEEN ASKED BUT NOT UNTIL THIS YEAR TRANSGENDER IDENTITY. SO WE HAVE HIGHER RATES OF LIVING ALONE. STATISTICALLY SIGNIFICANTLY HIGHER RATES, LGB ELDERS, GAY MEN, SOMETHING CLOSE TO TWO THIRDS OF GAY MEN LIVE ALONE, MUCH HIGHER THAN HETEROSEXUAL MEN WHO ARE COMPARABLE. AND [A] SIMILAR NUMBER OF BISEXUAL PEOPLE. SO NOT ONLY DO WE HAVE RACIAL AND ETHNIC DIVERSITY, BUT WE HAVE DIVERSITY WITHIN OUR AGE COHORTS AS YOU CAN SAW EARLIER, AND IN PARTICULAR COHORTS WE HAVE ISSUES THAT ARE NOT THOROUGHLY ADDRESSED YET. THESE ARE HIV INCIDENCE DATA. AND IF YOU LOOK AT THESE DATA YOU CAN SEE A CHALLENGE OF HOW THIS DISEASE DRAMATICALLY AFFECTED LGBT POPULATIONS AND STILL DOES, BUT THE AGE RANGE IS DIFFERENT THAN THE RACIAL ETHNIC BREAK ADS [SPELLED PHONETICALLY]. AND YOU SEE WHAT YOU READ ABOUT A LOT NOW AND KNOW FROM YOUR OWN EXPERIENCE IF YOU WORK IN THESE COMMUNITIES THAT THE SPIKING RATE, THE HIGHEST RATE OF NEW HIV INCIDENCE, IS IN YOUNG BLACK MEN. WITHIN OUR POPULATIONS ARE ALL OF THESE DIFFERENT TYPES OF DIVERSITIES. AND A MAJOR CONCERN ARE AN AREA OF INTEREST OF HOW DOES ALL OF THIS WORK TOGETHER? IT USED TO BE IF YOU THOUGHT THAT IF YOU WERE A LESBIAN YOU WERE BLACK, YOU WERE POOR, YOU WERE, YOU KNOW, HAD A LIMITED EDUCATION, YOU DO SORT OF ADD THESE THINGS UP AND THINK, WELL, IF YOU HAD ALL FOUR OF THESE THINGS (LAUGHS) GOING AGAINST YOU, YOU WERE FOUR TIMES WORSE OFF THAN IF YOU JUST HAD NONE. BUT NOW WE UNDERSTAND BETTER THAT THESE ARE DIFFERENT IDENTITIES THAT PEOPLE HAVE AND THAT THEY COME TOGETHER IN A WAY TO MAKE A DIFFERENCE. I'LL SAY MORE ABOUT THAT WHEN I TALK ABOUT THE IOM REPORT IN A FEW MINUTES. WE STARTED TO SEE VERY INTERESTING RESPONSES FROM FEDERAL ORGANIZATIONS AS A CONVERSATION [OF] FEDERAL AGENCIES AROUND, AS A CONVERSATION ABOUT SEXUAL AND GENDER MINORITY HEALTH AND BECOMING MORE AND MORE OF A TOPIC IN THE NATIONAL LEVEL AND IN NO SMALL PART THANKS TO OUR PRESIDENT. THE CENTERS FOR DISEASE CONTROL, JUST TWO DAYS AGO, THREE DAYS AGO, RELEASED A REPORT IN WHICH THEY TOOK ALL OF THE DATA FROM THE YOUTH RISK BEHAVIOR SURVEYS, THE SITES THAT COLLECTED SEXUAL IDENTIFY AND/OR SEXUAL CONTEXT DATA AND LOOKED AT THE HEALTH RISK LGBT, LGB USE. HIGH SCHOOL NINE TO 12 YEARS, GRADES. AND THIS IS A SURVEILLANCE REPORT SO IT DOESN'T REALLY GET INTO WHAT I WAS JUST TALKING ABOUT IN TERMS OF THE DIVERSITY WITHIN THE POPULATIONS, BUT THESE ARE VERY STRONG POPULATION-BASED DATA THAT TELL US VERY CLEARLY THAT THE ISSUE IS NOW HERE TO LOOK DEEPER IN THIS AND TRY TO UNDERSTAND HOW THESE THINGS WORK TOGETHER. YOU CAN'T PUT ALL THESE DATA SETS FROM THE INDIVIDUAL STATES AND URBAN AREAS TOGETHER EASILY. THIS IS A GREAT START. SO THESE ARE DATA FROM SEVEN STATES AND SIX URBAN SCHOOL DISTRICTS. AND IT'S REALLY REMARKABLE IN THE SITES THAT ASSESS SEXUAL IDENTITY THE PREVALENCE FOR ALL OF THE RISK BEHAVIORS THAT WERE ASSESSED WAS HIGHER AMONG GAY AND LESBIAN STUDENTS THAN HETEROSEXUAL STUDENTS FOR MEDIAN DIFFERENCE OF 64 PERCENT. THIS IS AMAZING FROM ALL RISK BEHAVIORS FROM THE CDC AND THE YRBS AND THE PREVALENCE AMONG BISEXUAL STUDENTS WAS HIGHER THAN AMONG HETEROSEXUAL STUDENTS FOR ALL RISK BEHAVIORS THAT WERE MEASURED FOR A MEDIAN OF 76 PERCENT. SO IN SEXUAL IDENTITY THIS MEANS THAT THERE WERE HIGHER PREVALENCE OF THE RISK BEHAVIORS RELATED TO VIOLENCE, ATTEMPTED SUICIDE, TOBACCO USE, ALCOHOL USE, OTHER DRUGS, SEXUAL BEHAVIORS AND WEIGHT MANAGEMENT. AND IN BISEXUAL STUDENTS YOU CAN SEE THE SAME PATTERN BUT ADD IN THERE UNINTENTIONAL INJURIES. THIS CONFIRMS WHAT WE THOUGHT AND WANTED TO THINK WERE THE BEST DATA WE HAD UNTIL RECENTLY ABOUT THE HEALTH DISPARITIES OR THE HEALTH CONCERNS OF LGBT POPULATIONS. BUT NOW THAT WE START TO SEE POPULATION DATA LIKE THIS, WE SEE THE SAME TRENDS. USING THE SEXUAL CONTACTS MEASURE IN YRBS, WE SEE ESSENTIALLY THE SAME PATTERNS AND THIS IS A VERY DENSE REPORT AND I ENCOURAGE YOU TO READ IT. I'M JUST GIVING SORT OF A VERY TOP LEVEL SHOUT OUT ABOUT THIS, BUT THE INTERPRETATION OF THE DATA ON THE PREVALENCE OF BOTH SEXUAL CONTACTS, THIS IS MEASURED BY ASKING PEOPLE IF THEY HAVE HAD SEXUAL CONTACTS WITH A PERSON OF THE SAME SEX OR OTHER SEX OR BOTH. SO BOTH SEX--THE PEOPLE WHO HAD BOTH SEXUAL CONTACT WERE HIGHER THAN THE PREVALENCE OF OPPOSITE SEX CONTACTS--AGAIN, ALL RISK BEHAVIORS. SO THE INTERPRETATION OF THIS IS THAT SEXUAL MINORITY STUDENTS, PARTICULARLY THOSE WHO IDENTIFY AND STUDENTS WHO HAD SEXUAL CONTACT WITH BOTH SEXES ARE MORE LIKELY TO ENGAGE IN RISK BEHAVIORS. AND WHAT DOES THIS MEAN? AND WHAT CAN WE DO ABOUT IT? WELL, THIS RELEASE OF THE MMWR DOES TAKE A STAND ON THIS AND SAY TWO THINGS THAT ARE VERY CRITICALLY ADDRESSED IN THE IOM REPORT. AND IN THE WORK THAT HEALTHY PEOPLE 2020 HAS ADDRESSED AND IS MOVING FORWARD WITH THE NEW LGBT TOPIC AREA. AND THAT IS IN STATE AND LOCAL PUBLIC HEALTH ORGANIZATIONS AND SCHOOLS, THEIR POLICIES AND PRACTICE HAVE TO BE DEVELOPED AND HELP REDUCE THE PREVALENCE BECAUSE UNLESS YOU DO THAT HEALTH OUTCOMES ARE GOING TO STAY AS DESPERATE AS THEY ARE. AND THIS WAS A KEY POINT IN HEALTHY PEOPLE 2020. A KEY POINT IN THE IOM REPORT IS THAT WE HAVE TO DEAL WITH THE LOCAL SURVEYS, STATE SURVEYS, AS WELL AS THE FEDERAL SURVEYS THAT MONITOR HEALTH RISK BEHAVIORS AND SELECTED HEALTH OUTCOMES, AND WE HAVE TO INCLUDE THESE MEASURES IN THERE. HERE'S THE EVIDENCE THAT CDC PUTS FORWARD. I'M GOING DO AN OVERVIEW OF THE INSTITUTE OF MEDICINE REPORT AND I'M SURE THAT SOME OF YOUR ARE VERY FAMILIAR WITH IT AND I'LL TRY TO GO THROUGH IT FAIRLY QUICKLY AND GET TO WHAT I THINK THE MEAT OF IT IS FOR THE DISCUSSION THAT I HOPE WE CAN HAVE TOGETHER. SO AS DR. RUFFIN POINTED OUT THE NIH COMMISSIONED THIS REPORT TO CONDUCT A REVIEW [ON THE] STATUS- OF THE LGBT POPULATIONS. AND COMMISSIONING THIS REPORT WAS INCREDIBLY NECESSARY TO MOVE US FORWARD. BASICALLY VERY FEW POPULATION RESEARCH DATA THAT WE CAN USE, AND WE WERE COMING TO HAVE BUILT A BODY OF KNOWLEDGE BASED ON STUDIES THAT WERE NOT POPULATION-BASED, A CONVERGENCE OF FINDINGS NO DOUBT, BUT WITHOUT THE STRENGTH THAT YOU NEED TO HAVE TO REALLY ADDRESS THESE ISSUES ACROSS THE BOARD, ACROSS THE COUNTRY. SO THIS REVIEW WAS CRITICAL AND IDENTIFYING THE RESEARCH GAPS AND OPPORTUNITIES WAS A LARGE PART OF WHAT WE DID. ALSO TO OUTLINE A RESEARCH AGENDA, WHAT SHOULD BE DONE AND TO ADDRESS RESEARCH TRAINING NEEDS BECAUSE WE NEED MORE PEOPLE TO STUDY THESE AREAS AND TO APPLY THEM. WITH AN ENORMOUS BODY OF RESEARCH (LAUGHS) AND I THINK WE REALIZE THAT, WE THOUGHT, HOW ARE WE GOING TO DO THIS? BUT WE DEVELOPED FIVE PRIORITY RESEARCH AREAS AFTER REVIEWING THE LITERATURE THAT WE THOUGHT WOULD HELP US FRAME THIS IN WAYS THAT COULD BE BETTER UNDERSTOOD. THE NECESSITY FOR DEMOGRAPHIC RESEARCH, TO STUDY THE SOCIAL INFLUENCES THAT AFFECT OUR HEALTH, TO LOOK AT HEALTH CARE INEQUITIES INTERVENTION AND RESEARCH AND SPECIFICALLY TRANSGENDER HEALTH NEEDS. TRANSGENDERS WERE THE ONLY SUBPOPULATION OF THIS GROUP IN WHICH WE FELT IT WAS NECESSARY TO MAKE THAT A KEY PRIORITY AREA IN ITSELF FOR LACK OF RESEARCH. THE REPORT USED FOR CONCEPTUAL FRAMEWORK IS A (UNINTELLIGIBLE) BY WHICH WE CAN LOOK AT THIS VAST AMOUNT OF INFORMATION THAT WAS AVAILABLE AND TRY TO PUT MEANING INTO IT TO BE ABLE TO DESCRIBE WHAT THIS POPULATION WAS ABOUT. AND [I] THINK THE FIRST MEETING OF THE IOM COMMITTEE WAS SO REMARKABLE FOR ME THAT THE KEYNOTE WAS GIVEN BY DR. RAYNARD KINGTON, SOMEONE WHO'VE I ADMIRED GREATLY FOR MANY, MANY YEARS AND DR. KINGTON SAID TO US, YOU KNOW IF YOU ALL COULD JUST WRITE A REPORT THAT WILL HELP PEOPLE WHO DON'T UNDERSTAND WHAT THIS MEANS, THIS WILL BE A TREMENDOUS VALUE. IT'S EASY FOR SOMEONE LIKE ME WHO'S BEEN LIVING THIS LIFE NOW FOR A LONG TIME, I'M SORT OF IMMERSED IN IT TO FORGET THAT THERE ARE MANY PEOPLE IN THIS COUNTRY AND MANY PEOPLE AROUND ME PERHAPS WHO WOULD THINK DIFFERENTLY ABOUT ME IF THEY KNEW THAT I WAS A LESBIAN AND THAT I HAVE LIVED THIS LIVE FOR A LONG TIME AND I CERTAINLY KNOW WHAT IT WAS LIKE WHEN I WAS A YOUNGER PERSON IN MY AGE GROUP TO BE VERY CAUTIOUS ABOUT THIS. AND SO, YOU KNOW, WHEN DR. KINGTON SAID THAT TO US, IT REALLY, YOU KNOW, CAME HOME TO ME AND [I] THINK TO OTHERS OF US IN THE COMMITTEE THIS IS NOT JUST ABOUT A DATA REVIEW AND PROVIDING STATISTICS, WHICH IN SOME CASES OR IN MOST CASES FOR US WE JUST DON'T HAVE, BUT IT'S REALLY ABOUT AN OPPORTUNITY TO CONVEY THE VERY IMPORTANT INFORMATION ABOUT A POPULATION THAT MANY PEOPLE DON'T UNDERSTAND. SO WE USE THESE FOR FRAMES TO HELP US DO THAT. THE LIFE COURSE [SPELLED PHONETICALLY] FRAME, UNDERSTANDING THAT ACROSS YOUR LIFE COURSE CHARACTERISTICS ABOUT YOU CHANGE. IF YOU ARE A 60-, 70-, 80-YEAR-OLD GAY PERSON, YOU CAME OUT IN A VERY, VERY--IF YOU CAME OUT AT ALL--IN A VERY DIFFERENT ENVIRONMENT FROM WHAT YOUNG PEOPLE DO TODAY AND SO THE HISTORICAL CONTEXT IS CRITICAL TO UNDERSTAND. MINORITY STRESS, IT'S BEEN WELL ESTABLISHED THAT PEOPLE OF RACIAL AND ETHNIC MINORITY EXPERIENCE PARTICULAR STRESSORS BECAUSE OF THAT CHARACTERISTIC THEY HAVE. A VERY IMPORTANT STUDY DONE BY ILAN MEYER [SPELLED PHONETICALLY] AT COLUMBIA DEMONSTRATED HOW IT IS THAT SOCIETAL DISCRIMINATION, BEING A SEXUAL MINORITY PERSON INCREASES THE LIKELIHOOD OF CHRONIC STRESS. INTERSECTIONALITY [SPELLED PHONETICALLY] I RARELY TALKED ABOUT, THE--HOW WE HAVE MANY IDENTITIES AND THEY COME TOGETHER TO DESCRIBE WHO YOU ARE AND SOCIAL ECOLOGY. SOCIAL ECOLOGY--LET ME JUST GO BACK FOR A SECOND. SOCIAL ECOLOGY MEANS WHO YOU KNOW AND SO ONE OF THE WAYS THAT THIS FACTORS IN IS THE SLIDE THAT I SHOWED ABOUT HOW IT IS THAT PEOPLE ARE RELUCTANT TO COME OUT AT WORK AND IN SOME WORK ENVIRONMENTS ARE SUPPORTIVE AND PEOPLE CAN FEEL SAFE TO COME OUT, BUT OTHERS ARE NOT AND SIMILARLY WITH FAMILIES, SOME OF US HAVE FAMILIES THAT ARE VERY SUPPORTIVE AND OTHERS THAT ARE VERY--THAT ACTUALLY TREAT US VERY POORLY., SO THAT'S THE GIST OF WHAT WE MEAN HERE. THIS IS A SLIDE FROM A SUMMARY OF THE IOM REPORT THAT KIND OF SUMS THIS UP THAT SAYS THIS THE FRAMEWORK THAT WE USE TO THINK ABOUT THIS VAST BODY OF LITERATURE. THESE FOUR FRAMES THAT I MENTIONED, THE PRIORITY RESEARCH AREAS AND THEN OUR HOPE THAT THIS WOULD ORGANIZE IN A WAY THAT WOULD BE SENSIBLE AND UNDERSTANDING OF LGBT HEALTH. THE SOCIAL ECOLOGY IS A VERY SIMPLE MODEL; IT'S BEEN AROUND FOR A LONG TIME. MANY MODELS USING THIS HAVE BEEN MORE ARTICULATED THAT THIS ONE. BUT I THINK THIS REALLY SORT OF SAYS IT ALL THAT IF YOU PUT YOURSELF--IF YOU'RE AN LGBT PERSON, A SEXUAL MINORITY PERSON, AND YOU PUT YOURSELF IN THAT MENTAL [SPELLED PHONETICALLY] BOX AS AN INDIVIDUAL, ALL OF THOSE OTHER RINGS EFFECT YOU. WHAT YOUR FAMILY THINKS AND HOW THEY ACT, WHAT YOUR ORGANIZATION--HOW ACCEPTING YOUR ORGANIZATION IS--THE COMMUNITY THAT YOU LIVE IN, ARE YOU SAFE THERE? DO YOU LIVE IN AN AREA WHERE THERE ARE VERY FEW OTHER PEOPLE LIKE YOU IN THIS WAY? OR DO YOU LIVE IN ONE WHERE THERE IS A LARGE GAY POPULATION? AND WHAT ABOUT PUBLIC POLICY AND HOW THAT AFFECTS [PEOPLE]? ALL OF THESE THINGS HAVE AN IMPACT ON THE LIVES OF INDIVIDUAL SEXUAL MINORITY PEOPLE. SO HEALTH IS NOT JUST AN INDIVIDUAL MATTER, IT'S A NATIONAL MATTER. WE'VE LOOKED AT THE--THOSE AREAS THAT I JUST MENTIONED ACROSS THREE LIFE STAGES. IN EACH OF THESE SIX AREAS, SO WE HAVE THREE COHORTS, YOU SEE THESE AT THE AGE COHORTS, CHILDHOOD ADOLESCENCE, EARLY MIDDLE ADULTHOOD AND LATER ADULTHOOD. AND THESE AREAS WERE EXAMINED IN EACH OF THOSE. THE DEVELOPMENT OF SEXUAL ORIENTATION IN GENDER IDENTITY, MENTAL HEALTH STATUS, PHYSICAL HEALTH, RISK AND PROTECTIVE FACTORS, ACCESS TO HEALTHCARE AND EXPERIENCES WITH HEALTHCARE AND CONTEXTUAL INFLUENCES. THE PRINCIPAL FINDING OF THE STUDY WAS THAT MOST AREAS RELATED TO LGBT HEALTH ARE LACKING RESEARCH ALL TOGETHER OR REQUIRE ADDITIONAL RESEARCH. THE RESEARCH HAS BEEN CONDUCTED UNEVENLY WITH MORE ON GAY MEN AND LESBIANS AND LESS ON BISEXUAL AND TRANSGENDER INDIVIDUALS. MOST RESEARCH IS FOCUSED ON ADULTS, LESS ON ADOLESCENTS AND VERY FEW STUDIES ON LGBT ELDERS AND RESEARCH HAS NOT ADEQUATELY EXAMINED SUBPOPULATIONS, PARTICULARLY RACIAL AND ETHNIC GROUPS. THE CONCLUSIONS WERE THAT LGBT INDIVIDUALS HAVE UNIQUE HEALTH EXPERIENCES AND NEEDS, BUT AS A NATION WE DON'T KNOW WHAT THESE EXPERIENCES AND NEEDS ARE. RESEARCH HAS FACED A NUMBER OF CHALLENGES IN UNDERSTANDING THESE NEEDS INCLUDING A LACK OF DATA AND BUILDING A MORE SOLID DATABASE IS ESSENTIAL FOR DEVELOPMENT OF THIS FIELD. SO THE FIRST RECOMMENDATION IN THE STUDY IS TO IMPLEMENT--IS A RECOMMENDATION TO NIH TO IMPLEMENT A RESEARCH AGENDA THAT IS DESIGNED TO ADVANCE KNOWLEDGE AND UNDERSTANDING OF LGBT HEALTH USING THAT CONCEPTUAL FRAMEWORK. WE SIMPLY CAN'T GO FORWARD STUDYING GAY MEN AND AIDS, LESBIANS AND OBESITY, OR SAME SEX FAMILIES AND CALL THAT A NATIONAL RESPONSE TO LGBT HEALTH. WE HAVE TO DEAL WITH THESE CONCEPTUAL THINGS THAT I MENTIONED AND DIVERSITIES WITHIN OUR POPULATION. SO I'M GOING TO SORT OF WALK YOU THROUGH FAIRLY QUICKLY HERE, WHAT THE IDENTIFIED GAPS IN OPPORTUNITIES WERE THAT CAME FROM THIS REVIEW OF THE LITERATURE IN EACH OF THESE AREAS. AND I'VE BROKEN THIS OUT BY THE DIFFERENT AGE COHORTS AND YOU'LL SEE WHEN YOU LOOK AT THESE THAT MANY OF THESE AREAS THAT ARE LACKING DATA AND ARE PRIORITIES FOR RESEARCH APPLY ACROSS THE LIFE COURSE BUT SOME OF THEM ARE MORE SPECIFIC TO AGE COHORTS. BUT THE PERCENTAGES WHO ARE LGBT, WE HAVE TO HAVE TRANSGENDER MEASURES AS WELL OR ACROSS THE BOARD WE DON'T HAVE RELIABLY, TIMELY DATA ACROSS THE BOARD SO WE NEED TO DO MORE WITH WORK, WORK WITH THIS. ALSO THE DIVERSITY PIECE IS CRITICAL BECAUSE IT IS IN THE DIVERSITY OF OUR LIVES THAT WE LIVE OUR LIVES OUT ON A DAILY BASIS, NOT JUST HAVING ONE IDENTITY, BUT ALL OF THE MIXTURES THAT WE MAKE UP. THE GENERAL EXPERIENCES OF HAVING HEALTHCARE AND OF OUR HEALTH STATUS AND HOW THESE VARY BY DEMOGRAPHIC CHARACTERISTICS ARE CRITICAL. FOR ADULTS, PARTICULARLY IN EARLY TO MIDDLE ADULTHOOD, HOW MANY ARE PARENTS AND WHAT THEIR CHARACTERISTICS ARE? I SHOWED YOU SOME OF GARY GATES' SLIDES ON THE--A FEW CHARACTERISTICS ABOUT SAME SEX COUPLETY [SPELLED PHONETICALLY]. THERE'S MUCH MORE THAT WE KNOW ABOUT HIS WORK. BUT AGAIN, IT'S LIMITED TO THOSE HOUSEHOLDS WHO IDENTIFY AS SAME SEX HEADED HOUSEHOLDS ON THE CENSUS DATA. AND THE CENSUS DATA DOES NOT HAVE ELABORATE INFORMATION AROUND HEALTH STATUS AND SO THE--AND ALSO THE TRAJECTORY OF LGBT IDENTITY ACROSS THE LIFE COURSE. IN TERMS OF FAMILY AND INTERPERSONAL RELATIONS, THIS IS JUST THE CHILDHOOD GROUP; IT'S A LITTLE BIT DIFFERENT FROM ADULTHOOD. FAMILY LIFE OF LGBT YOUTH FROM DIVERSE BACKGROUNDS, THESE ARE AREAS IN WHICH WE DON'T HAVE THE RESEARCH AND MAJOR THE [SPELLED PHONETICALLY] IMPORTANT OPPORTUNITIES FOR STUDY. SOCIAL AND--SCHOOL AND SOCIAL LIFE CONCOMPETENCE [SPELLED PHONETICALLY] OF BEING IDENTIFIED AND ATTRACTED TO OTHER PEOPLE, SAME SEX PEOPLE, PROTECTIVE FACTORS, PATTERNS AND EXPERIENCES OF HOMELESSNESS, DOMESTIC VIOLENCE, VICTIMIZATION; YOU SEE SOME VERY SIMILAR THINGS IN ADULTHOOD, BUT IN ADULTHOOD, HERE YOU SEE THESE MEASURES ON FAMILY LIFE, THE EFFECT ON LGBT ADULTS OF NOT HAVING CHILDREN, YOU KNOW, THE LOSS OF--FOR PEOPLE WHO WANT TO HAVE CHILDREN--SOME DON'T, BUT MANY DO--TO WANT TO HAVE CHILDREN AND NOT BE ABLE TO DO IT. THERE ARE WAYS OF REPRODUCTIVE HEALTH THAT MANY OF US HAVE ACCESS TO, BUT OTHERS MAY NOT BECAUSE OF THE COST INVOLVED AND THE LACK OF ACCESSIBILITY. AND MANY LGBT PEOPLE ARE--REGRET THAT THEY ARE UNABLE TO HAVE CHILDREN, AND AS YOU ARE OLDER, NOT HAVING CHILDREN CAN BE A REAL DIFFICULT THING IF YOU DON'T COMPARE TO WHAT HETEROSEXUAL PEOPLE LIKE YOU--OTHERWISE LIKE YOU--MAY HAVE. AND THAT YOU DON'T HAVE YOUR CHILDREN AROUND YOU, AND SO WHERE ARE THE SUPPORTS THAT OTHERS MAY HAVE? THE EXPERIENCE OF PARENTING AND THE EXPERIENCE OF FAMILY SUPPORT ARE REALLY CRITICAL. YOU KNOW, LGBT PEOPLE DO THINGS ABOUT THIS. WE HAVE THE CONCEPT OF CHOSEN FAMILY TIES AND RELATIONS AND THESE ARE VERY IMPORTANT TO PEOPLE, BUT PARTICULARLY AS WE GET OLDER, WHAT ARE WE GOING TO DO? AND GRIEF AND LOSS ADD UP. YOU KNOW, THE MANY PEOPLE IN MY COHORT, PROBABLY MOST OF US WHO WERE OUT AT THAT TIME, WHO'VE LOST SO MANY OF OUR FRIENDS TO AIDS. AND IT'S, YOU KNOW--THIS IS SOMETHING YOU DON'T EASILY RECOVER FROM AND WITH HEALTH DISPARITIES IN LGBT PEOPLE, THIS CAN ADD UP AS YOU GET OLDER, SO [SPELLED PHONETICALLY] FAMILY VIOLENCE. HEALTH ACCESS ACROSS THE BOARD, PARTICULARLY RELATED TO IDENTITY DISCLOSURE AND INTERACTIONS WITH PROVIDERS, IT'S A COMMON CONCERN. AND REPORTS THAT--OF INADEQUATE HEALTHCARE, DISRESPECTFUL HEALTHCARE AT TIMES, THESE ARE CRITICAL AREAS BECAUSE IT'S IN THE NATURE OF THE POPULATION THAT HAS HEALTH DISPARITIES, WITHOUT HAVING CONFIDENCE THAT YOU CAN GET GOOD HEALTHCARE, THAT YOUR PROVIDER WILL TREAT YOU WELL, THAT PEOPLE AT THE FRONT DESK WILL NOT DISRESPECT YOU. THEN THIS IS A--THESE ARE BARRIERS TO GETTING THE HEALTHCARE YOU NEED AND IT'S ACROSS THE BOARD, ALL AGE GROUPS, SO THAT IT'S NOT SURPRISING THAT HEALTHCARE UTILIZATION RATES ARE A PROBLEM AS WELL. SOME PEOPLE AVOID THIS CARE AND THE QUALITY OF CARE IS NOT WHAT IT SHOULD BE. LONG-TERM ISSUES OF OLDER LGBT PERSONS AND END OF LIFE ISSUES. IN MENTAL HEALTH, SOME AREAS ACROSS THE LIFE COURSE, THESE BOXES ARE HERE AND THEY'RE GRAYED OUT BECAUSE THE SYSTEMATIC REVIEW OF ALL OF THE DATA THAT WE HAVE SAY TO US THESE ARE HEALTH DISPARITIES AREAS BASED ON EVERYTHING WE KNOW AND THESE ARE THE AREAS THAT HAVE TO BE STUDIED AND ISN'T [IT] HORRIBLE WHEN YOU LOOK AT THIS TO SEE HOW MANY OF THESE THERE ARE AND THAT SOME THEM CUT ACROSS ALL OF OUR POPULATIONS. DEPRESSION AND SUICIDALITY, EFFECTS OF STIGMA AND DISCRIMINATION, PARTICULARLY AMONG TRANSGENDER ADULTS AND ACROSS THE LIFE COURSE. SUBSTANCE USE, OBESITY, CANCER RATES, CARDIOVASCULAR DISEASE AMONG ELDERS, LONG-TERM HORMONE USE AMONG OLDER TRANSGENDER PERSONS, EFFECTS OF DISABILITIES, WE HAVE ALMOST NO DATA ON DISABILITIES IN LGBT POPULATIONS. SEXUAL AND REPRODUCTIVE HEALTH, HIV AND RISK INTERVENTIONS ACROSS THE LIFE COURSE, IT VARIES ACCORDING TO THE AGE GROUP. BUT IT'S THERE ACROSS THE LIFE COURSE, SEXUALLY TRANSMITTED INFECTIONS, SEXUAL DEVELOPMENT, REPRODUCTIVE AND HEALTH RISKS IN CHILDHOOD AND ADOLESCENCE IN MIDDLE AGE--IN THE EARLY MIDDLE ADULTHOOD PERIOD, THESE REPRODUCTIVE ISSUES THAT I WAS TALKING ABOUT, REPRODUCTIVE TECHNOLOGY AND HOW TO GAIN ACCESS TO IT, AND SEXUAL WELLBEING AND SEXUAL DYSFUNCTION IN OLDER ADULTHOOD. YOU KNOW, WE KNOW FROM A VERY PROMINENT NATIONAL STUDY OF SEXUAL PRACTICES OF OLDER ADULTS IN THIS COUNTRY, NSHAP [SPELLED PHONETICALLY], THAT SEXUAL OLDER ADULTS HAVE ACTIVE SEXUAL LIVES, MEN AND WOMEN. WE KNOW THIS ABOUT HETEROSEXUALS, AND WE HAVE NO GOOD DATA TO TELL US ABOUT HOW TO BE SEXUALLY HEALTHY AS YOU AGE OR WHETHER IT'S THE THING TO DO. WE JUST DON'T KNOW, AND BECAUSE SEXUAL AND GENDER MINORITY PEOPLE HAVE CERTAIN HEALTH DISPARITIES, IT'S REALLY IMPORTANT UNDERSTAND OUR SEXUAL PRACTICES AND NEEDS. OUR SECOND AREA OF RECOMMENDATIONS IS RELATED TO DATA COLLECTION. AND THIS HAS TO DO WITH SOME OF THE THINGS THAT [I] MENTIONED AROUND MMWR, [SPELLED PHONETICALLY] FOR INSTANCE, THAT WE NEED TO HAVE MEASURES OF SEXUAL ORIENTATION AND INCREASINGLY WE DO, BUT WE ALSO NEED MEASURES OF GENDER IDENTITY AND FEDERALLY FUNDED STUDIES. AND THAT DATA--AND THIS IS A CONTROVERSIAL ISSUE, THE SECOND BULLET POINT, BY MANY--AMONG MANY FOLKS--WHETHER OR NOT DEBATE [SPELLED PHONETICALLY]--WE RECOMMENDED THAT DATA ON SEXUAL ORIENTATION AND GENDER IDENTITY SHOULD BE COLLECTED IN ELECTRONIC MEDICAL RECORDS. AND THE JOINT COMMISSION HAS COME OUT AS A LEADER IN RECOMMENDING THAT THE ORGANIZATIONS THAT THEY ACKNOWLEDGE COLLECT THESE DATA AND ADD THEM TO ELECTRONIC MEDICAL RECORDS. TO THE FIRST POINT, BRFSS, ANOTHER PROMINENT CDC STUDY, THAT'S IMPLEMENTED AT THE STATE LEVEL, OFFERS STATE-ADDED QUESTIONS FOR SEXUAL ORIENTATION THAT ARE NOT REQUIRED. BRFSS, IF YOU LOOK AT THIS YOU'LL SEE THAT THERE ARE SOME STATES [WHERE] SEXUAL ORIENTATION IS INCLUDED, OTHER STATES WHERE IT'S NOT, SOME THAT FUSE [SPELLED PHONETICALLY] OR THAT INCLUDE BOTH SEXUAL ORIENTATION, IDENTITY AND BEHAVIOR. SO IT'S A PATCH--IT'S A LITTLE BIT OF A PATCHWORK, AND I PUT THIS JUST UP HERE SO THAT YOU CAN SEE THAT WHEN WE THINK ABOUT SEX HEALTH SURVEYS IN PARTICULAR, THE BRFSS BEING ONE THAT HAS GOOD MEASURES OF HEALTH RISKS, THEN--AND YOU WANT TO DO THIS AT A NATIONAL LEVEL--WHAT DO YOU HAVE TO DO TO THINK ABOUT, OR CAN YOU USE THIS VEHICLE, WHICH COULD BE A VERY POWERFUL VEHICLE IF THERE WERE SOME WAY TO HAVE ALL OF THE STATES COLLECT THESE DATA AND COLLECT SIMILAR MEASURES? THERE ARE DIFFERENT MEASURES THAT YOU CAN USE, IDENTITY AND BEHAVIOR OR ATTRACTION. THIS IS ANOTHER JUST WAY TO SEE WHICH STATES--THERE ARE 10 OF THEM, AND THE DISTRICT OF COLUMBIA THAT ASK SEXUAL IDENTITY AND THREE THAT DON'T ASK THE QUESTIONS AT ALL, AND IN BETWEEN SOME WHO ASK BOTH. IF THERE'S TIME IN THIS INTEREST DURING THIS DISCUSSION, I'LL COME BACK AND TALK TO YOU A LITTLE BIT AROUND THIS MATTER OF ELECTRONIC HEALTH RECORDS AND HOW IT IS WE ARE MEASURING THIS AND THINKING ABOUT THIS AT OUR HEALTH CENTER IN BOSTON. TWO RECOMMENDATIONS WERE MADE AROUND METHODOLOGICAL RESEARCH THAT NIH SHOULD SUPPORT THE DEVELOPMENT AND STANDARDIZATION OF SEXUAL ORIENTATION AND GENDER IDENTITY MEASURES. THIS APPLIES IN A COUPLE OF DIFFERENT WAYS. IF YOU'RE DOING RECURRING SURVEYS, FOR INSTANCE, BRFSS, A CDC STUDY FUNDED AND SUPPORTED STUDY, THEN YOU WANT TO HAVE THE MEASURES BE THE SAME YEAR AFTER YEAR. IF YOU'RE DOING STUDIES, SCIENTIFIC STUDIES DESIGNED TO EXPLORE SCIENTIFIC QUESTIONS, THEN THE STANDARDIZATION OF MEASURES IN THIS RECOMMENDATION DOESN'T AUTOMATICALLY APPLY. THEN THE QUESTION OF HOW YOU ASK ABOUT SEXUAL ORIENTATION AND BEHAVIOR MAY INCLUDE SOME OF THE SAME STANDARDIZED MEASURES THAT ARE ON FEDERALLY OCCURRING STUDIES, BUT WILL HAVE DIFFERENT QUESTIONS THAT YOU ASK RELATED TO THE AIMS OF YOUR STUDY. IN THE SECOND BULLET, NIH IS RECOMMENDED TO SUPPORT METHODOLOGICAL RESEARCH THAT HELPS US UNDERSTAND HOW TO STUDY LGBT HEALTH. THIS IS A QUESTION OF WHEN YOU DON'T HAVE ANY LISTS TO SAMPLE FROM AND YOU HAVE NO EASY WAY TO FIND STUDY PARTICIPANTS, WHAT ARE YOU SUPPOSED TO DO ABOUT IT? AND WHAT DOES IT TAKE TO GET PEOPLE TO PARTICIPATE IN A STUDY? THIS HAS BEEN A REAL CHALLENGE OF MUCH OF THE DATA THAT HAS BEEN DONE AND THE TERM "CONVENIENT SAMPLE" IS USED AND THOSE ALL OF US THAT CONDUCTED THESE STUDIES KNOW THAT IT'S NOT CONVENIENT, CAN BE VERY, VERY INCONVENIENT. SO HERE'S ONE EXAMPLE OF USING A MIXED METHODS APPROACH AND IT'S A STUDY OF TRANSGENDER PEOPLE IN VIRGINIA NOT TOO LONG AGO. I WORKED WITH COLLEAGUES FROM THE TRANSGENDER COMMUNITY TO DEVELOP A STUDY ABOUT LGBT--THE HEALTH OF TRANSGENDER PEOPLE IN VIRGINIA AND AFTER--THIS IS--WE USED THE COMMUNITY-BASED PARTICIPATORY PROCESS WITH THIS AND WE ENDED UP WITH A DIFFERENT RESPONSE RATE ON THE ONLINE SURVEY FROM THE PAPER SURVEYS. BUT HERE'S THE POINT: DEPENDING ON THE METHOD OF DATA COLLECTION OR THE MODE OF DATA COLLECTION, YOU GET A VERY DIFFERENT SAMPLE. ON THE PAPER SURVEY, ALMOST 60 PERCENT OF THE RESPONDENTS WERE AFRICAN AMERICAN. ONLINE, THREE PERCENT. OTHER CHARACTERISTICS VARIED ON THE PAPER SURVEY AND URBAN POPULATION ON THE WEB OF SUBURBAN POPULATION. MY CO-INVESTIGATOR ON THIS, JESSICA XAVIER [SPELLED PHONETICALLY], LOOKED AT THIS--AND THE FIELD COORDINATOR FOR THE STUDY--LOOKED AT THIS AND SAID IT WAS JUST AS SHE THOUGHT, THE DIGITAL DIVIDE IS THERE, TRANSGENDER PEOPLE, BUT LOOK AT THIS. SO MANY OF OUR STUDIES DON'T TAKE THE TIME OR HAVE THE RESOURCES TO COMPARE METHODS AND SEE HOW THE DIFFERENCES ARE THERE. RECOMMENDATION--THE LAST COUPLE OF RECOMMENDATIONS ARE FOR RESEARCH TRAINING AND PARTICIPATION. FIRST, THAT THERE BE A COMPREHENSIVE RESEARCH TRAINING APPROACH TO STRENGTHEN LGBT HEALTH RESEARCH AT NIH. TO EXPAND INTRAMURAL AND EXTRAMURAL TRAINING PROGRAMS. FOCUS ON THREE AUDIENCES: RESEARCHERS WHO ARE CURRENTLY WORKING WITH LGBT POPULATIONS, RESEARCHERS WHO MAY NOT BE AWARE OF THESE ISSUES, AND STAFF AT THE NIH. AND THEN WE ADDED THIS ONE: THAT NIH SHOULD ENCOURAGE GRANT APPLICANTS TO ADDRESS EXPLICITLY THE INCLUSION OR EXCLUSION OF SEXUAL AND GENDER MINORITIES IN THEIR SAMPLES. WHEN YOU APPLY FOR AN NIH GRANT NOW YOU HAVE TO SAY HOW YOU ARE TAILORING YOUR STUDY, WHETHER OR NOT YOU HAVE INCLUDED MINORITY POPULATIONS, WOMEN AND CHILDREN, RACIAL AND ETHNIC POPULATIONS, IN YOUR STUDY SAMPLE OR WHETHER YOU HAVEN'T, AND WHAT YOUR RATIONALE FOR THAT IS. WE THINK THAT--OR WE MADE THIS RECOMMENDATION THAT IF THIS WERE ADDED IN SOME WAY AS THE EXPECTATION OF NIH GRANT APPLICANTS, JUST THAT THEY ADDRESS IT, NOT NECESSARILY THAT THEY--THAT IT BE A REQUIREMENT, BUT ENCOURAGE PEOPLE TO DO THAT, THEN THE SIGNAL GOES OUT TO SCIENTISTS WHO APPLY TO NIH THAT THIS IS IMPORTANT TO THINK ABOUT, BECAUSE ONE OF THE MAJOR CONCERNS WE HAVE IS HOW DO PEOPLE START THINKING ABOUT THIS IF IT'S SCIENCE THAT NEEDS TO BE DONE, IF IT'S HEALTH DATA THAT NEED TO BE COLLECTED? AND MOST OF THE STUDIES THAT ARE FUNDED NOW DON'T INCLUDE THOSE MEASURES, HOW CAN THE WORD GET OUT? SO NIH IS A VERY POWERFUL ORGANIZATION IN THIS WORK. IF SUGGESTING TO ITS--OR RECOMMENDING TO ITS SCIENTISTS TO ADDRESS THIS ISSUE IN SOME WAY, PERHAPS IT WILL HELP TO OPEN THE MINDS AND THE STUDIES AND INCREASE THE FLOW OF SCIENCE IN THIS AREA. AND I'LL JUST TAKE ONE LAST MINUTE TO DESCRIBE FOR YOU, BRIEFLY, THE POPULATION RESEARCH CENTER THAT I WORK WITH IN BOSTON AT THE FENWAY INSTITUTE. THIS WAS A RESPONSE THAT, TO OUR DESIRE, TO FIND A WAY TO PULL SCIENTISTS TOGETHER ACROSS THE COUNTRY TO ADDRESS THESE ISSUES BECAUSE ONE OF THE LIMITATIONS HAS BEEN THAT A VERY--THERE'S A SMALL CADRE OF PEOPLE WHO FOCUS IN THIS AREA, WHO STUDY THIS AREA ACROSS THE COUNTRY. THERE'S A LARGE GROUP OF PEOPLE WHO STUDY HIV/AIDS, NO QUESTION ABOUT THAT. BUT WHEN YOU LOOK AT LGBT HEALTH MORE BROADLY, NOT TOO MANY PEOPLE, AND THEY'RE SCATTERED ACROSS THE COUNTRY, AND FEW UNIVERSITIES AT THE TIME--AT THAT TIME, ONLY ONE, OFFERED A CERTIFICATE PROGRAM OR A SPECIALIZATION IN LGBT HEALTH. SO WE WERE FUNDED THROUGH AN R21 TO BEGIN DEVELOPMENT OF SUCH A CENTER AND, IN ESSENCE, THIS IS OUR GOAL. AND OUR GOAL IS TO INCREASE THE RESEARCH AT--PUT [SPELLED PHONETICALLY] BUT TO BUILD THE NEXT GENERATION OF LGBT SCIENTISTS AND THIS IS OUR LOGIC MODEL. WE HAVE AN AWARD--A CONSORTIUM AGREEMENT WITH ICPSR IN ANN ARBOR, IN MICHIGAN, WHICH--IN WHICH WE ARE BUILDING A DATA ARCHIVE OF DATA SETS WITH LGBT MEASURES IN THEM. WE HAVE TO UNEARTH THEM AND THEN GET THEM IN THERE. THEY CONNECT THROUGH DATA LINKAGES TO THE GENERAL ARCHIVE IF--UNLESS PIS WANT TO RESTRICT THEM FOR A PERIOD OF TIME. AND WE HAVE A PARTNERSHIP WITH BU, WITH BOSTON UNIVERSITY, TO USE THEIR RESOURCES AND THINGS THAT WE DON'T HAVE AT FENWAY, SUCH AS DORMITORIES AND EXTENSIVE COMPUTER LABS. AND WE HAVE A FACULTY NOW, A SCIENTISTS [SPELLED PHONETICALLY, FACULTY?] OF 54 FROM ACROSS THE COUNTRY, WHO COME TOGETHER AND WORK ON STUDIES TOGETHER AND MENTOR STUDENTS. WE SUPPORT THAT FACULTY THROUGH PROVIDING THEM WITH RESOURCES AND OPPORTUNITIES TO GET TOGETHER, AND OUR STAFF AT THE INSTITUTE ARE IN CONSTANT CONTACT WITH THEM. THIS IS A SHOT OF OUR DATA ARCHIVE, WHICH IS ACCESSIBLE THROUGH ICPSR, AND YOU CAN GO ON THERE AND YOU'LL FIND MORE DATA SETS THAN YOU MAY HAVE KNOWN ABOUT THAT INCLUDE MEASURES AND THAT YOU CAN DOWNLOAD. AND IT IS PROGRAMMED IN SUCH A WAY WITH THE SCRIPTURES OF THE MEASURES THAT ARE NOT COMMONLY USED EVERYWHERE AND MEASURES THAT WE'VE CREATED THROUGH A PROCESS OF WORKING OVERTIME WITH FOLKS AFFILIATED WITH US AND OTHERS, AND--BUT MOSTLY, WHAT I WANTED TO DO WAS CLOSE WITH A COUPLE OF SLIDES ABOUT OUR SUMMER PROGRAM IN LGBT POPULATION HEALTH BECAUSE I THINK THIS IS REALLY WHERE THIS CAME TOGETHER FOR US. WHEN WE STARTED WE THOUGHT, YOU KNOW, THAT THIS--IT WOULD BE GOOD TO GET EVERYBODY TOGETHER AND WE WOULD BE ABLE TO DO MORE WORK IF WE HAD AT LEAST AN OPPORTUNITY TO CONNECT AND TO STEP OUTSIDE OF OUR UNIVERSITY ENVIRONMENTS AND BE ABLE TO WORK IN A COMMUNITY SETTING WAS A NOVEL IDEA AND A VERY WELCOME ONE, BECAUSE WE JUST WERE STRUGGLING TO FIND COLLEAGUES IN OUR UNIVERSITIES. SO, OUR--WE ARE NOW FUNDED BY NICHD TO WITH AN R25 TO DO EDUCATIONAL RESEARCH, AND WE USING [IT TO STUDY] LGBT HEALTH. AND WE'RE USING THAT FOR A SUMMER PROGRAM. IT'S A--THIS WILL BE OUR SECOND YEAR--IT'S A FOUR WEEKS INTENSIVE SEMINAR IN BOSTON, AND IT INCLUDES THE REQUIREMENT THAT YOU BRING A POPULATION DATA SET WITH LGBT MEASURES IN IT, AND--OR YOU ASK US TO HELP YOU FIND ONE THAT FITS WHAT YOU'D LIKE TO STUDY. IT'S INTENDED TO BRING TOGETHER THE KNOWLEDGE BASE AND THE METHODOLOGIES SO THAT PEOPLE, WHO MAY HAVE OFTEN BEEN TRAINED IN EXCELLENT POPULATION RESEARCH PROGRAMS, KNOW THE METHODOLOGIES VERY WELL, ARE GREAT STATISTICIANS, BUT MAY NOT HAVE HAD ACCESS TO A COURSE AROUND THE FOUNDATIONS FOR LGBT HEALTH. SO, WE DO THE KNOWLEDGE FOUNDATIONS, THE ANALYSIS PART, THE--WE HAVE FOLKS FROM ICPSR WHO COME AND TEACH STATS CAMP, AND THEN THE STUDENTS WORK TOGETHER IN INTENSIVE SEMINARS EVERY MORNING AND STATS CAMP IN THE AFTERNOON, BUT ONE WEEK IS DEDICATED TO DATA ANALYSIS TRAINING. IT'S--SO LET'S SEE. THE PURPOSE OF THIS IS ADDRESSED TOWARDS OUR ULTIMATE GOAL OF THE POP CENTER [SPELLED PHONETICALLY] TO SUPPORT THE DEVELOPMENT OF THE NEXT GENERATION OF LGBT POPULATION SCIENTISTS. WE, BASICALLY--HERE THEY ARE BY THE WAY, AREN'T THEY GREAT? THIS IS THE FIRST YEAR. WANT TO SAY THAT--AND WE HAVE A NEW CLASS ARRIVING IN ABOUT THREE WEEKS OF 18 STUDENTS, WHICH IS THE NUMBER THAT WE CAN ACCOMMODATE IN OUR SURVEY LAB, I MEAN, IN THE LAB AT BU THAT WE'RE USING. I WANT TO SAY THAT THESE STUDENTS, WHO ARE REMARKABLE PEOPLE, COME OVER FROM ALL OVER THIS COUNTRY. AND WE HAVE APPLICANTS FROM ACROSS THE WORLD NOW. WE CAN FUND U.S. STUDENTS THROUGH OUR GRANT. THEY COME FROM UNIVERSITIES THAT ASTOUNDED ME. THEY COME FROM MAJOR UNIVERSITIES ACROSS THE COUNTRY. AND WHAT'S GREAT ABOUT THEM--MANY THINGS ARE GREAT ABOUT THEM--I THINK ONE OF THE THINGS THAT REALLY IMPRESSED ME ABOUT THEM A LOT IS THAT THEY CAME TO A CONCLUSION THAT THEY WANTED TO SELECT THIS CLASS FOR 2011, AND THEY ARE VERY INVESTED IN THIS. THEY ARE WORKING ON STUDIES, AND--BUT IT WAS--IT'S A GREAT EXPERIENCE. AND I THINK THIS IS--BUT I SHOW YOU THAT PICTURE BECAUSE I WANT TO CLOSE WITH THIS IDEA: THAT THESE ARE REMARKABLE INDIVIDUALS WHO ARE--WANT TO DO THEIR SCIENTIFIC CAREERS IN LGBT HEALTH, AND THEY WANT TO DO IT IN A WAY THAT'S GOING TO MAKE A DIFFERENCE. BUT WHERE THEY ARE IN THEIR DOCTORAL PROGRAMS, THEY HAVEN'T HAD A MENTOR WHO WAS AN EXPERT IN THIS AREA. AND THEY HAVEN'T HAD THE OPPORTUNITY TO PUT TOGETHER THE STATISTICAL TRAINING THEY WERE GETTING WITH A KNOWLEDGE BASE. AND SO MANY OF THEM APPROACHED US THE FIRST YEAR ASKING, "WELL, I'M NOT--I CAN'T DO MY DISSERTATION ON THIS BECAUSE I'M DEVELOPING SOMETHING ELSE, BUT I REALLY WANT TO MAKE A CAREER OF THIS." AND SO IT'S REALLY REMARKABLE THAT WE ARE ABLE TO HAVE A PROGRAM LIKE THIS ANYWHERE. WE'RE VERY PRIVILEGED TO BE ABLE TO BE DOING THIS. AND THEN THIS IS WHAT THIS MEANS: FOR ALL OF US WHO ARE SEXUAL AND GENDER MINORITIES, WHAT THIS IS ALL ABOUT IS HOW IMPORTANT IT IS JUST TO BE RECOGNIZED BECAUSE YOU MATTER. NOT ALL OF THIS CLASS--MEMBERS OF THIS--CLASS ARE SEXUAL MINORITY PEOPLE. SOME OF THEM ARE, SOME OF THEM ARE NOT. IT WAS FASCINATING TO WATCH THIS IN THE CLASS AS THEY GOT TO KNOW EACH OTHER AND SEE THAT IT MADE NO DIFFERENCE TO THEM WHATSOEVER. IT'S IMPORTANT THAT YOU MATTER, AND WHEN YOU'RE PLANNING A CAREER, AND YOU WANT TO HAVE A CAREER IN SOMETHING THAT HAS--FOR WHICH IT'S NOT EASY TO GET TRAINED, IT MATTERS IF YOU CAN--IF YOUR NEEDS CAN BE RECOGNIZED AND IF THERE IS A PLACE AVAILABLE THAT YOU CAN GO AND LEARN THE THINGS YOU NEED TO LEARN AND FOR ALL OF US WHO ARE SEXUAL MINORITY PEOPLE, SIMPLY TO BE RECOGNIZED IN STUDIES, IN TRAINING PROGRAMS WHERE WE WORK, THESE ARE THE THINGS THAT MAKE LIFE SO MUCH BETTER FOR US. WE ARE EXTREMELY FORTUNATE TO HAVE THIS FUNDING FROM NICHD. WE ARE ENORMOUSLY PLEASED AND PRIVILEGED TO BE ABLE TO BE HERE AND TO TALK WITH YOU, AND WE ARE ENORMOUSLY GRATEFUL TO THE INSTITUTE--TO THE NATIONAL INSTITUTES OF HEALTH FOR CONDUCTING THE IOM REPORT AND GIVING US NOW INCREASED CONFIDENCE THAT THE WORK THAT WE HAVE BEEN DOING FOR A LONG TIME REALLY IS PAYING OFF AND THAT THERE'S WORK TO DO THAT HOPEFULLY WILL BE MORE RECOGNIZED AND WILL MAKE IT POSSIBLE FOR US TO BRING MORE AND MORE DATA FORWARD. THANK YOU VERY MUCH. [APPLAUSE] FEMALE SPEAKER: WELL, WE'D LIKE TO THANK FOR DR. BRADFORD FOR THAT INTERESTING PRESENTATION. [APPLAUSE] AND WE'RE GOING TO TAKE SOME QUESTIONS NOW. SO THE FLOOR IS OPEN FOR QUESTIONS. THERE ARE MICROPHONES ON EACH SIDE, AND EDGAR , OVER HERE, IS GOING TO FLOAT AROUND WITH A HANDHELD. SO I THINK WE HAVE A QUESTION RIGHT DOWN FRONT HERE. FEMALE SPEAKER: SHALL I STAY HERE? FEMALE SPEAKER: YEAH, YOU GO AHEAD. FEMALE SPEAKER: [INAUDIBLE] [LAUGHTER] FEMALE SPEAKER: OKAY. FEMALE SPEAKER: HI, [INAUDIBLE] I HAVE A QUESTION--WELL, I HAVE TWO QUESTIONS. ONE, WHEN YOU TALKED ABOUT DATA COLLECTION AND COLLECTING DATA ON SEXUAL--IN GENDER MINORITIES, I CAN SEE, LIKE WITH SOME GROUPS LIKE RACIAL AND ETHNIC MINORITIES AND [UNINTELLIGIBLE] WHERE THEY'RE SORT OF SEGREGATED, YOU KNOW, SO YOU CAN, LIKE, SPECIFICALLY TARGET CERTAIN NEIGHBORHOODS OR COMMUNITIES BECAUSE WE'RE SEGREGATED -- DR. JUDITH BRADFORD: RIGHT. FEMALE SPEAKER -- BUT WHEN YOU TALK ABOUT COLLECTING, YOU KNOW, THIS NATIONAL DATA, LIKE HOW WOULD YOU GO ABOUT--BECAUSE THEY'RE INTEGRATED. THE MAPS YOU SHOWED, YOU KNOW, THAT THEY WERE INTEGRATED OR CROSSED, YOU KNOW, BASED ON RACE AND ETHNICITY. BUT HOW DO YOU SPECIFICALLY TARGET A POPULATION TO COLLECT NATIONAL DATA WHEN THEY ARE SO INTEGRATED WITHIN THE -- DR. JUDITH BRADFORD: LET ME SEE IF I--IF I CAN GIVE YOU AN APPROPRIATE ANSWER FOR THAT. I THINK THE CHALLENGE COMES WHEN YOU HAVE A POPULATION THAT IS A SMALL PERCENTAGE OF THE OVERALL POPULATION. AND SO YOU MAY GET FROM A NATIONAL STUDY, FIVE OR SIX PERCENT OR THREE OR FOUR PERCENT OF PEOPLE. WHEN YOU BREAK THAT DOWN BY RACE ETHNICITY OR BY PARTICULAR GEOGRAPHIC REGION, YOU JUST DON'T HAVE ENOUGH CASES TO MAKE COMPARISONS. THIS IS A KEY ISSUE OF TRYING TO GET NATIONAL DATA IN ONE DATA POINT. SO THE NATIONAL CENTER FOR--THE NATIONAL SURVEY OF FAMILY GROWTH AGGREGATES DATA ACROSS YEARS. YOU GET A LITTLE LARGER SAMPLING; YOU CAN DO MORE BREAKOUTS. WITH A CENSUS DATA WHICH, UNFORTUNATELY, DOESN'T HAVE HEALTH MEASURES, BUT IT TELLS US ABOUT HOW MANY OF US THERE MAY BE YOU HAVE A VERY LARGE SAMPLE, AND SO YOU CAN BREAK OUT SOME OF THESE THINGS AS DR. GATES HAS DONE. IN HEALTH SURVEYS, IT'S A, YOU KNOW, SOME INTERESTING STATISTICAL METHODS HAVE BEEN DEVELOPED, AND IT'S ACTUALLY--IT WAS THE OFFICE OF MINORITY HEALTH THAT DID--USED A TECHNIQUE CALLED THE KALMAN, THE MODIFIED KALMAN FILTER [SPELLED PHONETICALLY] STATISTICAL PROCEDURE THAT MAXIMIZES, YOU KNOW, THE PROJECTIONS YOU CAN MAKE FROM A SMALL SAMPLE SIZE. BUT IT'S VERY--THAT'S ONE EXAMPLE. IT'S VERY COMPLICATED. ONE OF THE THINGS THAT WE ARE ADDING TO OUR DATABASE, AND IT WILL BE AVAILABLE SOON, IS A NATIONAL--AN AGGREGATED DATA SET OF YRBS DATA FROM ACROSS THE COUNTRY, NOT JUST THE SITES [SPELLED PHONETICALLY] THAT ARE IN THE MMWR, BUT ALL OF THEM. AND THAT DATA SET HAS BEEN WEIGHTED TO ADJUST FOR THE CHARACTERISTICS OF THE STATE OR THE CITY WHERE THEY WERE COLLECTED, AND SOME OTHER STATISTICAL PROCEDURES, TO CREATE A DATA SET THAT CAN BE ANALYZED AS A NATIONAL DATA SET. SO IT TAKES A LOT OF WORK TO DO THAT AND--BUT IT CAN BE DONE, AND THAT'S ONE OF THE RECOMMENDATIONS, IF YOU GO INTO A LITTLE MORE DETAIL IN THE IOM REPORT, THAT SAYS, THESE ARE SOME OTHER WAYS THAT YOU CAN START TO USE THE DATA THAT YOU HAVE NOW. BUT IT'S VERY COMPLICATED AND ONE OF THE REASONS WHY WE DON'T HAVE BETTER DATA THAN WE HAVE RIGHT NOW. FEMALE SPEAKER: [INAUDIBLE] FEMALE SPEAKER: OR THE FOLLOW-UP AND ALSO ABOUT THE ISSUE OF SELF-IDENTIFICATION. SO HOW DO YOU GET--BECAUSE YOU CAN DO THE SURVEY--AND I USED TO WORK WITH NSFG--BUT YOU CAN DO THE SURVEY AND ASK PEOPLE TO SELF-IDENTIFY, BUT IN YOUR DATA, YOU SAID, YOU KNOW, IF PEOPLE WEREN'T LIKELY TO SELFáOR BISEXUALS WERE LESS LIKELYá DR. JUDITH BRADFORD: RIGHT. FEMALE SPEAKER: -- SO, AGAIN, YOU KNOW, HOW DO YOU GET AROUND THOSE ISSUES TO REALLY BE ABLE TO, YOU KNOW? DR. JUDITH BRADFORD: RIGHT. I THINK THIS IS GETTING BETTER, AND THE--I THINK YOU'RE ASKING ABOUT THE NON-RESPONSE RATE, BASICALLY, IN SURVEYS. SO THIS HAS BEEN A MATTER OF GREAT CONCERN. THE RESPONSE--THE NON-RESPONSE RATE ON FEDERAL SURVEYS IS LOWERING NOW. AND IN--WHERE THE ISSUES ARE WITH NON-RESPONSE ARE NOT SPECIFICALLY AROUND THE LGB MEASURES, AS MUCH AS THEY ARE WITH LOW INCOME POPULATIONS AND HISPANIC POPULATIONS. SO MODIFYING THE WAY THE QUESTIONS ARE ASKED ON--AND ON NSFG, OR HOW THEY MAY BE ASKED ON [UNINTELLIGIBLE] NHIS, WHICH IS A MAJOR UNDERTAKING RIGHT NOW, THAT PROJECT IS IN THE NATIONAL CENTER FOR HEALTH STATISTICS QUESTIONNAIRE LAB, TO TRY TO FIGURE OUT HOW TO MAKE THE MEASURES WORK ADEQUATELY FOR LOW INCOME PEOPLE AND HISPANIC PEOPLE, PEOPLE WHO IDENTIFY AS HISPANIC. SO IT'S A MOVING TARGET, BUT IT'S STRONG ENOUGH NOW AND THE NON-RESPONSE RATE IS LOW ENOUGH ON NATIONAL SURVEY OF FAMILY GROWTH, FOR INSTANCE, SO THE QUESTIONS CAN BE ASKED. ONE OF THE THINGS ABOUT THIS THAT I PERSONALLY HAVE SOME REACTIONS TO, IS A RECOMMENDATION THAT SOME WOULD MAKE THAT YOU NOT PROVIDE A SPACE TO PUT SOMETHING ELSE. AND WE ARE TESTING THAT A LITTLE BIT IN OUR HEALTH--IN OUR POPULATION AT FENWAY HEALTH RIGHT NOW TO SEE WHETHER YOU GET A DIFFERENT RESPONSE RATE IF YOU ALLOW PEOPLE TO SAY SOMETHING ELSE OR IF YOU FORCE PEOPLE TO CHECK A QUESTION, BUT IT'S STILL A MOVING TARGET. MALE SPEAKER: LET ME RESPOND TO THAT QUESTION, BECAUSE I ATTENDED THE COUNSEL MEETING OF THE NATIONAL CENTER FOR HEALTH STATISTICS, AND [UNINTELLIGIBLE] ALSO FUNDED A STUDY WITH NCHS ON [UNINTELLIGIBLE] TO AUDIO COMPUTER-ASSISTED [UNINTELLIGIBLE] SURVEY. SO THEY TALK ABOUT THE NATIONAL FAMILY GROWTH CYCLE [SPELLED PHONETICALLY] STUDY. THEY TALK ABOUT [UNINTELLIGIBLE] STUDY, AS WELL AS THE [UNINTELLIGIBLE], AND AS DR. BRADFORD MENTIONED IN THE EARLIER SURVEYS, THAT THERE'S A LOT OF MISSING DATA--ALSO THE WAY THE QUESTION'S ASKED ABOUT WHETHER YOU ARE HETEROSEXUAL, BISEXUAL, HOMOSEXUAL, ET CETERA. BUT EVENTUALLY, WHEN THEY IMPROVED THEIR QUESTION BY ADDING A QUOTATION SAYING, "HETEROSEXUAL, PARENTHESES, STRAIGHT, HOMOSEXUAL, PARENTHESES, GAY," THEY IMPROVED THE RESPONSE RATE, AND THERE WERE LESS MISSING QUESTIONS. AND ALSO OVER THE YEARS THAT FURTHER DEFINE THEIR QUESTIONS BETTER, AND ALSO BY ADDING THIS [UNINTELLIGIBLE] QUESTION WHERE--THAT THERE IS, FORTUNATELY [SPELLED PHONETICALLY], FOR THE RESPONDENTS TO PUT IN THEIR RESPONSES, HAS ALSO IMPROVED THE RESPONSES OF THE OTHER PARTICIPANTS AND THAT STUDY'S STILL GOING ON. FEMALE SPEAKER: THANK YOU, VERY MUCH, THAT WAS REALLY GREAT. YES, SUSAN? OH, I'M SORRY. FEMALE SPEAKER: I THINK WE SHOULD ALSO PUT IT INTO CONTEXT THAT THERE'S A LOT MORE MISSING VALUES ON HOW MUCH MONEY DO YOU MAKE THAN THERE IS ON WHAT'S YOUR GENDER ORIENTATION, THAT MONEY IS A HECK OF A LOT MORE SENSITIVE TO MOST RESPONDENTS THAN IS SEX. FEMALE SPEAKER: I WOULD LIKE TO BRING TWO ISSUES UP THAT MAYBE YOU CAN HELP ME WITH IN TERMS OF UNDERSTANDING THEM. AND BEFORE I ASK THEM, I FEEL THAT I SHOULD SAY THAT THE HISPANIC OR LATINO COMMUNITY HAS BEEN TRYING TO HAVE ADEQUATE INFORMATION GATHERED FOR THE POPULATION GROUP FOR THE LAST 30 YEARS, AND STILL THEY ARE NOT ABLE, THOSE THAT COLLECT THE INFORMATION, ARE STILL NOT ABLE TO DISAGGREGATE THE INFORMATION BY SUB-ETHNIC GROUP. SO, THAT IS AN AREA OF CONCERN BECAUSE A PUERTO RICAN IS NOT A CUBAN IS NOT A MEXICAN AMERICAN, AND THERE ARE VERY DISTINCT SUB-ETHNIC CULTURAL AND LINGUISTIC DIFFERENCES AMONG THE GROUPS. SINCE THE SAMPLES ARE VERY SMALL TO DESEGREGATE THE DATA BY THOSE SUB-CATEGORIES -- DR. JUDITH BRADFORD: RIGHT. FEMALE SPEAKER: -- IS THERE A POSSIBILITY OF DOING A NATIONAL--OF TRYING TO OBTAIN A NATIONAL DATA SET THAT WILL FOCUS PRIMARILY ON LATINOS OR HISPANICS, SO THAT IT CAN BE REFINED TO THE DEGREE THAT SUB-CATEGORIES SUCH AS SUB-ETHNICITY CAN BE INCLUDED, AS WELL AS CULTURAL ISSUES, SUCH AS FIRST GENERATION ARRIVALS VERSUS SECOND, THIRD, AND FOURTH GENERATION. YOU KNOW, THAT IS ONE ISSUE, AND THE SECOND ONE IS I SEE THAT WE ARE TALKING ABOUT NATIONAL DATA, BUT I DIDN'T SEE PUERTO RICO OR THE VIRGIN ISLANDS APPEARING IN THE MAP, AND I'M WONDERING WHETHER PUERTO RICO WAS PART OF THIS NATIONAL SURVEY DATA OR WHETHER IT WAS NOT? DR. JUDITH BRADFORD: IS IT [SPELLED PHONETICALLY] THAT IS NOT ON THE SLIDES THAT I SHOWED FROM DR. GATES' STUDY, THEN I CAN'T--I'M SORRY I CAN'T ANSWER. FEMALE SPEAKER: THE REASON I -- DR. JUDITH BRADFORD: I DON'T KNOW THE ANSWER TO THE QUESTION, MAYBE SOMEONE ELSE DOES. FEMALE SPEAKER: THE REASON I BRING IT UP IS--AND THAT IS SOMETHING THAT ALSO HAPPENS WITH CDC DATA. DR. JUDITH BRADFORD: I SEE WHAT YOU'RE SAYING. FEMALE SPEAKER: SO SOMETIMES THEY'LL SHOW PUERTO RICO AND SOMETIMES THEY WON'T. SO ONE NEVER KNOWS WHETHER IT'S REFERRING TO THE CONTINENTAL UNITES STATES, OR WHETHER, YOU KNOW, IT'S NATIONAL IN SCOPE. BUT PUERTO RICO NOW HAS ALMOST A 5 MILLION POPULATION NUMBER IN THE ISLAND, PLUS SOME ADDITIONAL 4 MILLION RESIDING OUTSIDE THE ISLAND, AND THE LBGT POPULATION IN PUERTO RICO IS RATHER SIZABLE, BECAUSE HIV/AIDS SURVEYS HAVE TAKEN SOME OF THE FIGURES INTO ACCOUNT, SO IT WOULD APPEAR TO ME THAT IF THIS DATA DON'T HAVE INFORMATION INCLUDING PUERTO RICO WITHIN THE HISPANIC POPULATION GROUP, IT'S UNDERCOUNTING, AND THE NUMBERS WOULD BE MUCH HIGHER. DR. JUDITH BRADFORD: I THINK THAT'S AN EXCELLENT POINT TO MAKE. JUST SO THAT I'M CLEAR, WHICH DATA SET ARE YOU REFERRING TO? THE MMWR REPORT OR THE BRFSS DATA? FEMALE SPEAKER: BOTH OF THEM. DR. JUDITH BRADFORD: ALL RIGHT. FEMALE SPEAKER: IT WASN'T CLEAR TO ME, AS TO WHETHER--EVEN THE CENSUS DATA -- DR. JUDITH BRADFORD: YEAH. FEMALE SPEAKER: -- IS NOT CLEAR WHETHER THEY'VE INCLUDED PUERTO RICO. DR. JUDITH BRADFORD: OKAY. FEMALE SPEAKER: OKAY. DO WE HAVE ANY OTHER QUESTIONS? WE'D LIKE TO THANK DR. BRADFORD FOR THAT WONDERFUL PRESENTATION.. [APPLAUSE] DR. JUDITH BRADFORD: YOU'RE VERY WELCOME. DR. JOYCE HUNTER: AND [UNINTELLIGIBLE] AND I WOULD LIKE TO REMIND EVERYONE THAT OUR NEXT SEMINAR IS JULY 28. IT WILL BE AT THE NATCHER CONFERENCE CENTER AT 2 P.M., AND OUR SPEAKER IS DR. PETE--PETER HOTEZ. HE'S FROM GEORGE WASHINGTON UNIVERSITY, AND HIS SUBJECT IS "LEFT BEHIND IN AMERICA: OUR NATION'S NEGLECTED INFECTIONS OF POVERTY." THANK YOU ALL VERY MUCH, AND AS I ALWAYS SAY, COME NEXT WEEK, BRING A FRIEND, AND HAVE THEM BRING TWO FRIENDS. THANK YOU. NEXT MONTH, NOT NEXT WEEK. DR. JOHN RUFFIN: JUST ONE QUICK COMMENT, FIRST OF ALL, I WANT TO THANK DR. BRADFORD FOR A VERY STIMULATING CHAT, AND I HAD SAID TO HER EARLY ON THAT ONE OF THE THINGS ABOUT MINORITY HEALTH AND HEALTH DISPARITIES, AND AS I HAVE BEEN AT NIH NOW ABOUT 22 YEARS, AND I REMEMBER SOMEONE ASKING ME ALONG THE WAY, WHAT WAS THE MOST DIFFICULT PART OF THE JOB AS IT RELATES TO STIMULATING DISCUSSIONS OF MINORITY HEALTH AND HEALTH DISPARITIES? AND OF COURSE, MY COMMENT TO THE PERSON AT THE TIME WAS THAT THE MOST DIFFICULT PART OF THE JOB IS CONVINCING PEOPLE, BUT PEOPLE WHO CAN MAKE A DIFFERENCE. OTHERWISE, YOU'RE JUST PREACHING TO THE CHOIR. BUT PEOPLE WHO CAN MAKE A DIFFERENCE THAT THESE ISSUES, FIRST OF ALL ARE REAL, AND THEN ONCE WE CAN DO THAT, THEN WE CAN MOVE ON WITH THE DISCUSSION OF MAKING SURE THAT WE CAN FIND WHERE THE GAPS ARE AND BEGIN TO ADDRESS THOSE GAPS. SO I WANT TO THANK YOU FOR BRINGING THIS DISCUSSION TO THE FOREFRONT, BUT NOT ONLY FOR BRINGING THE DISCUSSION TO THE FOREFRONT, BUT TO THANK YOU ON BEHALF OF NIH FOR SERVING ON THE IOM COMMITTEE. I WAS THERE THE DAY THAT THEY PRESENTED THE RESULTS OF THE STUDY, AND SO I WANT TO THANK YOU PUBLICLY FOR WHAT YOU HAVE DONE, AND WHAT YOU ARE CONTRIBUTING TO [INAUDIBLE]. THANK YOU SO MUCH. [APPLAUSE] [APPLAUSE]