>>ON BEHALF OF THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DISPARITIES, I WOULD LIKE
TO WELCOME YOU TO THE HEALTH
DISPARITIES AMONG SEXUAL AND
GENDER MINORITIES WORKSHOP.
MY NAME IS RADA DAGHER AND I'M A
SCIENTIFIC DIRECTOR AT THE
NATIONAL INNSITUTE ON NIMHD, I
WILL BE GIVING YOU AN OVERVIEW
OF THIS WORKSHOP, NEXT SLIDE,
THIS WAS PREPARED BY ME AND ANY
OPINIONS EXPRESSED REFLECT MY
OWN AND NOT THE NATIONAL
INTUITYS OF HEALTH'S OPINIONS OR
THE UNITED STATES OF GOVERNMENT
NEXT SLIDE, PLEASE.
TO GIVE YOU SOME BACKGROUND,
ACCORDING TO THE NATIONAL
ACADEMY OF SCIENCES REPORT OF
2020, THERE ARE ABOUT 11 MILLION
LESBIAN, GAY, BISEXUAL, ASEXUAL,
TRANSGENDER IN THE UNITED
STATES, THAT'S APPROXIMATELY THE
POPULATION SIZE OF OHIO.
THE NATIONAL INTUITYS OF HEALTH
AND SEXUAL GENDER MINORITY
RESEARCH OFFICE STATES THAT
SEXUAL AND GENDER MINORITY
POPULATIONS INCLUDE BUT ARE NOT
LIMITED TO LESBIAN GAY,
BISEXUAL, ASEXUAL, TRANSGENDER,
2 SPIRIT, QUEER AND/OR INTERSEX.
ALSO INDIVIDUALS WHO IDENTIFY AS
SAME SEX OR GENDER ATTRACTIONS
AND BEHAVIORS AND THOSE WITH
BEHAVIORS IN SEX DEVELOPMENT ARE
ALSO INCLUDED.
ALSO INCLUDED ARE THOSE WHO DO
NOT SELF-IDENTIFY WITH 1 OF THE
TERMS BUT WHOSE SEXUAL ORIENT
ANTICIPATION, GENDER E DENTITY
OR EXPRESSION OR REPRODUCTIVE
DEVELOPMENT IS CHARACTERIZED BY
NONBINARY CONSTRUCTS OF SEXUAL
ORIENTATION, GENDER AND/OR SEX.
SGM POPULATIONS HAVE INCREASED
RISK A RANGE OF HEALTH
DISPARITIES, INCLUDING
CARDIOVASCULAR DISEASE,
DIABETES, CANCER, VIOLENCE, HIV,
MENTAL HEALTH, SUBSTANCE USE AND
BEHAVIORIAL HEALTH.
THEY ALSO ENCOUNTER HEALTH
DISPARITIES AND SLEEP
DISTURBANCES.
HOWEVER, HIV RESEARCH HAS TAKEN
THE LION'S SHARE OF RESEARCH IN
THIS AREA AND MANY OF THE OTHER
HEALTH OUTCOMES I MENTIONED DID
NOT RECEIVE ENOUGH RESEARCH.
NEXT SLIDE, PLEASE.
IN ADDITION AND NEW ARTICLE IN
THE JOURNAL OF THE MEDICAL,
AMERICAN MEDICAL ASSOCIATION,
FOUND THAT COMPARED WITH
HETEROSEXUAL ADULTS, A GREATER
PROPORTION OF GAY AND LESBIAN
ADULTS ARE REPORTED HAVING
RECEIVED AT LEAST 1 DOSE OF
COVID-19 VACCINE.
HOWEVER, VACCINATION RATES WERE
LOWEST AMONG BLACK LESBIAN GAY
BISEXUAL AND TRANSGENDER
INDIVIDUALS, PARTICULARLY WOMEN,
SO YOU CAN SEE THAT HOW
INTERSEXUALITY IS SO IMPORTANT.
NEXT SLIDE, PLEASE.
SO WHAT ARE SOME RECENT NIH
CONTRIBUTIONS TO SGM RESEARCH?
NIH HAS RECENTLY COMMISSIONED 2
NATIONAL ACADEMY OF SCIENCE
REPORTS, 1 IN 2020 THAT REVIEWED
WITH THE POPULATION AND ANOTHER
IN 2022, THAT MEASURED SEX,
GENDER IDENTITY AND SEXUAL
ORIENTATION.
THERE HAVE BEEN ALSO SOME RECENT
NIH FUNDING OPPORTUNITIES ON HIV
PREVENTIONS AS WELL AS OTHER
HEALTH OUTCOMES AFFECTING SEXUAL
AND GENDER MINORITY POPULATIONS.
IN ADDITION, THE NIMHD ADVICERY
COUNCIL IN MAY 2022 APPROVED THE
CONCEPT ON ADDRESSING HEALTH AND
HEALTH DISPARITIES ON SEXUAL AND
GENDER MINORITY POPULATION.
AND THIS WILL INFORM FUTURE
BASICALLY FUNDINGLY
OPPORTUNITIES AT NIH.
NEXT SLIDE, PLEASE.
SO SOME RESEARCH GAPS THAT THE
NATIONAL ACADEMY REPORT HAS
INDICATED AS WELL AS RECENT
LITERATURE, INCLUDE THE NEED FOR
EVIDENCE BASED INTERVENTION AND
LONGITUDINAL STUDIES IN SGM
RESEARCH, STUDIES ON HOW
STRUCTURAL STIGMA DEVELOPS AND
EVOLVES ACROSS THE LIFE SPAN TO
IMPACT HEALTH AND HEALTHCARE
DISPARITIES, INTERVENTIONS
ADDRESSING DISCIPLINARY
INTERSECTIONALITY.
INTERVENTIONS TO IMPROVE ACCESS
TO AND QUALITY OF CARE, STUDIES
EXAMINING SOCIAL DETERMINANTS OF
HEALTH AND HOW DIFFERENTIAL
ACCESS TO OPPORTUNITIES AND
RESOURCES IMPACT DISPARITIES AND
YOU LEARN A LOT MORE DURING THIS
WORKSHOP ABOUT WHAT THE GAPS
ARE.
NEXT SLIDE, PLEASE.
SO WHAT IS THE GOAL OF THIS
WORKSHOP?
WELL THE MAIN GOAL IS TO ADVANCE
RESEARCH ON HEALTH DISPARITIES
AMONG SEXUAL AND GENDER
MINORITIES.
WE HOPE TO IDENTIFY RESEARCH
GAPS AND OPPORTUNITIES IN DATA
SOURCES AND MEASURES THAT CAN BE
USED TO ASSESS AND ADDRESS SGM
HEALTH DISPARITIES AND
MECHANISMS OR PATHWAYS THAT
CAUSE AND DRIVE SGM HEALTH
DISPARITIES AND INTERVENTIONS
WITH THE POTENTIAL TO MITIGATE
OR REDUCE SGH M HEJT
DISPARITIES.
NEXT SLIDE, PLEASE.
I WOULD LIKE TO GIVE SPECIAL
THANKS TO THE WORKSHOP PLANNING
COMMITTEE AND MY COLLEAGUES WHO
CAME FROM DIFFERENT INSTITUTES
AND OFFICES AND BROUGHT THEIR
IMPORTANT EXPERTISE TO THE
PLANNING OF THIS WORKSHOP.
I WOULD ALSO LIKE TO THANK MY
SUPERVISOR FOR GIVING US
VALUABLE FEEDBACK THROUGHOUT THE
PLANNING OF THE WORKSHOP.
NEXT SLIDE, PLEASE.
IN TERMS OF SESSION MODERATING,
MEMBERS OF THE PLANNING
COMMITTEE ARE GOING TO HELP
MODERATE THE DIFFERENT SESSIONS
AND WE ARE ALSO FORTUNATE TO
HAVE DR. KAREN PARKER WHO WILL
ALSO MODERATE THE LAST SESSION
OF TODAY AND WILL HELP US MAKE
SENSE OF ALL THE THINGS THAT
WERE DISCUSSED TODAY.
NEXT SLIDE, PLEASE.
OKAY, SO, JUST TO GIVE YOU
BEFORE I CLOSE, A SENSE OF THE
WORKSHOP AGENDA, BASICALLY, EACH
SESSION WILL HAVE 3-4 SPEAKER
AND WILL BE FOLLOWED BY Q&A, AND
WE HOPE THAT THE SPEAKERS WILL
GIVE US SOME OF THEIR THOUGHTS
ABOUT WHERE THIS FIELD IS GOING
AND WHAT ARE SOME IMPORTANT
RESEARCH DIRECTIONS.
DAY 1 WILL DISCUSS MAINLY METHOD
LOGICAL ISSUES AND DRIVERS AND
MECHANISMS OF HEALTH
DISPARITIES.
DAY 2 WILL DISCUSS INTERSECTION
BETWEEN SGM AND OTHER
POPULATIONS AND GAPS AND
OPPORTUNITIES IN INTERVENTION
RESEARCH AND AT THE END OF EACH
DAY, WE WILL HAVE TIME TO
BASICALLY DISCUSS AND MAKE SENSE
OF WHAT WAS DISCUSSED DURING THE
DAY.
NEXT SLIDE, PLEASE.
I WOULD LIKE TO END WITH A QUOTE
BY THE GREAT POET LORCA, EVERY
STEP WE TAKE ON EITHER BRINGS US
TO A NEW WORLD.
I DO HOPE THIS WORKSHIP WILL
TAKE US 1 STEP FURTHER AND
CLOSER TO A NEW WORLD THAT IS
FREE OF HEALTH DISPARITIES.
NEXT SLIDE, PLEASE.
IT IS MY PLEASURE NOW TO
INTRODUCE DR. ELISEO
PEREZ-STABLE WHO HELPED US WITH
THIS WORKSHOP AND PLANNED THE
FUNDING FOR IT, HE WAS ALSO, IN
HIS LEADERSHIP IN 20 SCEKS, SGM
POPULATIONS WHERE DESIGNATED AS
A HEALTH DISPARITY POPULATIONS
FOR NIH RESEARCH.
DR. PEREZ-STABLE, PLEASE GO
AHEAD.
>>THANK YOU SO MUCH RADA, AND
YOU TURN MY HEAD THERE WITH THE
QUOTE FROM LORCA.
SO WELCOME, EVERYONE AND I WANT
TO RITY RIGHT MY THANKS TO ALL
THE STAFF WHO WORKED ON THIS
WORKSHOP OVER THE LAST SEVERAL
MONTHS.
GREAT PLANNING COMMITTEE.
GREAT EFFORT AND PASSION IN THE
COLLABORATION FROM OTHER NIH
UNITS, PARTICULARLY SGM AND THE
OFFICE OF RESEARCH ON WOMEN'S
HEALTH.
I'M GOING TO DO A BRIEF
PRESENTATION ON GENERAL NIMHD
PERSPECTIVES.
LET ME GET MY SCREEN SHARED.
BEFORE YOU GET ON WITH THE REAL
WORK, LET ME GET THIS SLIDE TO
SHOW.
HERE WE GO.
HOPEFULLY EVERYONE CAN SEE THIS.
LET ME GET THOSE THINGS OUT OF
THE WAY.
ALL RIGHT.
AS RADA SAID IN 2016, WE
DECLARED SEXUAL AND GENDER
MINORITIES AS THE POPULATION
WITH HEALTH DISPARITIES.
THAT ACTUALLY WAS A PROCESS THAT
HAD BEEN ONGOING AT NIH FOR
SEVERAL YEARS AND IN FACT WITHIN
THE FIRST WEEK OF MY ARRIVAL AT
NIH, I RECEIVED A REQUEST FROM
DR. TABAK ABOUT, YOU KNOW
WHETHER I SUPPORTED THIS OR NOT
AND IT HAD NOT BEEN SOMETHING I
WAS AWARE OF BEFORE COMING HERE.
BE THAT AS IT MAY, THE FOLLOW
UP, THE FIRST 3 BULLETS ON THIS
SLIDE IS WHAT'S INCLUDED IN OUR
ORIGINAL LEGISLATION, ALL RACIAL
AND ETHNIC MINORITY POPULATIONS
IN CENSUS AND THEY MAY BE
EVOLVING FOR 2030.
ALL POOR PEOPLE OF ANY RACE
ETHNICITY, HOWEVER WE DEFINED
IT, AND THEN UNDERSERVED RURAL
RESIDENTS.
THE ADDITION OF SEXUAL AND
GENDER MINORITIES TOOK A
PROCESS, I THINK THE UPON--AT
THE TIME IN DEALING WITH THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, THIS PARTICULAR COPY
EMPHASIZING SOCIAL DISADVANTAGE
THAT RESILTS IN PART IF BEING
SUBJECT TO DISCRIMINATION OR
RACISM IN ADDITION BEING
UNDERSERVED IN HEALTHCARE, WAS I
THINK THE CLENCHER IN PERSUADING
THE DEPARTMENT THAT THIS WAS A
GOOD MOVE.
IT IS QUALIFIED AS A--FOR NIH
RESEARCH AND I EMPHASIZE IT
NIMHD DOES DECLARE THE
POPULATIONS ON THE PERSON
DESIGNATED TO MAKE THAT
DECLARATION OR DECISION BUT THIS
IS FOR ALL OF NIH NOT JUST FOR
NIMHD, WE FUND 15-20% OF ALL
RESEARCH IN MINORITY HEALTH,
HEALTH DISPARITIES SO THIS IS
REALLY APPLICABLE TO EVERY
INSTITUTE, CENTER AND OFFICE AT
THE AGENCY ANDEN IT DEFINING
DISPARITY, WE FOCUS ON HEALTH
OUTCOMES THAT ARE WORSE IN 1 OF
THESE POPULATIONS GROUPS, WE'VE
ALMOST ALWAYS USED A COMPARISON
GROUP FOR EXAMPLE IN THE RACIAL
ETHNIC COMPARISONS, AND I THINK
THIS IS A--TO DEFINE HEALTH
DISPARITY AND THIS IS SOMETHING
THAT WE ARE REVIEWING AGAIN THIS
YEAR.
WHAT CAN WE DO TO REDUCE THESE
DISPARITIES OR INIQUITIES, THESE
ARE JUST GENERAL PRINCIPLES FOR
ALL THIS RESEARCH, STANDARDIZED
MEASURES, EVER ALL THE SOCIAL
AND DEMOGRAPHIC FACTORS THAT
AFFECT HEALTH, I'LL COME BACK TO
THAT IN A MINUTE.
WE REALLY NEED TO DEVELOP MORE
CAPACITY AND SKILLS AND BIG DATA
AND IN DATA SCIENCE BECAUSE THIS
IS NOT ONLY CONTINUING TO GROW,
BUT WE ARE UNDERRESOURCED AS A
POPULATION OF SCIENTISTS TO WORK
WITH THESE DATA.
SO WE ENCOURAGE ANY OF YOUR
TRAINEES TO THINK AND CONSIDER
THIS.
WE ALSO NEED TO BE AN ENGINE FOR
PROMOTING DIVERSITY OF THE
SCIENTIFIC AND CLINICAL
WORKFORCE.
MOST OF THE TIME WE MEASURE THIS
THROUGH UNDERREPRESENTED RACIAL
AND ETHNIC GROUPS.
WE HAVE MADE VERY LITTLE
PROGRESS OVER THE LAST 40 YEARS
OR SO, IT'S ABOUT 7% OF NIH
PRINCIPLE INVESTIGATORS, ARE
COME FROM UNDERREPRESENTED
RACIAL AND ETHNIC GROUPS.
YOU MAY WANT TO KNOW, WELL
WHAT'S THE REPRESENTATION OF
SEXUAL AND GENDER MINORITIES, WE
DON'T KNOW BECAUSE IT'S
STILL--WE'RE STILL TRYING TO GET
PEOPLE TO ASK AS YOU WILL HEAR,
I'M SURE LATER TODAY.
I THINK THE PANDEMIC REALLY MADE
IT CLEAR THAT HAVING A COMMUNITY
ENGAGED APPROACH TO PROBLEMS IS
A RESEARCH METHOD THAT NEEDS TO
BE SUPPORTED AND SUSTAINED IN
CULTIVATING THESE COMMUNITY
ENGAGEMENT, IT'S A CENTRAL PART
OF NIMHD SINCE ITS FOUNDING IN
THE EARLY 2000S.
AND I WOULD SAY THIS APPLIES TO
MANY OF THE CHALLENGES WE FACE
IN HELT CARE AND HEALTH.
AND FINALLY WE NEED TO EMPHASIZE
IMPLEMENTATION SCIENCE.
IMPLEMENT WHAT WE KNOW WORKS
BECAUSE FREQUENTLY, THE THINGS
WE KNOW WORK ARE OFTEN UNDER
DEPLOYED, UNDERIMPLEMENTED IN
THE POPULATIONS THAT SUFFER THE
MOST.
SO LET ME SHOW YOU AN EXAMPLE OF
WHAT I WOULD SAY
INTERSECTIONALITY, THIS IS
EXTRACTED FROM A REPORT IN MMWR
A FEW YEARS AGO AND IT'S LOOKING
AT YOUTH OBESITY AND IF YOU LOOK
AT IT BY RACE ETHNICITY WITH
THESE 4 GROUPS THAT WERE
REPORTED IN MALES AND FEMALES,
THE DIFFERENCES HERE IS HOW MUCH
LESS YOUTH OBESITY THERE WAS BY
THE EDUCATIONAL LEVEL OF THE
HEAD OF HOUSEHOLD.
COLLEGE IS I HIGH END AND LESS
THAN HIGH SCHOOL ON THE LOW END
THEY WERE IN BETWEEN CATEGORIES
AS WELL BUT IT'S SIMPLIFIED TO
MAKE A POINT.
FIRST OF ALL OBESITY RATES AMONG
YOUTH VARY WITH BLACKS AND
LATINOS HAVING THE HIGHEST RATE
PARTICULARLY BLACK FEMALES AND
WE ALSO KNOW, AND THEN WHITES
ARE CLOSE BEHIND, ASIANS BEING
LOWER AND THIS IS HOW MUCH IT
CHANGED WHEN YOU HAD A MORE
EDUCATED HEAD OF HOUSEHOLD, A
COLLEGE HEAD EDUCATED HOUSEHOLD
VERSUS A LESS THAN HIGH SCHOOL.
YOU CAN SEE DEFERENTIAL BENEFIT
BY ETHNICITY AND THIS IS
PRECISELY THE KIND OF RESEARCH
THAT WE NEED TO DO MORE OF AS
OPPOSE TO DISCRYPTIVE OF ONLY 1
MINORITY GROUP WHICH CAN BE
HELPFUL OR WHEN WE DON'T KNOW OR
COMBINING AND ADJUSTING FOR THE
OTHER FACTORS.
HERE'S AN EXAMPLE OF COMMONLY
NATIONAL RATES OF BEHAVIOR RISKS
IN LESBIAN GAY AND BISEXUAL
INDIVIDUALS REPORTED BY THIS CDC
ON TOBACCO USE A NUMBER OF YEARS
AGO.
OF CONCERN, YOU CAN SEE THAT
FORAYS ETHNICITY THERE'S SOME
INTERESTING PATTERNS BUT NOTHING
THAT STANDS OUT TREMENDOUSLY,
HIGHER RATE FOR AMERICAN INDIAN
AND ALASKA NATIVES, LOWER FOR
LATINOS AND ASIANS BUT FOR
LESBIAN GAY AND BISEXUAL, THE
RATE OF COMBUSTIBLE TOBACCO USE
WAS AS HIGH AS IT WAS FOR
AMERICAN INDIAN AND ALASKA
NATIVE AND WE SEE A STRONG
EDUCATIONAL GRADIENT.
THIS IS WORK WE ARE
COLLABORATING WITH, THE
INSTITUTE FOR HEALTH METRIC
EVALUATION AT THE UNIVERSITY OF
WASHINGTON, LOOKING AT
DIFFERENCES IN LIFE EXPECTANCY
BY COUNTY AND RACE ETHNICITY AND
WE CONFIRM THAT FOR EXAMPLE,
AMONG ASIAN AMERICANS, WE SEE
BETTER OUTCOMES WITH LIFE
EXPECTANCY ACROSS THE COUNTRY,
AMONG LATINO HISPANICS,
GENERALLY BETTER BUT THERE ARE
AREAS, THE BORDER, HAWAII AND
THE 4 CORNER AREAS AND PARTS OF
ARIZONA WHERE LIFE EXPECTANCY IS
SHORTER THAN FOR WHITES.
I SHOULD HAVE SAID THE BROWN
COLOR OR LESS THAN WHITE, THE
PURPLISH COLORS ARE BETTER THAN
WHITES.
FOR AFRICAN AMERICANS WE SEE
MOSTLY WORSE THAN WHITES, BUT
THERE ARE AREAS OF BETTER
OUTCOMES AND FOR AMERICAN INDIAN
AND ALASKA NATIVE SIMILARLY,
MOSTLY SHORTER LIFE EXPECTANCY
WITH SOME AREAS WHERE RESULTS
ARE BETTER.
I MENTIONED BEFORE THE
STANDARDIZED MEASUREMENT OF
SOCIAL AND DEMOGRAPHIC FACTORS.
NIMHD EMBARK OFFICE OF DIVERSITY
THIS PROJECT BACK IN I GUESS
2018, WE'VE GONE THROUGH 2
PHASES, IT'SOT PHOENIX TOOL KIT
WEBSITE, WE HAVE A SOCIAL
DETERMINANTS OF HEALTH PAGE, WE
COLLECTED THE DEMOGRAPHIC
MEASURES THAT WERE ALREADY THERE
AND IT IS NOW PROBABLY A GOOD
TIME TO REVIEW THOSE AND REVISE
THEM IN SOME PROCESS, GIVEN THE
RECENT OMB REQUEST FOR CHANGES
FOR ASKING ABOUT RACE ETHNICITY
AS WELL AS DISCUSSIONS THAT YOU
WILL HAVE ABOUT MEASUREMENT OF
SEXUAL ORIENTATION AND GENDER
IDENTITY.
BUT THE DEMOGRAPHICS INCLUDE A
VARIETY OF FACTORS AND THEN
STRUCTURAL DETERMINANTS AS I
LIKE TO CALL THEM RELATED TO
HOUSING, TECHNOLOGY, ACCESS TO
BROAD BAND, GREEN SPACE, ET
CETERA, HAVE BEEN MOST OF THE
FOCUS OF THE PROCESSES WE'VE HAD
IN THESE LAST 4 YEARS.
AND WE'RE AT A POINT WHERE WE
CAN PAUSE AND REFLECT ON WHERE
THIS IS.
WE WILL ENCOURAGE ALL OUR
INVESTIGATORS TO GO TO THIS
WEBSITE AND USE THESE MEASURES
IN THEIR RESEARCH AND WE
CERTAINLY WORKED UNDER THAT
OPERATIONAL ASPECT IN THE COVID
RESPONSE USING THE RAD-X UP AS
OUR MODEL.
WE CO CHAIRED THAT WITH OUR
MODEL AND THE INSTITUTE ON AGING
AND THE REALITY IS THERE'S A LOT
OF--THERE'S A LOT OF WORK TO BE
DONE IN USING THESE COMMON DATA
ELEMENTS, BOTH IN BUY IN AND
PRIMARILY FROM THE INVESTIGATOR
COMMUNITY, BUT ALSO THE GENERAL
COMMUNITIES, AND THERE ARE
PARTICULARLY ISSUES THAT NEED TO
BE ADDRESSED WITH SOME
POPULATIONS ABOUT ASKING CERTAIN
TYPES OF QUESTIONS.
BUT THIS THE DIRECTION WE NEED
TO MOVE IN THIS ORDER TO MAKE
BIG DATA BETTER.
IF WE ASK QUESTION 5 DIFFERENT
WAYS, THE COMPARABLE AND ABILITY
TO LINK THEM ARE GOING TO BE
LIMITED.
NIMHD STAFF DEVELOPED THIS
RESEARCH FRAMEWORK AS A GUIDE,
AS A ROADMAP IF YOU WISH TO
REALLY OUTLINE THE DIFFERENT
ASPECTS OF RESEARCH THAT
ENCOMPASS THE SCIENCE THAT WE
EMBRACE LOOKING AT BOTH
INDIVIDUAL AND PERSONAL,
COMMUNITY AND SOCIETAL POLICY
LEVEL ISSUES AS WELL AS THE
DIFFERENT DOMAINS OF INFLUENCE
HERE, EMPHASIZE THE HEALTH
SYSTEM THAT PEOPLE WITH CHRONIC
DISEASE ARE GOING TO DEPEND ON
AND USE EVEN THOUGH OVER 50% OF
THE ADULT POPULATION FREQUENTLY
NEEDS OR USES THE HELT CARE
SYSTEM FOR ANY CHRONIC PROBLEMS
FOR SURE.
THINK OF THE PHYSICAL BUILT-IN
ENVIRONMENT AS A NEWER
DEVELOPMENT LIKE THE BIOLOGICAL
EXPLOSION OF INFORMATION THE
LAST 25 YEARS, THIS IS AN AREA
OF RESEARCH THAT IT REALLY
EXPANDED IN THE LAST 20 YEARS.
SORRY, I KEEP HITTING THE WRONG
BUTTON.
AND THEN THE SOCIAL CULTURAL
ENVIRONMENT RELATED TO
ACTIVITIES HAS BEEN WELL STOABED
FOR MANY YEARS.
SO I MENTIONED THE CHALLENGE OF
RACISM, NOT A NEW PROBLEM, THESE
ARE DATA FROM 2015 THAT THE
KAISER FAMILY FOUNDATION SURVEY
REPORTED ON AND IN THE PAST 30
DAYS MORE THAN HALF OF AFRICAN
AMERICANS AND MORE THAN A THIRD
OF LATINOS, THESE ARE THE 3
GROUPS THAT WERE SAMPLED
REPORTED BEING TREATED UNFAIRLY
BECAUSE OF THEIR RACIAL OR
ETHNIC BACKGROUND IN A VARIETY
OF SETTINGS.
THIS REALLY HIGHLIGHTS A
PROBLEM.
IT'S SOMETHING WE HAVE BEEN
FOCUSED ON AND AWARE OF SINCE
OUR FOUNDING AND CERTAINLY THE
PANDEMIC IN 2020 AND THE EVENTS
SURROUNDING THE MURDER OF GEORGE
FLOYD RAISE THE AWARENESS OF
THIS AMONGST INSTITUTIONS AND
INDIVIDUALS.
THAT HAS WANED SOME BUT THE
PROBLEM HASN'T AND ON THE
INTERPERSONAL LEVEL, WE CAN DEAL
WITH IT IN DIFFERENT WAYS BUT
THE STRUCTURAL 1S ARE REALLY
DAUNTING.
THIS IS A MAP OF WASHINGTON D.
C. TO HIGHLIGHT THE POLICY OF
RED LINES OR WHAT CREATED
RESIDENTIAL SEGREGATION IN THE
UNITED STATES IN THE MAJORITY OF
URBAN CENTERS WHERE BANKS WOULD
NOT PROVIDE LOANS FOR PURCHASING
HOME TO THIS TYPE H
NEGRO-DEVELOPMENTS AND LOWEST
GRADE, THIS IS ACROSS THE RIVER
COMPARED TO HIGHEST GRADE
RESIDENTIAL POPULARITY THAT WAS
DOMINATED PRIMARILY BY WHITE
INDIVIDUALS.
YOU CAN SEE IN WASHINGTON D. C.,
YOU CAN SEE IT BY MAJORITY RACE
AREA, DIVISION, AND BY LIFE
EXPECTANCY.
AND THESE DATA HAD BEEN LOOKED
AT AND REPORTED IN MULTIPLE YEAR
SETTING.
YOUR ZIP CODE IS MORE IMPORTANT
FOR YOUR HEALTH THAN YOUR
GENETIC CODE AND SOME OF IS REAL
LOW BORNE OUT BY THESE
SOCIOECONOMIC CONDITIONS CREATED
BY REZONING DEBTIAL SEGREGATION.
I THINK IT'S IMPORTANT REALLY
THIS GROUP EMPHASIZE AGAIN, WHAT
IMPORTANCE IT IS TO DEVELOP A
DIVERSE CLINICAL WORKFORCE THAT
WILL CARE FOR OUR PATIENTS, WE
ALREADY SEE IMPERICALLY DATA
THAT THIS HAPPENS, THAT PATIENTS
ARE MORE LIKELY TO SEE MINORITY
CLINICIANS AND AGAIN, WE DON'T
HAVE DATA ON SGM STATUS OF
WHETHER OR NOT THAT WOULD BE THE
CASE AND MY SENSE, HAVING
PRACTICED MEDICINE FOR 37 YEARS
IN SAN FRANCISCO STHAT THERE IS
A COMPONENT OF THAT PRESENCE AS
WELL.
BUT WITHOUT HAVING DATA WE CAN'T
MAKE THESE OBSERVATIONS.
AND THERE IS LACK OF DATA ON
WHETHER DIVERSE SCIENTIFICS ARE
ACTUALLY BETTER AT RECRUITING
UNDERREPRESENTED POPULATIONS,
FOCUSING ON HEGHT DISPARITIES,
THERE IS SOME SELECTION BIOS
INVOLVED AND I THINK THIS IS AN
AREA FOR ONGOING WORK THAT NEEDS
TO BE COMPLETED.
I WANT TO PUT IN A PLUG FOR THE
HEALTH DISPARITIES RESEARCH
INSTITUTE THE APPLICATIONS ARE
OPEN UNTIL 2 WEEKS FROM
YESTERDAY MARCH 13th, WE'VE
BEEN DOING THIS SINCE 2016,
WE'VE HAD OVER 400 SCHOLARS
ATTEND.
WE'VE HAD SUPPORT FROM SGM RO,
AND INCLUDED A VARIETY OF
DISCIPLINES AND SPECIALTIES, SO
REALLY ENCOURAGE YOUR POST
DOCTORAL FELLOWS, USUALLY ON THE
SENIOR SIDE OR EARLY ASSISTANT
PROFESSORS TO APPLY.
WE ARE GOING BACK TO IN-PERSON
THIS YEAR, IN AUGUST SO LOOK
FORWARD TO A GREAT PROGRAM AT
THAT TIME.
LET ME SPEND THE LAST FEW
MINUTES TALKING ABOUT OUR
FUNDING.
FOR THE LAST 2 FISCAL YEAR, THIS
IS NIMHD ONLY, WE FUNDED 67
AWARDS OVER 2 YEARS THAT WERE
FOLK UTIONED ON SEXUAL AND
GENDER MINORITY RESEARCH WITHIN
NIMHD, WE ALSO HAD AWARDS THAT
WERE DONE WITH OTHER
EN--STRATEGIESITUTES, HEARTH
LUNG AND BLOOD, CHILD HEALTH AND
MENTAL HEALTH SPECIFICALLY.
YOU CAN SEE THE TOTAL THERE
AMOUNT THERE IS ABOUT
$44 MILLION OVER THESE 2 YEARS.
MOST OF THESE ARE RO-1S OR R21S,
THERE SOME Ks AND A SPRINKLE
OF F-GRANTS IN THERE AS WELL.
WE WORKED WITH THE HISPANIC
COMMUNITY HEALTH STUDY PIs,
BACK IN 2019 TO ADD THE
MEASURES, SOGI AND OTHER
MEASURES TO THEIR VISIT 3
QUESTIONNAIRE.
AND THAT WAS I THINK A VERY GOOD
PROCESS, IT WAS A TEAM OF US
FROM INTRAMURAL THAT WORKED ON
THIS WITH THEIR LEADERS.
THEY PRETESTED THE QUESTIONS.
THE MODULES WE'RE ADDED IN, SO
THEY'RE ON THE ONGOING DATA
COLLECTION NOW.
ANOTHER NHLBI COHORT MESA ALSO
ADDED SOGI QUESTIONS AND THERE'S
A GROUP OF AT LEAST 3
INVESTIGATOR WHO IS ARE FUNDED
IN ANCILLARY STUDIES TO THESE
COHORTS THAT ARE ACTIVELY WORKS
IN THIS ERIC RODRIGUEZ, AS THE
PLANNING COMMITTEE IS A
SCIENTIST IN MY LAB AND WE HAVE
A NUMBER OF PROPOSALS ONCE THE
STUDY IS COMPLETED IN THE
Q-RATING SO WE REALLY NEED TO
ASCERTAIN THE POPULATION IN
ORDER TO HAVE, REASONABLE
INCLUSION AND DIVERSITY GOALS.
WE DON'T KNOW THE DIMENSION OF
THE PROBLEM OR HOW VARIABLE IT
IS BECAUSE THERE HAS NOT BEEN
SYSTEMATIC ADMINISTRATION OF
QUESTIONS.
COUPLE OF QUICK EXAMPLES OF SOME
OF OUR FUNDED WORK THAT I'VE
SHOWN SHOULD COUNCIL, THIS IS
HOW DISCRIMINATION AND MEDICAL
MISTRUST CONTRIBUTE TO HIV AND
EQUITIES AMONG BLACKS.
HIV IS A STRONG COMPONENT OF THE
RESEARCH THAT CIRCULATES AROUND
SGM POPULATIONS, BUT 1 OF THE
PURPOSES OF DOING THIS WORKSHOP
AND WHEN WE WENT THROUGH THE
COUNCIL CONCEPT REVIEW IS REALLY
TO EXPAND TO OTHER AREAS BECAUSE
IT SEEMS THAT HIV HAS BEEN THE
FOCUS AND HAS BEEN THE
PREDOMINANT TOPIC, OF EITHER
RISK BEHAVIORS RELATED TO OR SEX
RELATED TO RISK OF ACQUIRING HIV
OR NOW, YOU KNOW TREATMENT AND
MAINTENANCE OR THERAPY.
THAT'S 1 OF THE GOALS.
THIS IS ANOTHER HIV RELATED
ARTICLE THAT RELATES TO
PREEXPOSURE PROPHYLAXIS USED BY
YOUTH, ADOLESCENTS WHO, MALES
WHO HAVE SEX WITH OTHER MALES
AND YOU CAN SEE THE ISSUE THERE
OF PARENTING AND FAMILY WAS
IMPORTANT AND FINALLY, THIS
OTHER STUDY THAT LOOKS AT THE
NATIONAL EPIDEMIOLOGY SURVEY ON
ALCOHOL AND RELATED CONCISIONS
SHOWING STRATIFIED REPORTING BY
RACE AND ETHNICITY BY ALCOHOL
USE DISORDER, TOBACCO USE
DISORDER AND KAN--KANA CANNABIE
DISORDER, AND I THINK A TREND IN
THE DATA I'VE SEEN AND THE DATA
I'VE SEEN THAT COMES THROUGH MY
COMPUTER WHERE DISCIPLINARY
SEXUAL INDIVIDUALS APPEAR TO
HAVE A HIGHER RISKS OF
BEHAVIORIAL RISK FACTORS IN THE
DATA WHERE THAT HAS BEEN LOOKED
AT.
MOST OF OUR FUNDED STUDY SAYS,
THERE'S BEEN A LOT.
THERE'S BEEN EMPHASIS ON
TRANSGENDER, WOMEN'S HEALTH,
PARTICULARLY AROUND THE RISK OF
VIOLENCE, SEX WORK AND SUBSTANCE
USE, AND FROM A CLINICAL
PERSPECTIVE, BOTH IN THE D. C.
AREA AS WELL AS IN THE
SAN FRANCISCO BAY AREA, VISIT
PARTICULARLY HIGH RISK GROUP IN
TERMS OF EXPLOITATION AND
BEHAVIOR AND HELT RISK BOTH FOR
ACQUIRING HIV AND OTHER
SUBSTANCES.
MENTAL HEALTH AND SUBSTANCE USE
HAVE BEEN FOCUSED ON HEAVILY IN
THIS RESEARCH, INTERPERSONAL
VIOLENCE, RELATED AGAIN TO SOME
TYPES OF SEX WORK, INTIMATE
PARTNER VIOLENCE, ASSAULT, YOU
KNOW JUST TARGETED FOR
DISCRIMINATION, SO AGAIN, THIS
IS WHERE WE'VE SEEN A NUMBER OF
RESEARCH PROJECT.
YOUTH BEHAVIOR IN THE DINL THAL
WORLD HAS BEEN BIG, PARTICULARLY
OF OUR KEY NOTE SPEAKER THIS
MORNING.
THE EFFECTS OF THE
DISCRIMINATION, LOTS OF HIV RISK
AND INFECTION MANAGEMENT AND
SOME POLICY STUDIES FOCUSED ON
INSURANCE, ACCESS OR NOT, A LACK
OF ACCESS, AND PARTICULARLY IN
IMMIGRANTS, THE AUTHORIZED OR
DOCUMENTED STATUS OF IMMIGRANTS.
THERE WAS COVID-19 STUDIES, A
NUMBER OF THEM, MOSTLY REGIONAL
OR LOCAL, VERY LITTLE ON THE
NATIONAL SCALE AND I THINK IN
GENERAL RADA SUMMARIZED 1 OF THE
PAPERS.
LET ME FINISH WITH JUST A
SUMMARY OF WHERE NIMHD IS IN
TERMS OF OUR BUDGET, OUR FISCAL
23 APPROPRIATIONS SHOWN HERE ON
THE RIGHT, 524 MILLION, WE'VE
GROWN, EACH OF THE LAST 2 YEARS
WITH DISCRETIONARY INCREASES,
THAT THE CONGRESS ALLOCATED TO
NIMHD ON REQUEST OF THE
PRESIDENT, NOT NEARLY AS MUCH AS
THE PRESIDENT ASKED FOR, BUT
WE'RE DELIGHTED TO HAVE A HIGHER
PROPORTION, HIGHER
APPROPRIATIONS THAT WE CAN DO
MORE RESEARCH.
THIS IS A BREAK DOWN OF OUR
BUNLET SUG95 CANT AMOUNT OF OUR
BUDGET IS COMMITTED TO CENTERS
AND THEN WE DO HAVE RESEARCH IN
THE R&D CONTRACTS, THIS IS WHERE
OUR SUPPORT FOR THE HISPANIC
COMMUNITY HEALTH STUDY, LOAN
REPAYMENT AND THE JACKSON
[INDISCERNIBLE] STUDY IS, AS
WELL AS ECONOMIC ANALYSIS BURDEN
OF HEALTH DISPARITIES BUT WE'RE
NOT QUITE 50% OF OUR BUDGET IS
THE RESEARCH PROJECT, MOSTLY
RO-1S, I WAS HAPPY TO SEE THESE
FIGURES RECENTLY, SHOWED THEM AT
OUR COUNCIL IN EARLY FEBRUARY WE
FOUNDED MORE RO-1S WITH INCREASE
IN BUDGET IN FISCAL YEAR 22 AND
OUR SUCCESS RIGHT NOW IS 18%
NIMHD DOES NOT USE A PAY LINE.
WE EVALUATE GRANTS AT EVERY
LEVEL OF SCORE.
WE WILL FUND GRANTS INTO THE
IMPACT SCORE INTO THE HIGH 30S
IF WE BELIEVE IT IS A GOOD
GRANT, COVERING AN IMPORTANT
TOPIC.
THIS ALLOWS US TO DO MORE OF
THAT RISK TAKING, GETTING CLOSER
TO AT LEAST 20% SUCCESS RATE,
THE HIGHEST SUCCESS RATE AT NIH
TEND TO BE AROUND 25% FOR A
COUPLE OF INSTITUTES.
WE'RE ALSO DELIGHTED TO SEE MORE
K-AWARDS WHERE WE GENERALLY WILL
USE MORE OF A CUT OFF OF PAY
LINE WHERE AGAIN, HIGHER BUDGETS
MEANT MORE K-AWARDS FUNDED KO1S,
K28S AND K23S WERE NEWS
BEGINNING IN FISCAL--NOT QUITE
17, BUT 18.
AND K99s WE'VE BEEN FUNDING
THOSE FOR SOMETIME.
SO LET ME FINISH JUST WITH
GENERAL PRINCIPLES ABOUT
RESEARCH DIRECTIONS.
WE REALLY NEED MULTILEVEL
INTERVENTIONS WHENEVER POSSIBLE
AND NO MATTER WHAT WE DON'T DO
ENOUGH INTERVENTION RESEARCH.
I FEEL LIKE EVERY TIME I LOOK,
WHAT ARE THE BEST FUNDED STUDIES
EACH CYCLE FOR EACH COUNCIL.
MAJORITY OF THE REPORTS I GET
FROM PROGRAM RELATE TO
OBSERVATIONAL STUDIES AND I
THINK EMPHASIZING INTERVENTIONS
IS IMPORTANT.
IN THIS PARTICULAR WORKSHOP, THE
EMPHASIS ON INTERSECTIONALITY.
NIMHD'S PRINCIPLES REALLY ARE
DRIVEN BY AND IT'S FOUNDING
ORIGINS OF RACE ETHNICITY AND
SOCIAL CLASS AND RURAL
POPULATIONS AND POPULATIONS OF
SEXUAL AND GENDER MINORITY
STATUS, LOOKING AT THE
INTERSECTIONS OF THOSE IS THE
INSTITUTES EMPHASIS, KEEP IN
MIND THAT AGAIN, THESE
POPULATIONS WITH HEALTH
DISPARITIES APPLY TO THE ENTIRE
AGENCY.
WE ARE ALSO INTERESTED IN
MECHANISMS, BIOLOGICAL, SOCIAL,
INDIVIDUAL, BEHAVIOR,
ENVIRONMENT AND WITHIN THE
HEALTH SYSTEM.
AND THEN ALSO I REALLY EMPHASIZE
THIS COMMUNICATION STRATEGIES
BETWEEN PATIENTS AND CLINICIANS
DEVELOPING TRUST I THINK AS A
PRINCIPLE THIS WOULD APPLY A
HUNDRED% TO SGM POPULATIONS
INDEPENDENT OF
INTERSECTIONALITY, FEELING
COMFORTABLE IN TRUSTING A
CLINICIAN WILL NOT BE EITHER
JUDGMENTAL OR OPEN, AND ABLE TO
TALK ABOUT ALL THE DIFFERENT
CONCERNS FROM A HEALTH
PROFESSIONAL PERSPECTIVE AND THE
TRUST THAT IS REALLY NEEDED FOR
THAT RELATIONSHIP TO BE
THERAPEUTIC AND ACTUALLY AN
INTERVENTION TO IMPROVE HEALTH.
AND THEN STRUCTURAL CHANGE TO
MODIFY GROUP BEHAVIORS OR
INDIVIDUAL BEHAVIORS, I THINK IS
IMPORTANT SO I'LL STOP THERE AND
GO RIGHT TO IT AND STOP SHARING.
THANK YOU.
I RAN A LITTLE OVER SO I WILL GO
RIGHT IN AND PRESENT BY
COLLEAGUE AND FRIEND BRIAN
MUSTANSKI, HE IS THE DIRECTOR OF
INSTITUTE FOR SEXUAL AND GENDER
MINORITY HEALTH AND WELL BEING,
AT NORTHWESTERN AND A FORMER
MEMBER OF OUR COUNCIL, I DID NOT
REALLY KNOW BRIAN PERSONALLY
UNTIL I ASKED HIM TO JOIN OUR
COUNCIL.
HE'S A TERRIFIC SCIENTIST AND
I--IT WAS REALLY A PLEASURE AND
A PRIVILEGE TO HAVE HIM BE AN
ADVISOR TO US FOR 4 YEARS.
SO, BRIAN, IT'S ALL YOURS.
>>THANK YOU ELISEO, FOR
INCLUDING ME IN THIS AND I'LL
SAY I DO MISS- YOU SAY I GO TO
TOO MANY MEETINGS, THAT'S 1 I
MISS GOING TO IS THE COUNCIL
MEETING, SO ANYWAY, I WANT TO
START BY SAYING THANK YOU TO
ELISEO AND THE FOLKS AT NIMHD
FOR ORGANIZING THIS WORKSHOP.
I THINK - IT'S JUST AN
INCREDIBLE LOAMACYY IMPRESSIVE
LINE UP OF SPEAKERS, I'M HONORED
TO GIVE THE KEY NOTE ADDRESS
TODAY ALONG WITH SO MANY
FABULOUS LGBT SGM HEALTH
RESEARCHERS AND I WILL JUST
POINT OUT, I WELCOME QUESTIONS.
WE HAVE A LITTLE BIT OF TIME FOR
QUESTIONS TOWARDS THE END, DO
YOU WANT TO FOLLOW UP WITH MORE
QUESTIONS, FEEL FREE TO REACH
OUT TO ME ON TWITTER, --I PUT MY
TWITTER HANDLE ON THERE AND
TODAY I WILL BE TRYING TO LAY A
BROAD FRAMEWORK FOR WHAT I SEE
AS SOME OF THE BIG TAKE AWAYS
FROM THE STATE OF SCIENCE FOR
RESEARCH ON HELT DISPARITIES
AMONG SEXUAL GENDER AND MINORITY
POPULATION SAYS, I WILL NOT BE
ABLE TO GO INTO DEPTH OF ANY
PARTICULAR FINDING OR ANY
PARTICULAR AREA, AND TRY TO GIVE
A FEW TAKE AWAYS OF WHAT I THINK
WE'VE ESTABLISHED IN THE FIELD
AND WHERE I THINK THINGS SHOULD
GO.
SO THE FIRST IS THAT WE'VE KNOWN
FOR A WHILE A FAIR BIT ABOUT
EXISTENCE OF DISPARITIES--HEALTH
DISPARITIES, HEALTH INEQUITS
AMONG SEXUAL AND GENDER
POPULATION, HEALTHY PEOPLE 2020
WHICH WAS PUBLISHED IN 2010 WAS
THE FIRST HEALTHY PEOPLE REPORT
TO INCLUDE SEXUAL AND GENDER
MINORITY OR LGBT POPULATIONS AS
THEY WERE DESCRIBED IN THE
REPORT AND IN THAT REPORT THEY
IDENTIFIED A NUMBER OF VERY WELL
DOCUMENTED DISPARS AROUND
LGBT YOUTH BEING ABLE TO ATTEMPT
SUICIDE, LGBT YOUTH MORE LIKELY
TO BE HOMELESS, MORE LIKELY TO
GET PREVENTIVES FOR CANCER,
LESBIAN AND BISEXUAL WOMEN MORE
LIKELY TO BE OVERWEIGHT OR
OBESE, AND AMONGST THE
TRANSGENDER COMMUNITY HIGHER
REFULENCE OF HIV, VICTIMIZATION,
MENTAL HEALTH, SUICIDE AND LESS
LIKELY TO HAVE ACCESS TO HIGH
QUALITY HEALTHCARE.
ALSO SOME DISPARITIES THAT ARE
QUITE WELL DOCUMENTS AROUND
SUBSTANCE USE AND I WOULD SAY MY
FIRST TAKE AWAY FROM MY
PRESENTATION TODAY IS THAT OUR
FIELD, OVER THE LAST 30 YEARS
HAS DONE AN EXCEPTIONAL JOB OF
DOCUMENTING THE EXISTENCE OF SGM
DISPARITIES ACROSS A RANGE OF
HEALTH DOMAINS.
AND I THINK WE'RE AT THE POINT
WHERE THESE DISPARITIES ARE SO
WELL DOCUMENTS THAT WE MIGHT
PIVOT OUR ATTENTION MORE TO
UNDERSTANDING THE MECHANISMS AND
INTERVENTIONS THAT WILL ADDRESS
THESE EXISTING DISPARITIES.
THE OTHER THING I WANT TO POINT
OUT, I THINK ELISEO SHOWED THIS
WITH THE NIMHD PORT FOAL DWROA
BUT THERE HAS BEEN TREMENDOUS
GROWTH IN FUNDING FOR SGM HEGHT
RESEARCH FROM 2015-2020, THIS IS
THE PORTFOLIO ANALYSIS SHOWING A
LARGE INCREASE OF 61% INCREASE
IN THE NUMBER OF SGM FOCUSED
PROJECTS DURING THAT 5 YEAR
PERIOD COMPARED TO AN OVERALL
INCREASE AT NIH IN THE NUMBER OF
PROJECTS BY A LITTLE SHY OF 22%.
AND ELISEO ALSO PREVIEWED THIS
THAT THE NUMBER OF PROJECTS THAT
ARE FOCUSED ON HEALTH ISSUES
BESIDES HIV HAS ALSO GROWN.
SO, IN 2015, 73% OF NIH FUNDED
PROJECTS IN THE SGM DOMAIN WERE
FOCUSED ON HIV AND THAT'S DOWN
TO A LITTLE SHY OF 60% IN 2020
AND THAT'S NOT BECAUSE THERE'S
LESS HIV RESEARCH HAPPENING,
IT'S BECAUSE THERE'S BEEN GROWTH
IN OTHER AREAS SUCH AS MENTAL
HEALTH, SUBSTANCE USE DISORDERS,
VIOLENCE.
AND ALONG WITH THE SHIFT WE'VE
SEEN MORE RESEARCH ON
POPULATIONS OTHER THAN MEN WHO
HAVE SEX WITH MEN TO INCLUDE 22%
OF THE PROJECTS FOCUSED ON
TRANSGENDER DIFFERENCESSER AND
BISEXUAL HEALTH, THERE ARE STILL
A FAW PROJECTS FOCUSED ON
WOMEN'S HEALTH AND VIEW FEW OF
THESE PROJECTS ARE CLINICAL
TRIALS MOST OF THEM ARE
OBSERVATIONAL STUDIES SO LESS
THAN 9% WERE CLINICAL TRIALS.
SO MY TAKE AWAY FROM IS THAT SGM
HEALTH RESEARCH IS GROWING BUT
SOME GROUPS ARE STILL VERY
UNDERREPRESENTED PARTICULARLY
ARE CIS GENDER WOMEN AND MUCH OF
THE RESEARCH IS OBSERVATIONAL
RATHER THAN TEACHTING ATTENTION
WITH THE HEALTH AND EQUITS THAT
ARE DOCUMENTED.
I WILL SAY THERE ARE SOME HEALTH
DOMAINS THAT STILL IN MY OPINION
VERY UNDERSTUDIED PARTICULARLY
RELATIVE TO THE SIZE OF THE
DISPARITY.
ISSUES LIKE SUICIDE, SMOKING,
CANCER ARE STILL FAIRLY WELL
UNDERSTUDIED WITHIN OUR
COMMUNITY.
SO GIVEN ALL THIS GROWTH AND
RESEARCH FOCUSED ON THE HEALTH
OF THE SEXUAL AND GENDER
MINORITY COMMUNITY, I THINK THE
NEXT QUESTION IS, HAVE WE SEEN
THESE RESEARCH PROJECTS, THIS
GROWTH AND RESEARCH PARTICULARLY
SINCE 2015 TRANSLATE INTO AN
IMPROVEMENT IN THE HEALTH OF THE
HEALTH AND SEXUAL GENDER
COMMUNITY OR THE HELT SYSTEM OF
THE HEALTH DISPARITIES AND I
JUST WANT TO SHOW, 2 HEALTH
DOMAINS THAT I PERSONALLY DO
WORK IN ANDLET FIRST IS HIV, AND
YOU CAN SEE THAT SINCE THE
BEGINNING OF THE EPIDEMIC
THROUGH 2191 OF THE MOST RECENT
DATA IN WHICH IT'S AVAILABLE AND
I WANT TO THANK MY COLLEAGUE FOR
MAKING THE SLIDE FOR ME USING
DATA FROM THE CDC.
OF COURSE WE KNOW THIS VERY WELL
DOCUMENTED HIGH LEVEL OF HIV
DIAGNOSIS OF MEN WHO HAVE SEX
WITH MEN EARLY ON IN THE EARLY
EPIDEMIC, IN THE EARLY 80S AND
WITH BEHAVIOR CHANGE, WITH
CONDOM USE, COMMUNITY
MOBILIZATION WE SAW LARGE
DECLINE IN HIV EVEN WHEN WE HAD
NO OTHER SOLUTIONS LIKE
TREATMENT AND THEN IN THE MID90S
WE SAW EFFECTIVE HIV TREATMENT
BECOME AVAILABLE AND WHAT YOU
SEE IS OVER THE PROCEEDING YEARS
THE SIZE OF THE SEXUAL
ORIENTATION IN HIV, ACTUALLY
GREW.
CASES HAVE DECLEANED SINCE THE
MID90S AND THE RATE WAS
INCREASING AMONGST MEN WHO HAVE
SEX WITH MEN SINCE 2000 AND IT'S
BEEN RELATIVELY STABLE SINCE
THAT TIME DESPITE THE
INTRODUCTION OF TREATMENT AND
THE INTRODUCTION OF PROPHYLAXIS
AS A MEAN OF HIV PREVENTION.
AND SO WE'RE ACTUALLY NOT SEEING
A DECLINE IN THE DISPARITY.
WE'RE ACTUALLY SEEING A GROWTH
IN HIV DISPARITIES OVER TIME.
ANOTHER HEALTH ISSUE WITH ETHNIC
GROUPSAL HEALTH, THIS IS DATA
REPORTED IN THE JOURNAL
DEMOGRAPHY BY LEO AND
[INDISCERNIBLE] AND USING DATA
FROM THE 2018 NATIONAL HEALTH
AND INTERVIEW SURVEY THEY
ANALYZE 5 MENTAL AND PHYSICAL
OUTCOMES, PSYCHOLOGICAL
DISTRESS, ACTIVITY, PHYSICAL
HEALTH, ACTIVITY, AND
LIMITATIONS ACROSS 3 COHORTS,
KNOWN AS MILLENNIALS, GENERATION
XERS, BABY BOOMERS AND THEY
FOUND THE DIFFERENCE IN MENTAL
HEALTH ORIENTATION GROUPS WERE
SIGNIFICANTLY LARGER AMONG
GENERATION XERS AND MILLENNIALS,
THE MORE RECENT GENERATION THAN
AMONG BABY BOOMERS AND
PREBOOMERS AND THEY FOUND IN
SIMILAR PATTERN FOR OTHER
MEASURES OF MENTAL AND PHYSICAL
HEALTH.
SO THESE 2 STUDIES AND
OTHERS I
COULD SAY ARE SHOWING INCREASES
IN THE SIZE OF HEALTH
DISPARITIES BASED ON SEXUAL
ORYEBTATION.
SO IF WE'RE SEEING SOCIAL
PROGRESS, WE'VE SEEN SAME SEX
MARRIAGE, LEGALIZED WE HAVE
EMPLOYMENT NONDESCRIMINATION,
POLICIES HAVE PASSED, WE ARE
SEEING A GROWTH IN RESEARCH, WHY
HASN'T THIS TRANSLATED INTO
SHRINKING OF THE SGM HEALTH
DISPARITIES AND IN THAT ARTICLE
THAT I JUST MENTIONED BY LEO AND
[INDISCERNIBLE], THEY CONCLUDED
THAT LGBT HEALTH DISPARITIES ARE
PROBABLY A RESULT OF MORE
INSIDIOUS AND DEEPLY EMBEDDED
FACTORS IN U.S. SOCIETY THAT ARE
NOT ERADICATED IN CHANGES LIKE
MARRIAGE EQUALITY OR
DISCRAMINATION LAWS, INSTEAD
MORE DRASTIC SOCIAL CHANGE AT
MULTILE LEVEL SYSTEM REQUIRED TO
ADDRESS THESE DISPARITIES SO I
WANT TO DIG IN ON ON THE
MULTILEVEL AND MECHANISTIC
PERSPECTIVE.
NOW I'VE BEEN DOING SGM HEALTH
RESEARCH FOR OVER 20 YEARS AND
WHEN I STARPTED MY CAREER, I
THINK THIS IDEA OF INTERNALIZED
HOMOPHOBIA OF THE DRIVER OF
MENTAL AND BEHAVIOR HEALTH
PROBLEMS, DEPRESSION, SUICIDE,
RISK BEHAVIORS, AND MENTAL AND
BEHAVIORIAL WERE A PARADIGM.
THIS PARADIGM POSITIONED SGM
DISPARITIES OR HEALTH ISSUE, AS
AN INTERNAL ISSUE AND 1 THAT'S
PROBABLY BEST RESOLVED THROUGH
SOMETHING LIKE PSYCHOTHERAPY OR
DEVELOPMENTAL PROCESS THAT WOULD
LEAD TO GREATER SELF-ACCEPTANCE.
THIS WAS REALLY A DOMINANT
PARADIGM AS I WAS STARTING MY
CAREER.
AND AS I STARTED STUDYING LGBT
YOUTH BOTH QUANTITATIVELY AND
QUALITATIVELY, 1 OF THE THINGS
THAT I FOUND IS THAT WE ACTUALLY
RARELY FOUND MAJOR OR
SIGNIFICANT EFFECTS OF
INTURNOVERRALLIZED HOMOPHOBIA ON
MANY OF THE HEALTH OUTCOMES THAT
I WAS INTERESTED IN STUDYING.
INSTEAD WHAT WE FOUND WAS
SIGNIFICANT EFFECTS OF EXTERNAL
STIGMAS LIKE BULLYING AND
VICTIMIZATION AND OFTEN IN OUR
MULTIVARIANT ANALYSIS, ANALYSIS
WE FOUND THAT HOMOPHOBIA WAS NO
LONGER SIGNIFICANT ONCE WE
ACCOUNTED FOR THESE EXTERNAL
FACTORS LIKE BULLYING.
SO IS IT REALLY, YOU KNOW ARE
THESE DISPARITIES REALLY DRIVEN
BY INTERNAL FEELINGS OR IS IT
MORE ABOUT SOCIAL STRUCTUREs
AND EXTERNAL EXPERIENCES, AND IN
FACT, MY COLLEAGUE, MICHAEL
NUWCOMB AND I PUBLISHED A
META-ANALYSIS LOOKING AT DAT ON
THE RELATIONSHIP BETWEEN
INTERNALIZED HOMOPHOBIA AND
MENTAL HEALTH PROBLEMS.
THIRTY-ONE STUDIES OVER 5000
PARTICIPANTS AND IN THOSE
STUDIES, THEY FOUND A SMALL, WE
FOUND A SMALL OVERALL
ASSOCIATION WHICH SUGGEST THERE
IS IS SOMETHING THERE HAVING
CHALLENGES ACCEPTING THE SEXUAL
ORIENTATION IS RELATED TO MENTAL
HEALTH BUT NOT THE OVERALL
DRIVER OF THE DISPARITIES.
SO MY TAKE AWAY IS THAT RESEARCH
REALLY NEEDS TO MOVE BEYOND
DOCUMENTS DISPARITIES AND
LOOKING AT SORT OF INDIVIDUAL
LEVEL FACTORS TO STUDYING
INTERVENTIONS THAT ARE ON THE
MULTILEVEL MECHANISMS THAT ARE
DRIVING THESE DISPARITIES.
AND I'LL GIVE YOU JUST A FEW
EXAMPLES OF SOME OF THOSE
MULTILEVEL FACTORS AND OF SOME
EXAMPLES OF WHAT I SEE IS
EXCITING GEPMENTS IS
INTERVENTION RESEARCH JUST A FEW
EXAMPLES BECAUSE THERE REALLY
ARE SO MANY I COULD GO INTO.
SO THE FIRST IS THE IDEA OF
ROMANTIC RELATIONSHIPS.
WE KNOW THAT MARRIED
HETEROSEXUALS WHO ARE SATISFIED
IN THEIR RELATIONSHIPS REAP
NUMEROUS HEALTH BENIT IFS.
WE ALSO KNOW THAT 1 OF THE KEY
TASKS OF ADOLESCENTS IS
DEVELOPING SOCIAL SKILLS AND
SELF-AWARENESS FOR HEALTHY
ROMANTIC RELATIONSHIPS ISSUES
UNDERSTANDING WHAT KIND OF
PEOPLE YOU'RE ARK TRACTED TOO,
WHAT KIND OF RELATIONSHIPS
YOU'RE LOOKING FOR, AND BUT YET
THERE'S BEEN VERY LITTLE
RESEARCH ON HEALTHY ROMANTIC
RELATIONSHIPS AND SGM YOUNG
PEOPLE AND EVEN IN ADULTS IN
FACT, AND THIS IS A PAPER LED BY
MY COLLEAGUE SARAH WITTEN IN
JOURNAL OF ABNORMAL PSYCHOLOGY
AND IN THAT STUDY, WE LOOKED
LONGITUDINALLY AT THE PROTECTIVE
EFFECT OF BEING IN A ROMANTIC
RELATIONSHIP AGAINST LGBT
VICTIMIZATION, REALLY BULLYING
KINDS OF EXPERIENCES ON
EXPERIENCES OF PSYCHOLOGICAL
DISSTRUSES AND WHAT WE FOUND WAS
THAT VICTIMIZATION HAD A MAJOR
EFFECT ON PSYCHOLOGICAL DISTRESS
WHEN PEOPLE WERE NOT IN THE
RELATIONSHIP BUT WHEN THEY WERE
IN A ROMANTIC RELATIONSHIP, OR
AT TIMES WHEN THEY WERE IN A
ROMANTIC RELATIONSHIP, THEY WERE
MORE BUFFERED BY THOSE EFFECTS
OF VICTIMIZATION AGAINST
PSYCHOLOGICAL DISTRESS OUTCOMES
AND I HAVE TO SAY IN MY CAREER,
MY 20 YEAR CAREER, I HAVE DONE A
LOT TO LOOK FOR PROTECTIVE
EFFECT ANDS THIS IS 1 OF THE FEW
PROTECTIVE CENTER FOR EXCELLENCE
ON AGINGS WE'VE ACTUALLY FOUND
IN ANY OF OUR WORK.
AND MY COLLEAGUE, MIKE AT
NEWCOMB, WHO I MENTIONED EARLIER
HAS DRIVEN THIS WORK FORWARD IN
TERMS OF LOOKING AT HOW WE CAN
HARNESS HEALTHY ROMANTIC
RELATIONSHIPS AS A HEALTH
PROMOTION CHARACTERISTIC FOR THE
SGM COMMUNITY.
AND HE ALONG WITH SEVERAL
COLLEAGUES AN INTERVENTION
CALLED 2 GETHER, WHICH FOCUSES
ON TEACHING ROMANTIC SKILL AND
IT IS INTEGRATING THAT INTO A
HEALTH INTERVENTION AND FOUND
FETAL COMPARTMENT
NAMES--NAMESINAL EFFECTS REPORT
INDEED THE PILOT STUDY INCLUDING
EXCEL EPT RETENTION, THE YOUNG
MEN IN THIS STUDY ACTUALLY
REALLY WERE SEEKING THIS KIND OF
INTERVENTION AND OVER 99% OF
THEM WERE RETAINED THROUGH THE
INTERVENTION, THE FOLLOW UP AND
HE FOUND SIGNIFICANT EFFECT IT
IS ON CONDOMLESS ANALL SEX AS
WELL AS RELATIONSHIP OUTCOME
ANDS THIS IS NOW STUDIED IN 2
EFFECTIVENESS TRIALS THAT ARE
JUST WRAPPED UP AND THE RESULTS
WILL BE COMING SOON FROM THOSE,
AS WELL AS A NEW HYBRID
IMPLEMENTATION STUDY, I ALSO
THINK A VERY UNDER STUDIED AREA
IS THE ROLE OF PARENTS AND
PARENTS WE KNOW--PARENT SOCIAL
SUPPORT, PARENTAL PARENTING
PRACTICES LIKE MONITORING WHERE
YOUR KIDS ARE AT AND WHAT
THEY'RE UP TO AND HAVE
BENEFICIAL EFFECTS ACROSS
NUMEROUS OUTCOMES, BUT THERE
HAVE BEEN VERY FEW STUDIES
LOOKING AT PARENTING AS IT
RELATES TO SGM YOUNG PEOPLE, AND
MOST OF THOSE RELY ON THE
REPORTS OF PARENTS, THE REPORTS
OF YOUNG PEOPLE ABOUT THEIR
PARENTS RATHER THAN ACTUALLY
SPEAKING TO PARENTS.
IN 1 OF OUR STUDIES PUBLISHED
SEVERAL YEARS AGO, WE LOOKED AT
HOW PARENTAL SUPPORT WITH THE
FACILITATOR OF MENTAL HEALTH AND
WHAT WE FOUND IS THAT YOUNG
PEOPLE WHO HAD HIGHER LEVELS OF
PARENTAL SUPPORT HAD LOWER
LEVELS OF DEPRESSION AND THERE
WAS DEVELOPMENTAL
CHARACTERISTICS THAT THIS WAS
MOAF IMPORTANT AT THE YOUNGEST
AGES.
MY COLLEAGUE, DAVID HEDENER IS
ACTUALLY DOING SOME PHENOMENAL
WORK LOOKING AT PARENTING
INTERVENTIONS FOR SGM YOUNG
PEOPLE AND FOCUSING ON TEENS AND
NOT YOUNG ADULTS ABOUT YOU
ACTUALLY PATIENTS OF TEENAGERS
AND HAVE DEVELOPED THIS
INTERVENTION CALLED PARENTS AND
ADOLESCENTS TALKING ABOUT
HEALTHY SEXUALITY OR THE PAPS
PROGRAM WHICH IS AN ONLINE
PROGRAM DESIGNED FOR PARENTS TO
IMPROVE COMMUNICATION ABOUT HIV
AS WELL AS INCREASING BEHAVIOR
OF TEEN MSM SEXUAL HEALTH AND
WHAT THEY FOUND IN THIS STUDY
WAS THAT FAMILIES WHO WENT
THROUGH THIS INTERVENTION, BASED
ON BOTH PARENT AND SON REPORT
APPROXIMATE 3 MOPPINGS FOLLOWING
THE INTERVENTION, PATIENTS
ASSIGNED TO THE PATH AND THE
PROGRAM, WITH MORE DISCUSSIONS
WITH THE TEENS, MORE
DESCRIPTIONS ABOUT CONDOM USE,
MORE FACILITATION OF HIV TESTING
AND PARENTS ALSO REPORTED
PREPOST CHANGES IN THINGS LIKE
THEIR ATTITUDES AND SKILLS
RELATED TO PARENTING THEIR KIDS
AROUND SEXUAL HEALTH.
SO, I THINK THIS IS A REALLY
GREAT AREA OF DEVELOPMENT AROUND
DIADIC INTERVENTIONS, PARENTS
INTERVENTIONS, ANOTHER AREA I
THINK THAT I THINK IS EXCITING
IS GROWTH IN LOOKING AT THE
BIOLOGICAL MECHANISM THAT LINK
SGM, EXPERIENCES OF ADVERSITY TO
MEDICAL OUTCOMES, THIS IS A
PHENOMENAL PAPER BY
ANESSA FLENTJE, WHO LOOKEDDA THE
ASSOCIATION BETWEEN MINORITY
STRESS AS A PREDICTOR OF MEDICAL
OUTCOMES.
THEY DID FIND THAT ONLY 42% OF
THE STUDIES FOUNDS A SIGNIFICANT
ASSOCIATION WHICH MEANS THERE IS
SUPPORT FOR A RELATIONSHIP BUT I
THINK REALLY CALLS FOR MORE WORK
ON--MORE RESEARCH ON MEDICAL
OUTCOMES AND STUDIES THAT LINK
THE--OR IDENTIFY BIOLOGICAL
MECHANISMS THAT LINK MINORITY
STRESS TO THESE OUTCOMES SO
THAT'S MY FIFTH TAKE AWAY IS
MORE RESEARCH ON MEDICAL
OUTCOMES IN OUR COMMUNITY AS
WELL AS STUDIES THAT LINK THE
MECHANISMS BETWEEN ADVERSITY AND
THESE OUTCOMES.
THE NEXT THING I WANT TO SAY IS
IT'S A WELL KNOWN PHENOMENON
THAT IT TAKES 17 YEARS FOR ONLY
14% OF NEW SCIENTIFIC
DISCOVERIES TO ENTER DAY-TO-DAY
CLINICAL PRACTICE.
AND THAT IS CERTAINLY TRUE IN
OUR FIELD OF SGM HEALTH RESEARCH
AND I THINK THE SIXTH TAKE AWAY
WOULD SAY IS THAT WE NEED TO
THINK ABOUT HOW TO INTEGRATE
IMPLEMENTATION SCIENCE INTO OUR
CLINICAL RESEARCH TO HELP
ACCELERATE INTERVENTIONS
NIEWFING INTO PRACTICE TO
IMPROVE SGM HEALTH RESEARCH AND
YOU KNOW I WILL SAY WHEN I WAS
TRAINED IN MY GRADUATE CAREER, I
WAS BASICALLY TRAIN OFFICE OF
DIVERSITY THIS IDEA THAT IF YOU
STUDY BASIC MECHANISM, SOMEONE
ELSE WILL PICK UP THOSE IDEAS
AND APPLY THEM TO AN
INTERVENTION AND IF YOU DEVELOP
AN EFFECTIVE INTERVENTION AND
REPORT IT'S EFFECTIVE AND
SOMEONE ELSE WILL PICK IT UP AND
THINK ABOUT HOW TO GET IT
IMPLEMENTED IN PRACTICE AND I'M
CONVINCED THAT DOES NOT HAPPEN,
IF YOU'RE DOING THE WORK IT'S
REALLY IMPORTANT FOR YOU TO MOVE
IF ALONG THIS TRANSLATIONAL
SPECTRUM WHETHER QUIEWR DOING
THOSE STUDIES ACROSS MECHANISMS,
INTERVENTIONS TO IMPLEMENTATION
WHICH IS THE MODEL THAT I
SUBSCRIBE TO OR ACTIVELY WORKING
WITH PARTNERS AT THE NEXT STAGE
OF TRANSLATION TO MOVE THE WORK
ALONG THE TRANSLATIONAL
SPECTRUM.
THERE ARE SOME REALLY EXCITING
DEVELOPMENTS IN IMPLEMENTATION
SCIENCE THEY THINK PEOPLE NEED
TO BE AWARE OF, TO ADVANCE THE
MOVEMENT OF WORK FROM
EFFECTIVENESS INTO
IMPLEMENTATION, FOR EXAMPLE,
THERE ARE HYBRID TRIALS, I HAVE
LED 2 HYBRID TRIALS, A TYPE 1
TRIAL, FOR TEEN HIV PREVENTION
CALLED SMART WHERE IT'S REALLY
FOCUSED ON EFFECTIVENESS BUT
COLLECTING INFORMATION ON IMP
LEMMATION AND I'M NOW IN THE
FIELD WITH THE TYPE 3 HYBRID
TRIAL, WHERE WE STUDY
IMPLEMENTATION BUT WE'RE
CONTINUING TO MONITOR
EFFECTIVENESS SO I HOPE PEOPLE
FAMILIARIZE THEMSELVES WITH THIS
OF THESE HYBRID TRIALs AS WE
THINK ABOUT HOW TO ACCELERATE
THIS WORK.
I WILL POINT YOU TO OUR WEB SITE
HIVIMPSCI.NORTHWESTERN.EDU, WE
HAVE MORE TO LEARN ABOUT
IMPLEMENTATION SCIENCE, IDENTIFY
OUTCOMES, MAP, DETERMINANTS OF
STRATEGIES, SO PLEASE CHECK THAT
OUT IF YOU ARE INTERESTED IN
LEARNING MORE ABOUT
IMPLEMENTATION SCIENCE, FINALLY
I WANT TO SWITCH WITH GEARS AND
TALK A LITTLE BIT ABOUT THE
CAREER PIPELINE FOR SGM
SCIENTISTS, AS ELISEO MENTIONED
EARLIER, WE KNOW THAT DIVERSE
TEAMS PRODUCE MORE INNOVATIVE
PRODUCTS THAN HOMOGENIUS TEAMS
AND I THINK THAT'S VERY MUCH
TRUE ABOUT SGM SCIENTISTS IN THE
SCIENTIFIC ENTERPRISE AND I
THINK WE ALSO CARE ABOUT THE
WELL BEING OF SCIENTISTS IF WE
WANT TO SUSTAIN OUR WORKFORCE.
AND I WANT TO KIND OF TALK ABOUT
A LITTLE BIT THE PIPELINE OF
WHAT IT TAKES TO GET FROM
ELEMENTARY SCHOOL, THROUGH HIGH
SCHOOL, COLLEGE, GRADUATE
SCHOOL, POST DOC, FACULTY
POSITION, GETTING YOUR FIRST NIH
GRANT AND SUSTAINING YOUR
FUNDING AND THINKING ABOUT SOME
OF THE BARRIERS THAT SGM
SCIENTISTS STUDY ALONG THE WAY
AND AS I'VE BEEN DIGGING INTO
THIS, I'VE BEEN REALLY AMAZED BY
ACTUALLY HOW MUCH WE KNOW ABOUT
LEAKS IN THE STEM PIPELINE FOR
SGM SCIENTISTS.
SO THE FIRST IS HIGH SCHOOL AND
WE KNOW FROM THE CDC NATIONAL
DATA THAT SGM TEENS ARE MORE
LIKELY TO BE BULLIED IN SCHOOL,
ON SCHOOL PROPERTY, NOT GOING TO
SCHOOL BECAUSE THEY FEEL IT'S
UNSAFE.
THIS IS PARTICULARLY THE CASE
AMONGST YOUNG MEN AND SO, YOU
CAN IMAGINE OR WE KNOW HOW
BULLYING AFFECTS STUDENTS,
ATTENDANCE, ABLE TO CONCENTRATE
IN SCHOOL AND MY COLLEAGUES AND
I ACTUALLY DID A LARGE SURVEY OF
SGM TEENS TO LOOK AT HOW
BULLYING IN SCHOOL WAS RELATED
TO INTEREST IN A STEM CAREER AND
WHAT WE FOUND IS THAT SENSE OF
BELONGING, IN A STEM LEARNING
ENVIRONMENT WAS ACTUALLY
AFFECTED BY BULLYING, AND SO,
WHEN WE LOOK AT THE SCALE OF
STEM BELONGING, WE FOUND THAT
TEENS WHO EXPERIENCE MORE
BULLYING IN SCHOOL WERE LESS
LIKELY TO SAY THEY FELT LIKE
THEY HAD BELONGING IN A MATH
CLASS OR SCIENCE CLASS.
AND THERE'S SEVERAL OTHER
FINDINGS IN THIS PAPER THAT YOU
CAN LOOK AT AND WE FOUND THAT A
SENSE OF BELONGING IN A SCIENCE
CLASS WAS CORRELATED WITH
INTENTIONS TO ENROLL IN A STEM
FIELD IN COLLEGE.
SO WE SEE EVIDENCE OF BULLYING
AND WE SEE THAT THOSE
EXPERIENCES OF BULLYING EFFECT
INTEREST IN A STEM CAREER.
THE NIH WORKFORCE ENVIRONMENT
DATA SHOWS VERY ALARMING LEVELS
OF HARASSMENT BY SGM SCIENTISTS,
WORKING AT NIH.
SO WE SEE AT THE HIGH LEVEL OF
REACHING A CAREER, 1 OF OUR
PINNACLE ORGANIZATIONS AT THE
NIH THAT ARE HIGH LEVELS OF
HARASSMENT OF SGM SCIENTISTS IN
THAT ENVIRONMENT.
WE WOULD KNOW ABOUT
INTERSECTIONS AS WELL, THE
INTERSECTIONS OF PRIVILEGE BASED
ON RACE, BASED ON ABLE-BODIED
STATUS, BASED ON SEXUAL
ORIENTATION AND THIS IS TELENT
DATA FROM CATCH, LOOKING AT
THINGS LIKE INCOM, SHOWING
THERE'S A NEARLY 25,000 SO MY
FINAL TAKE AWAY IS THAT SGM
PEOPLE SHOULD BE CONSISTENTLY
AND EXPLICITLY INCLUDED IN
FEDERAL SCIENTIFIC WORKFORCE
DIVERSITY INITIATIVES, WE NEED
TO COLLECT DATA ON SGM SCIENCE,
SCIENTIST IDIDN'TITIES AND
SCIENTIFIC WORKFORCE STUDIES AND
PIPELINE SURVEYS AND WILL BE
CONVENING A WORKSHOP ON THIS IN
D. C. IN THE SPRING AND CHECK
OUR WEBBING SITE TO LEARN MORE
ABOUT IT SO JUST WANT TO
CONCLUDE BY THANKING MY FUNDERS
AND OUR STAFF THAT HAVE MADE ALL
THIS WORK POSSIBLE AND THAT I
WILL STOP AND TAKE QUESTIONS.
>>THANK YOU DR. MUSTANSKI,
GREAT SPEECH AND I WILL LOOK AT
THE CHA AND SEE IF ANY PEOPLE
HAVE QUESTIONS.
KARINA, CAN YOU SAY YOUR
QUESTION.
>>THANK YOU BRIAN FUR YOUR
PRESENTATION, IT WAS
COMPREHENSIVE AND GREAT, THANK
YOU.
QUICK QUESTION, YOU WENT THROUGH
IT QUICKLY BUT COULD YOU SAY
MORE ABOUT THE HARASSMENT SLIDE,
THE KIND OF HARASSMENT THAT
PEOPLE GO THROUGH.
>>THANKS I WAS GETTING TOWARDS
THE END SO I'M SPEEDING THROUGH
IT SO THANKS FOR THE QUESTION,
SO 1 OF THE--2 SLIDES THAT I
PRESENTED RELATED, THE FIRST WAS
FROM THE NIH STUDY OF HAD
RASESMENT SO FOLK WHO IS WORK AT
NIH AND THEY FOUND THAT SOME OF
THE HIGHEST RATES OF
EXPERIENCING SEXUAL HARASSMENT
WERE AMONG INDIVIDUALS
IDENTIFYING AS TRANSGENDER,
GENDER QUEER OR OTHER IDENTITY,
NEARLY 45% OF SCIENTISTS WITH
THOSE IDENTITYS REPORTED
EXPERIENCING SEXUAL HARASSMENT
AND 41% OF BISEXUAL INDIVIDUALS
REPORTED EXPERIENCING SEXUAL
HARASSMENT, FOR LESBIAN GAY,
HOMOSEXUALLY IDENTIFIED PEOPLE,
IT WAS 29%, AND THAT COMPARES TO
20% OF STRAIGHT OR HETEROSEXUAL
INDIVIDUALS LOOKER WORKING AT
THE NIH AND YOU KNOW THE ARTICLE
I MENTIONED BY CATCH PUBLISHED
IN SCIENCE ADVANCES REALLY
LOOKED AT THE INTERSECTION OF
HARASSMENT, BUT IT LOOKED AT
THINGS LIKE INCOME, FINDING BIG
DIFFERENCES AND IN EVEN THINGS
LIKE INCOME AND THOSE
DIFFERENCES EXISTED WHEN YOU
CONTROLLED FOR A LOT OF THE
FACTORS LIKE JOB
CHARACTERISTICS, WORK EFFORT,
BACKGROUND, FAMILY
RESPONSIBILITIES THOSE INCOME
DISPARITIES EXISTED EVEN AFTER
YOU CONTROL FOR THOSE
DIFFERENCES.
AND YOU KNOW THE LAST THING I
HAD TO SPEED THROUGH WAS VERY
RECENTLY, THERE WAS A SIMILAR
ARLIN SCIENCE AND IN NATURE ARE
SORT OF CAREER PATH THAT
SCIENTISTS SIGNED ON TO ASKING
NSF TO COLLECT DAT ON THE SEXUAL
ORIENTATION AND GENDER IDENTITY
OF GRADUATE STUDENTS THIS IS THE
DATA THIS IS THE FEDERAL DATA ON
REPRESENTATION IN THE SCIENTIFIC
PIPELINE AND IT'S UNCLEAR
WHETHER NSF WILL COLLECT THIS
DATA OR NOT.
I BELIEVE IT'S UNDER REVIEW WITH
OMB.
I BELIEVE THAT THE COLLECTION OF
THIS DATA IS ABSOLUTELY
ESSENTIAL.
THE EXAMPLES THAT I PROVIDED ARE
JUST A DROP IN THE BUCKET OF THE
EVIDENCE THAT SHOWS PINE LINE
ISSUES FOR SGM SCIENTISTS, WE
NEED TO COLLECT THIS DATA, WE
NEED TO UNDERSTAND THE SIZE OF
THIS PROBLEM AND WE HAVE THE
OPPORTUNITY TO DO IT, THE ITEMS
ARE AVAILABLE AND VALIDATED,
THEY JUST NEED TO BE COLLECTED.
NTHANK YOU.
I GUESS WE HAVE A COMMENT FROM
DR. KAREN BARKER, PLEASE GO
AHEAD.
>>YEAH, I WANT TO CLARIFY THAT
THE NIH SURVEY THAT BRIAN
MENTIONED WAS ALL ALL FOLKSA THE
NIH, NOT JUST FOLKS WHO WERE
SCIENTISTS ALTHOUGH I WOULD
POSIT THAT AS A SCIENTIFIC
INSTITUTION, RIGHT, THIS IS
PROBLEMATIC ACROSS THE BOARD AND
SO, I JUST WANT TO SAY THAT
IT'S--THIS IS YOU KNOW IN MANY
WAYS EVEN A BIGGER PROBLEM IF
YOU'RE TALKING ABOUT FOLKS WHO
ARE ALSO IN ADMINISTRATION FOR
EXAMPLE.
>>YEAH, THANKS FOR THAT
CLARIFICATION, KAREN.
>>ANY OTHER QUESTIONS?
I GUESS WE HAVE NO MORE
QUESTIONS SO THANK YOU VERY MUCH
DR. MUSTANSKI AND I WOULD LIKE
TO INTRODUCE DR. DEBBIE LENARES
WHO WILL BE MODERATING THE NKSZ
SESSION.
>>THANK YOU SO MUCH RADA, AND
WHAT A WONDERFUL WAY TO OPEN UP
THIS AFTERNOON IF YOU'RE HERE ON
THE EAST COAST.
SO OUR NEXT SESSION, EXCUSE ME
MY VOICE, I'M GETTING OVER A
COLD RIGHT NOW IS LEADING CAUSES
OF DEATH AND DISABILITY IN SGM
POPULATIONS SO FOR THIS SESSION
WE WILL BE DESCRIBING THE
LEADING CAUSES OF DEATH AND
DISABILITY IN SGM POPULATIONS IN
UNMET HEALTHCARE NEEDS INCLUDING
NATIONAL OR REGIONAL TRENDS.
OUR FIRST SPEAKER IS DR. BILLY
CACERES FROM COLUMBIA UNIVERSITY
SCHOOL OF NURSING AND HE WILL BE
SPEAKING ON THE STATE OF
CARDIOVASCULAR HEALTH AMONG
SEXUAL AND GENDER MINORITY
POPULATIONS, GAPS IN
OPPORTUNITIES.
I WILL NOW HAND THE FLOOR OVER
TO DR. CACERES FOR HIS TALK.
DID EMPLOY.
>>THANK YOU.
IT'S A PLEASURE BEING HERE FOR
THIS WORKSHOP AND TALKING TO ALL
OF YOU, I AM GOING TO TRY TO
CONDENSE THIS INTO 15 MINUTES,
BUT I CAN GO ON AND ON ABOUT IT
SO CARD QUO VASCULAR DISEASE AS
MANY YOU KNOW IS A LEADING CAUSE
OF DEATH AND DISABILITY WORLD
WIDE AND 19 MILL YOIN PEOPLE
WORLD WIDE DIED OF
CARDIOVASCULAR DISEASE.
THE THING THAT SOMETIMES IT'S
SURPRISING TO ME IS THE FACT
THAT PEOPLE DON'T OFTEN THINK OF
CARDIOVASCULAR DISEASE RISK AS
MODIFIABLE BUT SEIVET% OF
CARDIOVASCULAR DISEASE RISK IS
ATTRIBUTAL TO CARDIOVASCULAR
FACTORS APPROXIMATE AND YOU CAN
SEE THIS ON THE RIGHT, WHICH IS
THE LIFE'S ESSENTIAL 8 WHICH IS
THE IDEA OF CARDIOVASCULAR HELT
THAT IDENTIFYING 8 MODIFIABLE
RISK FACTORS THAT PEOPLE CAN
SORT OF GET UNDER CONTROL OR
REDUCE TO IMPROVE THEIR
CARDIOVASCULAR HEALTH AND I WILL
TALK ABOUT MOST OF THESE RISK
FACTORS HERE TODAY AND THE
INTERESTING THING IS THAT
ALTHOUGH WE KNOW THERE ARE SEX,
RACIAL AND SOCIOECONOMIC
DISPARITIES IN CDC PREVALENCE
AND TREATMENT, THERE HAS BEEN
CONSIDERABLY LESS ON SGM
POPULATIONS AND THIS IS 1 OF THE
THINGS THAT INSPIRED TO START
DOING RESEARCH IN THIS AREA WAS
THE 2011 REPORT FROM THE
INSTITUTE OF MEDICINE WHICH
REALLY IDENTIFIED THE LACK OF
RESEARCH AROUND CART
CARDIOVASCULAR DISEASE IN SGM
INDIVIDUALS AND THAT'S SORT OF
BEEN VERY INFORMATIVE SORT OF IN
A LOT OF WORK THEY WILL PRESENT
TODAY AND I WILL CALL OUT THE
FOLLOW UP REPORT IN 2020 YEAR ON
THE RIGHT WHICH NOW INCLUDES AN
ENTIRE SELECTION RELATED TO
CARDIOVASCULAR DISEASE,'S SO A
LOT OF WHAT I WILL TALK ABOUT
TODAY IS SUMMARIZED IN THAT
REPORT BUT IF YOU WANT TO LEARN
MORE, I ENCOURAGE TO YOU GO
THERE.
SO WE KNOW THAT SOCIAL
DETERMINANTS CONTRIBUTE TO
NEGATIVE OUTCOMES IN SGM PEOPLE.
THIS IS JUST SOME OF THEM, THIS
IS NOT AN EXHAUSTIVE LIST IN ANY
WAY BUT THE INTERESTING THING IS
THAT WE KNOW VERY LITTLE ABOUT
SOCIAL AND STRUCTURAL
DETERMINANTS THAT INFLUENCE
CARDIOVASCULAR HEALTH AND SOME
OF THE WORK WE'VE DONE RECENTLY
HAS REALLY TRIED TO SORT OF
UNDERSTAND THESE MECHANISMS AND
RISK FACTORS A LITTLE BIT
BETTER.
SO IN 2020 I HAD THE PLEASURE OF
LEADING THE AMERICAN HEART
ASSOCIATIONS FOR SCIENTIFIC
STATEMENTOT HEALTH OF SGM
INDIVIDUALS AND AS PART OF THAT
WRITING GROUP, WE PUBLISH IN
CONCEPTUAL MODEL THAT IDENTIFIES
HOW DIFFERENT STRESSORS AND
GENERAL LIKE MINORITY STRESSORS
INFLUENCE DIFFERENT RISK FACTORS
THAT ARE KNOWN TO INFLUENZ
CARDIOVASCULAR RISK BUT HAVE NOT
BEEN STUDIED WITHIN THE CONTEXT
OF CARDIO VASCLER HEALTH AMONG
THE RISK TO SGM INDIVIDUALS.
AND WE THINK SGM RESEARCH
FOCUSES ON SUBSTANCE USE HIV,
MENTAL HEALTH AND A LOT OF THOSE
HEALTH OUTCOMES ARE ACTUAL
ACTUALLY RISK OUTSTANDING
DEDICATION COMES AND WE DON'T
THINK ABOUT IT THAT WAALSO 1 OF
THE THINGS WE CALLED OUT IN THE
STATEMENT IS THE NEED MOO TO
LOOK AT PHYSIOLOGICAL
MECHANISMS, WHICH HAVE REALLY
BEEN UNDERSTUDIED WITHIN THE
CONTEXT OF CARDIOVASCULAR HEALTH
AMONG SGM PEOPLE.
WE THEN, I WAS FORTUNATE ENOUGH
TO BE A CO AUTHOR ON THE
AMERICAN HEART ASSOCIATION THAT
FOCUSED ON TRANSGENDER AND
GEPPEDDER DIVERSE INDIVIDUALS
AND AGAIN, I SHOWED THIS AS SORT
OF A RESEARCH TO LRCH MORE ABOUT
THIS TOPIC BUT 1 OF THE BIG
THINGS THAT CAME OUT OF THIS
SCIENTIFIC SPHAIMENT IS MANY OF
THE METHOD LOGICAL ISSUES THAT
EXAMINED THE CARDIOVASCULAR
HEALTH OF MINORITY INDIVIDUALS
AND I GALLONY INTO IT IN A FEW
SLIDES BUT A LOT OF WHAT WE KNOW
IS ABOUT CARDIOVASCULAR HEALTH
IN GENDER AND TRANSINDIVIDUALS
IS REALLY MIXED AND I THINK IT
HAS TO DO WITH METHOD LOGICAL
LIMITATIONS.
SO IN TERMS OF WHAT WE KNOW
ABOUT MINORITY STRESS AND CVD
RISK, THERE'S STRESSORS, UNIQUE
STRESSORS THAT INDIVIDUALS OR
GROUPS INDIVIDUALS EXPERIENCE
BECAUSE OF THEIR STIGMATIZED
IESHES DENTITIES AND WE KNOW
VERY LITTLE ABOUT CARDIOVASCULAR
HEALTH AND SGM INDIVIDUALS.
THERE HAVE BEEN SOME STUDIES
THAT SHOW THE MINORITY
STRESSORS, THINGS OF
DISCRIMINATION ARE ASSOCIATED
WITH THE HIGH PREVALENCE USE OF
TOBACCO USE AND INDIVIDUALS BUT
FOR OTHER CARDIOVASCULAR
OUTCOMES IT'S A NASCENT AREA OF
RESEARCH AND I WILL HIGHLIGHT
THE 1 EXAMPLE WHERE OUR TEAM IS
ABOUT TO PUBLISH, WE USE
LONGITUDINAL DATA FROM THE
CHICAGO AND HEGHT LIFE
EXPERIENCES OF WOMEN STUDY, IT
IS 23 YEAR LONG STUDY OF SEXUAL
MINORITY WOMEN'S HEALTH AND
FOUND THAT WOMEN WHO REPORTED
HAD HIGHER HYPER ATTENTION AND
THESE ARE WOMEN IN MIDLIFE SO
THE RATES OF HYPERTENSION ARE
HIGHER IN INDIVIDUALS OF MIDDLE
AGE AND OLDER AGE BUT IT'S STILL
1 OF THE FIRST TO USE TO LOOK AT
INFLUENCE OF MINORITY STRESSORS
IN RELATIONSHIP TO
CARDIOVASCULAR HEALTH.
I THINK IT'S IMPORTANT TO TALK
ABOUT ADDITION AMILLIO FACTORS,
SO WE KNOW THAT SGM INDIVIDUALS
REPORT HIGH RATES OF
EXPERIENCING VIOLENCE AND SOME
GROUPS EXPERIENCE HIGHER RATES
OF POVERTY THAN THE GENERATION
AND VIOLENCE AND POVERTY ARE
WELL DOCUMENTED RISK FACTORS FOR
CARDIOVASCULAR DISEASE IN THE
GENERAL POPULATION.
ONE OF THE THINGS I GET ASKED
ABOUT A LOT IS ABOUT GENDER
AFFIRMING HORMONE THERAPY AND
CARDIOVASCULAR RISK AMONG
TRANSGENDER PEOPLE BUT AS I
STATED BEFORE, THE EVIDENT IS
MIXED FOR A NUMBER OF REASONS
AND I CAN GET INTO IN A LITTLE
BIT AND ALSO WE KNOW THAT
CERTAIN GROUPS OF SGM
INDIVIDUALS EXPERIENCE MUCH
HIGHER RATES OF HIV AND AIDS AND
HIV AS BEEN AS A PRO
INFLAMMATORY CONDITION IT HAS
BEEN ASSOCIATED IN PEOPLE WHO
HAVE THE CONDITION.
THE OTHER ISSUE IS THAT MIGHT
EFFECT CARDIOVASCULAR DISEASE
PREVENTION AND TREATMENT IS
REALLY THE LACK OF ACCESS TO
CULTURALLY APPROPRIATE
HEALTHCARE THAT MANY SGM
INDIVIDUALS EXPERIENCE AS WELL
AS FEAR OF POTENTIALLY
EXPERIENCES DISCRIMINATION FROM
HEALTHCARE PROVIDERS, CAN CAUSE
MANY LGBT Q PEOPLE TO DELAY
SEEKING CARE ACTUALLY AVOID
SEEKING CARE UNTIL THEY
ABSOLUTELY NEED TO.
SO I WILL TALK ABOUT A FEW OF
THE RISK FACTORS, THERE'S 10
DIFFERENT RISK FACTORS, THERE
ARE TAKEN FOR CVD.
IERM ONLY GOING TO TALK ABOUT A
FEW OF THEM.
SO FOR TOBACCO USE, WE KNOW
PRETTY CONSISTENTLY THAT SEXUAL
MINORITY ADULTS ARE MORE LIKELY
TO REPORT CURRENT AND LIFETIME
USE THAN HETEROSEXUAL ADULTS,
FINDINGS FOR INDIVIDUALS ARE
CONFLICTING BUT WE DO KNOW THAT
DATA FROM THE U.S. TRANSGENDER
SURVEY HAS SHOWN THAT GREATER
EXPOSE TOWER DISCRIMINATION IS
ASSOCIATED WITH BOTH INCREASED
CIGARETTE USE AND DUAL CIGARETTE
USE WHICH IS THE USE OF
COMBUTTIVIBLE AND ELECTRONIC
CIGARETTES AT THE SAME TIME.
THIS STUDY MYSELF AND COLLEAGUES
FOCUSED ON A FEW YEARS AGO ON
DIET AND FOOD INSURVEYS CURITY
AND CVD RISK IN SEXUAL AND
GENDER MINORITY, THIS DIET IS
NOT SOMETHING THAT I STUDY OFTEN
BUT THERE WAS A LOT OF
INCONSISTENCIES IN FINDINGS
REGARDING QUALITY AND SGM AND
NONSGM INDIVIDUALS AND I THINK
THAT HAS TO DO WITH IS ISSUES
WITH THE MEASUREMENT OF DIET AND
DIET QUALITY WHERE SOMETIMES
PEOPLE USE VALIDATED MEASURE,
OFTEN TIMES THEY DON'T.
WE ENDED UP LOOKING AT FOOD
INSECURITY BECAUSE IT'S ROBUST
PREDICTOR OF CARDIOVASCULAR
OUTCOMES AND HAS BEEN
UNDERSTUDIED IN SGM PEOPLE AND
WHAT WE FOWBD WAS THAT PRETTY
CONSISTENTLY THE TRANSGENDER
INDIVIDUALS IN SEXUAL MINORITY
WOMEN HAVE MUCH HIGHER RATES OF
FOOD INSECURITY BUT THE RESEARCH
IN TERMS OF DIET AND CVD WAS
MINIMAL SO THERE'S A BIG GAP IN
THESE AREAS OF THESE FACTORS TO
1'S OVERALL CARDIOVASCULAR
HEALTH.
I'M GOING TO HIGHLIGHT THIS
NARRATIVE REVIEW THAT ROB AND
COLLEAGUES PUBLISHED 2 OR 3
YEARS AGO THAT FOCUS ON SLEEP
HEALTH AMONG SEX AND GENDER
MINORITY INDIVIDUALS AND AMONG
THE MAIN THINGS THAT THEY FOUND
WAS THAT PRETTY CONSISTENTLY
MINORITY AND TRANSGENDER
INDIVIDUALS HAD HIGHER RATES OF
SHORT SLEEVE DURATION COMPARED
TO NONSGM INDIVIDUALS AND THERE
WAS AN INTERESTING FINDINGS IN
TERMS OF MOST OF THE RESEARCH
HAS BEEN DESCRIPTIVE, VERY FEW
STUDIES HAVE LOOKED AT SOCIAL
AND STRUCTURALLY YOUAL
DENARMINANTS OF SLEEP HEALTH IN
THIS POPULATION AND MOST
STRIKINGLY, THERE IS A LACK OF
EXAM NATION OF RACIAL AND ETHNIC
DIFFERENCES IN SLEEP AMONG
SEXUAL AND GENDER MINORITY
PEOPLE.
AND IESM GOING HIGHLIGHT 1 OF
THE STUDIES WE LOOKEDDA WHERE WE
LOOK AT SLEEP DURATION
DIFFERENCES BETWEEN SEXUAL
MINORITY AND HETEROSEXUAL ADULTS
BUT THEN STRATIFY THESE BASED ON
RACE AND ETHNICITY AND UNCOVERED
INTERESTING THINGS SO I WILL
SUMMARIZE THAT IN THE NEXT
SLIDE.
SO CONSISTENT WITH THE SLEEP
NARRATIVE REVIEW THEY JUST
DISCUSSED, WE FOUND THAT SEXUAL
MINORITY WOMEN WERE 80% MORE
LIKELY THAN TO REPORT SLEEP
DURATION, WHICH IS ON AVERAGE
SLEEPING LESS THAN 4 HOURS PER
NIGHT BUT WHEN WEAC AT RACIAL
AND ETHNIC DIFFERENCES WE FOUND
THAT THIS DISPARITY WAS GREATER
FOR BLACK, LESBIAN AND BISEXUAL
WOMEN.
FOR SEXUAL MINORITY MEN AND GAY
AND BISEXUAL MEN WE FOUND NO
DIFFERENCES IN SLEEP DURATION
WHEN WE COMPARE THEM TO
HETEROSEXUAL MEN AND THEN THE
LARGER GROUP, BUT THEN WHEN WE
STRATIFIED THE SLEEP DURATION,
WE FOUND THAT BLACK GAY MEN AND
BLACK BISEXUAL MEN OF COLOR, AND
BISEXUAL MEN OF COLOR WERE MORE
LIKELY TO REPORT BOTH SHORT AND
LONG SLEEP DURATION.
AND SLEEP IS AN IMPORTANT THING
BECAUSE WE ALL SLEEP, SOME OF US
MIGHT WANT TO SLEEP MORE OR LESS
THAN WE CURRENTLY DO BUT SLEEP
IS A NOTED RISK FACTOR FOR
CHRONIC CONDITIONS IN CANCER AND
CARDIOVASCULAR CONDITIONS.
IN TERMS OF DIAGNOSES, THERE'S
LITTLE RESEARCH ON THESE
CARDIOVASCULAR DIAGNOSIS AND
THAT'S BECAUSE WE HAVE LIMITED
AVAILABILITY OF CLINICAL DAT
FROM ELECTRONIC HEALTH RECORDS
TO OTHER TYPES OF DATA TO
EXAMINE THIS, BUT THERE IS
EVIDENCE FROM THE ELECTRONIC
HEALTH RECORD DATA THAT
TRANSGENDER WOMEN ON ESTRO
GENERATED THERAPY HAVE A HIGHER
EN--STRATEGIES DENSE OF ESCHEMIC
STROKE BUT OVER ALL THERE'S
BEFORE VERY STUDIES THAT HAVE
BEEN CONDUCTED ON THIS TOPIC.
SO IN SUMMARY, WE SEE
CONSISTENTLY HIGH PREVALENCE
EVER TOBACCO USE, THERE'S
EVIDENCE OF DISPARITIES IN DIET
QUALITY AND PHYSICAL ACTIVITY
BUT THAT IS MIXED, LESBIAN AND
BISEXUAL WOMEN ARE AT HIGHER
RISK FOR HEAVY DRINKING, SLEEP
DURATION AND OBESITY AND
DIABETES, ALTHOUGH EVIDENCE FOR
DIABETES IS MIXED DEPENDING ON
WHETHER OR NOT IT'S A
SELF-REPORTED DIABETES OR WE'RE
ACTUALLY EXAMINING BIOMARKERS OF
DPLI SEEMIC STATUS, BISEXUAL MEN
SEEM TO BE AT RISK FOR OBESITY
AND HYPERTENSION AND GAY MEN
GENERALLY HAVE MORE FAVORABLE
CARDIOVASCULAR HEALTH PROFILES
THAN HETEROGENEOUSERY SEXUAL
MEN.
OVERALL WE SEE THAT
CARDIOVASCULAR HEALTH
DISPARITIES AMONG SEXUAL
MINORITY INDIVIDUALS ARE MORE
PRONOUNCED BY BLACK AND OTHER
INDIVIDUALS AND THERE'S GROWING
EVIDENCE THAT THE DISPARITIES
WE'VE SEEN AMONG SEXUAL ADULTS
EMERGES EARLY IN ADOLESCENCE,
OUR TEAM ANALYZED THIS SURVEY
AND THEY FOUND CONSISTENT
FINDINGS WE'VE DONE WITH THE
GROUPS.
AMONG GENDER MINORITY
POPULATIONS, MOST HAVE BEEN ON
THE GENDER-AFFIRMING HORMONE
THERAPY WHICH I UNDERSTAND WHY
PEOPLE ARE INTERESTED AND
CONCERNED ABOUT THAT BUT I THINK
THAT OFTEN TIMES, WE--DIMINISHES
THE IMPACT OF SOCIAL AND AND
OTHER DETERMINANTS, SO MOST OF
THESE CARDIOVASCULAR RISK
FOCTORS, FINDINGS ARE LARGELY
CONFLICTING, MOST OF THESE
STUDIES HAVE BEEN KROTIONZ
SECTIONAL WITH SMALL SAMPLES OF
TRANSGENDER ADULTS ON HORMONE
THERAPY AND AWNCH TIMES THEY
INCLUDE SAMPLES OF INDIVIDUALS
THAT ARE PRIMARILY WHITE, THEY
HAVE SORT OF LIKE METHOD LOGICAL
ISSUES, IN TERMS OF BOTH
RECRUITMENT AND DESIGN AND DATA
COLLECTION.
AND 1 THING THEY THINK IS
INTERESTING IS THAT AS MORE AND
MORE INDIVIDUALS IDENTIFY AS
GENDER CLEAR, GENDER NONBINARY,
WE HAVE FEW STUDIES THAT HAVE
EXAMINED THE RISK IN THOSE
GROUPS SO IT'S UNXOAN WHAT THE
CARDIOVASCULAR HEALTH OF THOSE
POPULATIONS MIGHT BE.
SO IN EMERGING ITS OF RESEARCH
GAPS, MOST OF THE EVIDENCE I
DESCRIBED TODAY WAS CROSS
SECTIONAL AND PRIMARILY HAS
EXAMINED AND BEEN DESCRIPTIVE
EXAMINING DIFFERENCES BETWEEN
SGM AND NONSGM PEOPLE, THERE'S
BEEN A LACK OF ATTENTION TO
INTERSECTIONALITY, OFTEN TIMES I
THINK THIS IS TRUE FOR MOST SGM
HEALTH RESEARCH, WE FOCUS ON
SEXUAL AND GENDER MINORITY
STRESSORS, RATHER THAN THINKING
ABOUT THE FACT THAT FOR MANY SGM
PEOPLE THEY OFTEN TIMES HOLD
MANY DIFFERENT IDENTITYS THEY
MIGHT CONSIDER TO BE STIGMATIZED
BY, THERE'S BEEN LIMITED TESTING
OF THE THE BIOSOCIAL MECHANISMS,
AS BIOBEHAVIORIAL RESEARCH, 1 OF
THE MAIN THINGS I LOOK AT IN
NIGH WORK.
LIMITED INVESTIGATION OF SOCIAL
AND STRUCTURAL DETARMINANTS AND
FOR ME, IT'S NOT JUST ABOUT
IDENTIFYING THESE DETERMINANTS
TO DESCRIBE THEM BUT IF WE
UNDERSTAND THESE DETERMINANTS,
WE'RE ABLE TO CREATE
INTERVENTIONS, POTENTIALLY
MULTILEVEL INTERVENTIONS THAT
CAN TARGET THE SOCIAL STRUCTURAL
DETERMINANTS OR IMPROVE THE
CARDIO VASCULARY HELT OF THESE
GROUPS AND ALONG THESE LINES WE
HAVE FEW EVIDENT BASED
INTERVENTIONS TO ADDRESS
NONCOMMUNICABLE DISEASE RISK
AMONG SGP PEOPLE FOR
CARDIOVASCULAR DISEASE RISK, I
CAN THINK OF 1 BUT IT WASN'T
REALLY NECESSARILY CREATED OR
DEVELOPED SPECIFICALLY FOR
CARDIOVASCULAR DISEASE RISK AND
ANOTHER THAT I THINK IS
IMPORTANT IS THAT MOST OF THESE
HAVE FOCUSED ON ADULTHOOD RATHER
THAN LOOKING AT YOUTH THAT ARE
OLDER ADULTS.
SO MY RECOMMENDATIONS ARE WE
NEED MORE LONGITUDE DWHRAL
RESEARCH THAT EXAMINES THESE
DETERMINANTS OF CARDIOVASCULAR
HEALTH AND DIVERSE SASMILES OF
SGM PEOPLE WE NEED TO DESIGN AND
TEST CDC RISK REDUCTION IN THESE
POPULATIONS AND AS ALWAYS IF WE
NEED TO PARTNER WITH COMMUNITIES
TO BEST UNDERSTAND HOW TO
CONDUCT THIS RESEARCH AND WHAT'S
MOST IMPORTANT TO SGM
INDIVIDUALS, AND WE REALLY NEED
TO DO MORE TO INVESTIGATE THE
NEEDS AND EXPERIENCES OF SGM
PEOPLE LIVING WITH CVD.
SO WHAT HAPPENS TO AN SGM OR A
TRANSPERSON AFTER THEY HAD A
HEART ATTACK OR STROKE.
WHAT DOES THAT LOOK LIKE FOR
THEM?
SO I WANT HIGHLIGHT AGAIN
THERE'S BEEN SIGNIFICANT
IMPROVES IN SGM RESEARCH AT THE
N
NIH BUT A SMALL PROPORTION
FOCUSED ON CVD, BUT THAT'S AN
AREA I WOULD LIKE TO SEE MORE
DONE IS EXPHA I'M FINDING NOW IS
THATY WE SLEEP APNEA AND OBESITY
A LOT OF CARDIOVASCULAR EXPERTS
DOING SGM WORK WITH VERY LITTLE
TRAINING IN SGM HEALTH AND WE
SEE HEALTH EXPERTS NOW DOING
CARDIOVASCULAR DISEASE RESEARCH
RESEARCH WITHOUT A LOT OF
TRAINING SORT OF ON CHRONIC
DISEASE.
SO IN CONCLUSION, THERE'S BEEN
CONSIDERABLE PROGRESS IN SGM
CARDIOVASCULAR HEALTH RESEARCH
AND SIGNIFICANT GAPS WERE MADE
RELATED TO SOCIAL DETERMINANTS
AND INTERVENTIONS AND THERE'S A
NEED FOR ADDITION RESEARCH THAT
ADDRESSES AND GROUP CAUSES OF
CARDIOVASCULAR DISPARITIES AND
AMONG SGM INFLUENCERS, THANK YOU
FOR YOUR TIME.
>>THANK YOU SO MUCH
DR. CACERES, I WANT TO SHARE
THAT BIOS FOR ALL THE SPEAKERS
ARE ON OUR WEBSITE, WE ARE
KEEPING OUR INTRODUCTIONS BRIEF
SO PEE --WE HAVE ENOUGH TIME TOE
WORK THAT'S TAKING PLACE AND WE
WILL HAVE A Q&A SESSION AFTER
THIS PANEL CONCLUDES SO IF YOU
DO HAVE QUESTIONS FEEL FREE TO
PUT THEM IN THE VIDEOCAST
SUBMISSION IN THE MEAN TIME.
OUR NEXT SPEAKER IS DR. MANDI
PRATT-CHAPMAN, FROM THE GEORGE
WASH UNIVERSITY CANCER CENTER
AND DR. PRATT-CHAPMAN WILL GIVE
US A PRESENTATION ONED WELLING
CAUSES OF DEATH AND DISABILITY
IN SEXUAL AND GENDER MINORITY
POPULATIONS.
HIGHLIGHTING ON CANCER.
DR. PRATT-CHAPMAN, YOU HAVE THE
FLOOR.
>>CAN YOU HEAR ME NOW?
>>YES.
>>OKAY.
GRIT.
THANK YOU SO MUCH.
I'M SO HONORED TO BE HERE.
THANK YOU FOR THE KIND
INTRODUCTION, MY NAME IS MANDY,
THESE ARE MY PRONOUNS, I ALWAYS
LIKE TO START WITH OBJECTIVES TO
ANCHOR WHAT I'M TALKING ABOUT SO
I WILL TALK ABOUT A FRAMEWORK
FOR UNDERSTANDING, SGM
DISPARITIES AND A LOT OF IT WILL
SOUND FAMILIAR FROM WHAT YOU'VE
HEARD SO I WILL TRY TO BE BRIEF
AND THEN FROM MY PERSPECTIVE
WHAT'S NEEDED TO ADDRESS CANCER
DISPARITIES AND RESOURCES
AVAILABLE AND I WOULD LIKE TO
TRY TO END WITH AT LEAST SOME
RESOURCES SO IT'S NOT JUST ALL
ABOUT THE PROBLEM WITH NOWHERE
TO GO.
SO THIS SHOULD NOT LOOK
SURPRISING BUT WHEN WE TALK
ABOUT DISPARITIES, AND EVEN THEN
IN THE SGM POPULATION, THAT'S
REEL KEEPSAKES TAIFLY NEW.
SO THESE THINGS ARE IMPORTANT
BUT IT'S ALSO MORE IMPORTANT TO
BE LOOKING AT OR IN COMBINATION
BE LOOKING AT THE SOCIAL
PROCESSES AND SOCIAL STRUCTURAL
CONSEQUENCES OF THE KINDS OF
EXPERIENCES OR DRIVE THE
EXPERIENCES THAT LEAD TO THOSE
DISPARITIES SO YOU HEARD THAT
FROM THE PRIOR 3 SPEAKERS
ALREADY, 1 POINT TO JUST KIND OF
EMPHASIZE THAT I'M NOT SURE, I
GUESS WAS ACTUALLY BROUGHT UP, A
LITTLE BIT IN TERMS OF THE
DISCUSSION ABOUT RED LINING BUT
THESE STRUCTURAL PROCESSES ARE
REALLY TIED TO OUR LEG
ASTERISKSY OF CREATING AN
ECONOMY THAT WAS BASED ON
SLAVERY IN THIS COUNTRY AND THE
DIRECT TIE OF THAT ECONOMY TO
THE STOCK MARKET AND TO
CAPITALISM WHICH I'M SURE SOME
PEOPLE MIGHT DISAGREE WITH ME
AND IT'S A LOT TO UNPACK BUT
SUCCINCTLY ENSLAVED PERSONS WERE
USED AS COLLATERAL FOR BANKING
LOANS AND BODIES OF AFRICANS AS
WELL AS NATIVE AMERICANS WERE
EXCHANGED NEAR WALL STREET SO
THERE ARE SEVERE IMPLICATIONS
AND DIRECT CONNECTIONS BETWEEN
THE DISPARITIES THAT WE SEE THAT
ARE GROW.
THE WEALTH GAP IN THE LAST 2
YEARS THAT ARE IN PART BASED ON
BOTH GENERATIONAL WEALTH
DIFFERENCES AS A RESULT OF THE
HISTORY OF ENSLAVEMENT,
SEGREGATION, RED LINING AND
DISCRIMINATION AND THE STOCK
MARKET, HAVE LED TO GROWING
DISPARITIES AT THE TOP 1% I
THINK DOUBLED THE AMOUNT OF
WEALTH THAT THEY GAINED COMPARED
TO THE REST OF THE NATION IN THE
LAST 2 YEARS DURING THE PANDEMIC
SO, IT'S A--IT'S A REAL DIRECT
CAUSE OF THE DISPARITIES THAT
WE'RE SEEING, IF YOU CAN'T TAKE
CARE OF YOUR BASIC SAFETY, AND
NEEDS, THEN OF COURSE, YOU WILL
EXPERIENCE SIGNIFICANT HEALTH
OUTCOMES AS A RESULT.
SO SAID ANOTHER WAY, THE WAY IN
WHICH WE EXPERIENCE THE WORLD,
HOW WE INTERACT WITH OTHERS AND
THE WAY IN WHICH WE ACT WITH
SYSTEMS, DO AFFECT US AND ARE
VARIOUS WAYS OF LIVING IN THIS
WORLD IN TERMS OF HOW PEOPLE
CATEGORIZE US AND HOW WE
IDENTIFY DEFINITELY EFFECT OUR
EXPERIENCES OF POWER AND
VULNERABILITY AND THIS ISN'T A
WORKSHOP WHERE I GET TO
EXCHAIRVELG A LOT OF IDEAS WITH
YOU AND HEAR A LOT BUT I WOULD
LOVE TO HEAR FROM YOU IF YOU ARE
UP FOR IT IN WAYS YOU EXPERIENCE
POWER VERSUS VULNERABILITY, WE
ALL EXPERIENCE BOTH BUT HOW THAT
POSITIONALLITY MIGHT AFFECT YOUR
HEALTH.
AND I WOULD KIND OF CHALLENGE US
TO THINK ABOUT POSITIONALLITY
AND 4 WHEN WE'RE HAPPENING ABOUT
MEANINGFUL HEALTH RESEARCH AND
HOW IT AFFECTS SEXUAL AND
GEPPEDDER MINORITY COMMUNITIES
AND ANOTHER .. IS THAT SEXUAL
AND GENDER MINORITY PEOPLE
EXPERIENCE STRESS KIND OF
THROUGH THE TRAJECTORY OF
ENTERING THE HEALTH SYSTEM, FROM
MAKING THE APPOINTMENT, GETTING
TO THE APPOINTMENT, TO WELCOMING
AT THE CLINIC, TO THE CLINICAL
INTERACTION AND THIS KIND OF
POTENTIAL TRAUMATIC EXPERIENCES
THAT HAPPEN THROUGHOUT THE
COURSE OF JUST TRYING TO ACCESS
CARE ARE ON TOP OF LIVED
EXPERIENCES WHERE THERE CAN BE
CHARGED DISCRIMINATION AND
TRAUMA WHERE BEING HUMAN CAUSES
STRESS AND IN THE LAST COUPLE OF
YEARS I WOULD SAY WE HAVE A
CERTAIN ERA OF TRAUMA FROM THE
PANDEMIC.
SO IT'S A LOT ON TOP OF A LOT ON
TOP OF A LOT ON TOP OF A LOT
THAT CAN DIRECTLY EFFECT OUR
HEALTH.
I THOUGHT WAS INTERESTING, THIS
WAS A RECENT STUDY ONOXIDATIVE
STRESS AND SURVIFFORSHIP AMONG
CANCER SURVIVORS AND THAT
RELAPSE WAS MORE COMOON AMONG
THOSE WITH SIGNIFICANT--WITH
THOSE WITH SIGNIFICANT STRESS SO
I THOUGHT THAT WAS AN IMPORTANT
COMPONENT.
THIS SUPPORT JUST LIMITED, BUT
IT'S NOT LIMITED TO HELP
SERVICES RESEARCH OR
INTERVENTIONAL RESEARCH IN THE
SYSTEMS ARENA, WE ALSO HAVE WORK
WE CAN DO IN THE BASIC SCIENCE
ARENA TO HELP US BETTER
UNDERSTAND IN OF THESE DRIVERS.
AND SO, PUT KIND OF MORE
DIRECTLY AND SUCCINCTLY WHERE
COMMUNITIES HAVE A HIGHER
TOBACCO AND ALCOHOL USE RATE AND
MANY OF US KNOW THAT'S A RESULT
OF DIRECT MARKETING FROM TOBACCO
AND ALCOHOL VENDORS OVER TIME
AND GAY BARS BEING A SANCTUARY
OF SAFETY FOR, YOU KNOW A GOOD
PERIOD OF TIME SO THAT 20%,
20-21% OF LGBT PEOPLE COMPARED
TO 15% OF THE HETEROSEXUAL
PEOPLE WERE FOUND TO HAVE
ALCOHOL AND TOBACCO USE
DISORDERS IN ADDITION SCREENING
GUIDELINES HAVE NOT REALLY
CAUGHT UP SO WE DON'T REALLY
HAVE GUIDELINES TO RESPOND TO
THE TRANSPOPPULATION AND THE
NONBINARY POPULATION AND SO
ALTHOUGH THE AMERICAN COLLEGE OF
RADIOLOGY HAS BEEN WORKING ON
THAT, AND IN SURVIVORSHIP, WE'RE
KIND OF, THIS ARTICLE THAT I DID
NOT WRITE BUT IT WAS RECENTLY
PUBLISHED SURVIVING
DISCRIMINATION PULLING IT
TOGETHER SOUNDED RIGHT TO ME IN
EMERGING ITS OF KIND OF
SURVIVORSHIP AND QUALITY OF LIFE
DIFFERENCES WHICH AGAIN ARE
LINKED TO SOCIAL SUPPORT THAT
WAS PREVENTIVUOUSLY MENTIONED
TODAY AS WELL.
SO WHERE DO WE GO FROM HERE,
THINGS WE CAN PROBABLY AGREE ON,
WE NEED EVIDENCE TO GUIDE
CLINICAL CARE, PATIENTS SHOULD
BE ABLE TO ACCESS CARE AT THE
RIGHT TIME BY THE RIGHT PROVIDER
AND CLINICTIONS AND RESEARCHERS
NEED PREPARATION TO MAKE SURE
PATES HAVE ACCESS TO
EVIDENCE-BASED CARE AT THE RIGHT
TIME AND PLACE.
SO THIS WAS WHAT I WAS THINKING
ABOUT WHEN WHERE DO WE NEED TO
GO, AND OF COURSE THIS
IS--ALIGNED WITH THE RESEARCH
PORTFOLIO THAT I HAVE BECAUSE
IT'S HOW I THINK ABOUT THIS
WORK, BUT WE NEED TO UNDERSTAND
SEXUAL ORIENTATION, GENDER
IDENTITY AND USE INCLUDING
HAVING A WILL TO ASK AND BELIEF
IN IMPORTANCE AND KNOWING HOW TO
ASK, WHERE TO STORE AND HOW TO
USE THAT DATA, WE NEED CULTURAL
AND CLINICAL TRAINING TO PROVIDE
FOR STAFF AND THE CARE AND
CONTEXT.
THIS IS AN ARTICLE I CAME OUT
WITH LAST YEAR WITH A NUMBER OF
COLLEAGUES ADVOCATING FOR SEXUAL
GENDER AND DATA TO BE RETEENLY
ASKED IN STUDIES AND I'M MAKING
A SERIES OF TAKE AWAY POINTS SO
WE DON'T ROUTINELY ASK ABOUT
SEXUAL ORIENTATION, GENDER
IDENTITY SO WE HAVE A LOT OF
DATA ON DISPARITIES BUT WE DON'T
HAVE SYSTEMATIC DATA AT A
POPULATION LEVEL AND THE WAY WE
NEED ALTHOUGH IT'S CHANGING
RIGHT?
WE DON'T KNOW HOW TO ASK ABOUT
SOGI, SO THIS IS RECENT ADVICE
FROM THE NATIONAL ACADEMIES AND
HOPEFULLY I WON'T GET INTO MANY
PEOPLE MAD AT ME BUT SOME OF US
DIDN'T LOVE THESE
RECOMMENDATIONS SO A GROUP OF US
LED BY DR. JAIR SAN FRANCISCO
JACKSON AT NCI ARE WORKING ON
DATA STANDARDS FOR THE SOGI
RECOMMENDATIONS ON IDENTITY,
GENDER COLLECTION, AND THESE ARE
THE POINTS WE ARE GOING TO
MEASURE, I'M LEADING A STUDY
ABOUT REVIEWING ITEMS AND
RESPONSE OPTIONS TO TRY TO ADD
TO THE DATA, ROUND HOW TO ASK
THESE QUESTIONS.
AND I JUST WANTED TO ALSO
REVIEW, JUST SOME RECENT DATA
THAT CAME OUT OF A STUDY, I JUST
WRAPPED UP AND THAT WAS JUST
PUBLISHED A FEW WEEKS AGO WHERE
WE INTERVIEWED RADIATION
ONCOLOGISTS AND RADIOLOGISTS
ABOUT THEIR EXPERIENCES WITH
TRANSGENDER AND INTERSEX
PATIENTS AND THIS STUDY REALLY
CAME OUT REALLY ORGANICALLY FOR
A COLLEAGUE'S REQUEST FOR A
SUBMISSION ON THIS TOPIC AND I
KNEW NOTHING ABOUT WHETHER
RADIATION ONCOLOGY OR RADIOLOGY
FOR SCREENING FOR SURE, BUT RAID
YIGZ ONCOLOGY IN PARTICULAR
WOULD HAVE ANY DIFFERENT
IMPLICATIONS OTHER THAN KIND OF
CULTURAL AND COMMUNICATION
CONFIDENCE OR SKILLS IN
INTERACTING WITH PEOPLE JUST AS
YOU WOULD WANT IN ANY OTHER
CLINICAL ENVIRONMENT AND THESE
ARE SOME OF THE DATA THAT CAME
OUT OF THAT QUALITATIVE STUDY
THAT WAS RECEIPTLY PUBLISHED, 1
IS WE DON'T HAVE A RELIABLE WAY
TO DOCUMENT SOGI DATA ASK AND
CLINICAL CARE CONTACTS SO 1
PHYSICIAN SAID YOU HAVE TO DO IT
ON THE PROGRAM WHERE YOU TYPE
YOUR NAME, CUM TO THE HOSPITAL
AND THEN IT TALKS TO OTHER
PROGRAM AND THEN IT HAS TO TALK
TO THIS OTHER PROGRAM SO
IT'S--THEY DON'T ALL HAVE THE
SAME CODING, YOU CAN HAVE MALE,
FEMALE AND NONBIENAR EXPE IT
MIGHT NOT COME UP AS THE SAME
VARIABLE SO MAKING SURE THAT OUR
SYSTEMS ARE TALKING TO EACH
OTHER AND PEOPLE ARE CLEAR ABOUT
WHERE YOU CAN EVEN RECORD THESE
DATA.
TO MY POINT I WAS MAKING EARLIER
ABOUT THE CONTINUUM OF POINTS IN
CARE WHERE PEOPLE COULD
EXPERIENCE REASONS TO LEAVE THE
HEALTHCARE SYSTEM OR NOT COME
BACK OR HAVE DISAFFIRMING
INTERACTIONS REALLY FROM
SCHEDULING AND REGISTRATION
THROUGH THE CLINIC ENVIRONMENT,
CONSULTATION PROCESS, BILLING
AND INSURANCE AND SUPPORTIVE
CARE, WE FOUND THERE WERE GAPS.
SO THIS 1 PHYSICIAN SAID, YOU
KNOW WE ONLY HAVE 2 BOXES, MALE
OR FEMALE SO RIGHT FROM THE
GET-GO, SCHEDULING,
REGISTRATION, TRANSGENDER PEOPLE
WOULD NONAPOPTOTIC THE HAVE AN
AFFIRMING EXPERIENCE.
IN TERMS OF ENVIRONMENT, ANOTHER
PERSON SAID WE GENDER IT SO MUCH
THAT IT'S ALL PINK AND HAS THE
WORD WOMEN EVERYWHERE AND WE
KNOW DISPORRIA AROUND SCREENING
FOR BODY PARTS FOR CANCER CAN BE
A DETERRENT TO CERVICAL
SCREENING OR BREAST SCREENING
FOR EXAMPLE SO WE NEED TO DO
BETTER THERE, TOO.
IN TERMS OF CULTURAL HUMILITY
AND COMMUNICATION TRAINING, 1
PERSON SAID I FEEL MILDLY
UNCOMFORTABLE BECAUSE I'M NOT
TRANSMYSELF, IT'S PARADOXABLE
BECAUSE I'MA A MINORITY
SEXUALITY AND I'M VERY OUT AT
WORK, I FEEL LIKE THE
EXPECTATION WOULD BE ALL OVER
ABOUT HOW TO CARE FOR A
TRANSPERSON.
SO SELF-REFLECTION ON NOT BEING
TRAINED OR EQUIPPED TO PROVIDE
TO PEOPLE OR GENDER AFFIRMING
CARE EVEN AMONG THOSE WHO ARE
KIND OF ANTICIPATED OR EXPECTED
TO KNOW BECAUSE THEY ARE UNDER
THE SGM UMBRELLA THEMSELVES.
IN TERMS OF CLINICAL TRAINING
FOLKS SAID THINGS LIKE I DON'T
THINK I HAD 1 TUTORIAL OR
GUIDELINE ON MANAGING PATIENT
WHO IS ARE TRANSGENDER.
ONE RADIATION ONCOLOGIST SAID
THE ABILITY TO HAVE LONG-TERM
GNARL LE LUBRICATION CAN BE
SEVERELY CHAIMPLED IN THINGS
LIKE MICROFISSURES UP THE
MUCOSAL SURFACES,
SECURITIZATION.UAL ACTIVITY CAN
BE MUCH WORSE AFTER RADIATION
DUE TO THE FRIABILITY OF
TISSUES, SO TO THE IMPACT OF
GENDER AFFIRMING CARE ON THE
POTENTIAL FOR TREATMENT
MODALITIES AND VICE VERSA, THE
IMPACT OF RADIATION ON PELVIC
TISSUE AND WHAT THAT MIGHT MEAN
IN TERMS OF--WHAT THOSE
COVERAGES MIGHT LOOK LIKE THAT
ARE RELEVANT TO CANCER KREENING
AND CANCER CARE THAT MIGHT BE
MANY PEOPLE SAID, AND LIKE THAT
REALLY HAVE AN IMPACT THAT YOU
WOULD LIKE TO KNOW SO ACROSS THE
BOARD, WE HAVE WORK TO DO, AND I
WANT TO LEAVE YOU WITH A FEW
RESOURCES, THERE ARE DEFINITELY
LOTS MORE WE CAN TALK ABOUT, I
KNOW THAT WAS SUPER FAST BUT
THINGS THAT WE CAN KIND OF DO
NOW THESE ARE SOME THINGS MY
TEAM HAS PUT TOGETHER IN THE
LAST FEW YEARS TO WELCOME SEXUAL
GENDER AND MINORITY PATIENTS SO
1 IS A--JUST A PATIENT WELCOME
CARD WHERE PEOPLE CAN INDICATE
WHAT SOCIOLOGICAL DEMOGRAPHIC
FACTORS THEY WANT TO REPORT TO
YOU WHO THEY WANT INVOLVED IN
THEIR CARE, WHAT THEY MIGHT WANT
TO TALK ABOUT, POSTERS TO
WELCOME PATIENTS THAT SPEAK
VARIOUS LANGUAGES AND ARE NOT
UNDER THE SGM UMBRELLA, TIPS FOR
KIND OF HAVING CONVERSATIONS
THAT OUR PATIENTS ARE SGM AND
ALL OF THESE ARE FREELY
DOWNLOADABLE AND ARE ON THE
SCREEN.
THIS WAS A REVIEW ARTICLE I
WROTE IN 2019 WITH DR. JENNIFER
POTTER AROUND CONSIDERINGS FOR
SEXUAL AND GENDER MINORITIES,
AND THIS WAS AROUND CANCER
SCREENING CONSIDERATIONS, THERE
HAS AS A MENTIONED BEEN
ADDITIONAL WORK IN 2021, THE
AMERICAN COLLEGE OF RADIOLOGY
PUBLISHED A HELPFUL UPDATED
RECOMMENDATION FOR TRANSGENDER
PEOPLE FOR DIFFERENT SCENARIOS
THAT I THINK IS A STEP IN THE
RIGHT DIRECTION AND I KNOW THAT
THE AMERICAN COLLEGE OF
OBSTETRICS GYNECOLOGY ARE
THINKING ABOUT THIS, RIGHT NOW
THAT MEASURES ARE TALK ABOUT
THIS RIGHT NOW I'VE TALKED TO
FOLKS FROM THE [INDISCERNIBLE]
GROUP AND CAPTURING ORGAN
SCREENING AS OPPOSE TO GENDER
MARKERS FOR SCREENING, SO THAT'S
JUST A SNAPSHOT, STANDARDS FOR
CULTURAL COMPETENCY TRAINING TO
ADDRESS THE CULTURAL COMPETENCY
PIECE, THIS IS NOT KIND OF THE
END ALL BE ALL BUT THESE ARE
STANDARDS FOR CULTURAL
COMPETENCY THAT CAME OUT OF A
WORKING GROUP OF ABOUT 20 PEOPLE
OVER A COUPLE OF YEARS SPONSORED
BY THE NATIONAL LGBT CANCER
NETWORK AND WOMEN WALKER HEALTH
AND WE IDENTIFIED ANCHORING MECH
MENDATIONS IN TERPS OF WHEN
YOU'RE THINKING ABOUT CULTURAL
COMPETENCY TRAINING AND I WILL
JUST THROW IN THE WORD
COMPETENCY IS AN ISSUE.
WE DECIDED TO TURN TERM THE
PAPER THAT BECAUSE OF HOW WE
THOUGHT PEOPLE WOULD SEARCH FOR
INFORMATION, NOT BECAUSE WE
THINK THAT COMPETENCY IS
SOMETHING THAT CAN BE ACQUIRED
AND IT'S DONE AND OVER.
TEAM SGM STANDS FOR EQUITABLE
ACCESSIBLE MEANINGFUL TRAINING
TO IMPROVE CANCER CARE FOR SGM,
THIS S&P A PILOT I WORKED WITH
AND WE HAD STATISTICALLY
SIGNIFICANT FINDINGS FOR THE
COHORT THAT WENT THROUGH THE
TRAIPING, I CURRENTLY HAVE AN
R25 THAT IT HAS BEEN SCORED AND
WE'LL SEE IF IT'S FUNDED.
AND REGARDLESS, I'M WORKING ON
TRYING TO MAKE SOME OF THIS
INFORMATION MORE PUBLICLY
AVAILABLE THROUGH OUR LEARNING
MANAGEMENT SYSTEM, AS I HAVE
CAPACITY TO DO SO, BUT THIS IS
ABOUT 20 HOURS OF CURRICULA ON
SOME OF THE TOPICS YOU SEE HERE
THAT ARE SPECIFICALLY ANCHORS
AND ALIGNED WITH CANCER
CONTINUUM OF CARE ISSUES FROM
RISK REDUCTION TO SCREENING TO
HORMONE CONSIDERATIONS, TO
RADIATION ONCOLOGY
CONSIDERATIONS TO BILLING
CONSIDERATIONS, POLICY
DIFFERENCES, BY STATE,
SURVIVORSHIP CONSIDERATIONS, SO
REALLY THINKING ABOUT THE
CLINICAL COMPONENT OF
CONSIDERATIONS WHEN WE'RE
THINKING ABOUT SEXUAL AND GENDER
MINORITY HEALTH.
AND THEN I JUST WANT TO END WITH
A CALL TO ACTION.
THIS WAS A QUOTATION FROM 1 OF
OUR PARTICIPANTS IN OUR QUAL
FATIVE STUDY I MENTIONED.
BUT THIS GYNECOLOGIST SAID MY
ROLE AS A DOCTOR ON THE TEAM
WOULD BE TO SET THE EXAMPLE FOR
OTHER STAFF TO CHAMP YEN SHOULD
TYPE OF PRACTICE IN YOUR
SETTING.
AND SO, I WOULD JUST SAY USE THE
POWER YOU HAVE WHERE YOU HAVE IT
TO ADVANCE CHANGE WHERE YOU CAN,
THESE ARE SOME OF MY
COLLABORATORS ON SOME OF THE
STUDIES THAT I MENTIONED THROUGH
THE PRESENTATION, AND SOME OF MY
MAJOR FUNDERS ON WORK THAT IS
RELATED TO WHAT I MENTIONED AS
WELL AS OTHER WORK THAT IS NOT
MENTIONED HERE.
AND THIS IS MY CONTACT
INFORMATION.
SO WITH THAT I WILL STOP SHARING
AND HAPPY TO TAKE QUESTIONS AT
THE END OF THE PANEL.
THANK YOU SO MUCH.
>>THANK YOU SO MUCH
DR. PRATT-CHAPMAN.
THAT WAS A WONDARERFUL
PRESENTATION.
OUR NEXT PRESENTATION IS
ENTITLED LESSONS NOT LEARNED
FROM THE HIV PANDEMIC:
DISPROPORTIONATE IMPACTS OF
CONVALESCENT 19 AND MONKEYPOX ON
SGM POP EULOGIES, DR. GEGRY
PHILLIPS FROM NORTHWESTERN
UNIVERSITY FEINBERG SCHOOL OF
MEDICINE WILL PRESENT OUR NEXT
SESSION, DR. PHIL EPIGENETICS,
HAVE YOU THE FLOOR.
--YOU HAVE THE FLOOR.
>>THANK YOU SO MUCH FOR HAVING
ME, TALKING ABOUT HIV AND MOVE
INTO MORE CURRENT TOPICS THAT
PEOPLE ARE LESS EXPERIENCED
WITH, SO FOR SGM POPULATIONS WE
TYPICALLY CONSIDER HIV AS A
FIRST PANDEMIC THAT REALLY
DEFINED THE RESEARCH, AND HOW
DISPROPORTIONATELY SGM
POPULATIONS WERE UNTIL HIV CAME
AROUND.
HIV WAS THE LAUNCHING POINT FOR
A LOT OF NEW ANTISGM STIGMA,
THIS RANGE FROM THE INITIAL
NAMING OF AIDS AS GAY RELATED
IMMUNE DEFICIENCIES, VILLISK OF
MSM, BATH HOUSES, A LOT OF
NEGATIVE STUFF, MY POST DOC HAS
DONE A LOT OF WORK LOOKING AT
CONNECTIONS BETWEEN SGM AND
ANTISGM SIGNATURES STATE
REGULATOR THAT STEMS FROM THIS
EARLY TIME PERIOD BUT NOT
EVERYTHING FROM HIV WAS NEG5 HIV
BROUGHT AROUND A NEW MODEL OF
COMMUNITY ACTIVISM AND POLITICAL
ENGAGEMENT, MAIN STREAM
ACKNOWLEDGMENT OF SGM
POPULATIONS AS PEOPLE WHO
ARE--WHO HAVE LIFE AND WORTH
HAVE ARE WORTH INVESTING IN.
WE HAVE BETTER SOGI MEASUREMENT,
WE DIDN'T HAVE GOOD MEASUREMENT
BEFORE ISSUES THIS WAS BETTER
AND THERE WAS THIS NEW INCREASED
FUNDING FOR SGM HEALTH RESEARCH
AS HAS BEEN MENTIONED SEVERAL
TIMES, MOST OF IT STILL IN HIV,
THIS IS WHERE A LOT OF THE
FUNDING STARTED TO COME FROM,
THOUGH.
SO DESPITE DECADES OF
EXPERIENCES WITH HIV THERE WAS
LOTS OF RESEARCH CHANGES,
ADVOCACY CHANGES, POLICY
CHANGES, REGARDLESS OF WHAT WAS
OCCURRING OVER THOSE DECADES,
THINGS DIDN'T CHANGE FOR THE
NEWEST PANDEMICS THAT WE HAVE
BEEN EXPERIENCING.
SO DESPITE ALL OF THIS LEARNED
LESSONS, WE SAW REFUSAL TO
COLLECT SOGI DATA ESPECIALLY
DURING COVID-19, REFUSAL TO
ACKNOWLEDGE DISPROPORTIONATE
IMPACTS ESPECIALLY DURING
COVID-19 AND THE SGM INDIVIDUALS
WERE DISPROPORTIONATELY IMPACTS,
USE OF STIGMATIZING AND
INACCURATE CAMPAIGNS, USE OF
FEARMONGERING TO STIMMULE
PREVENTIVE BEHAVIORS, AND
LIMITED FOCUS ON BISEXUAL AND
TRANSGEPPEDDER POPULATIONS.
SO STARTING WITH COVID-19,
MOVING INTO MPOX LATER, RESEARCH
FOUND A LOT OF THIS, I'M SURE
MANY OF THE PEOPLE HERE KNOW
COVID-19 IS VERY CLOSELY TIED TO
INEXPECTATIONS QUITY SO LONG
TIME DISCRIMINATION ARE REALLY
DRIVING DISPROPORTIONATE
COVID-19 RATES, A LOT OF THE
STRUCTURAL FACTORS WE KNOW THAT
EXIST, SO HEALTH, SERVICE
ACCESS, SOCIAL DETERMINE NABTS
ESPECIALLY PEOPLE WHO HAVE
MINORITIZED IDENTITIES SO SGM
PEOPLE OF COLOR AND THEN THE
FACT THAT THERE'S BEEN SO LITTLE
DATA COLLECTION ON COVID-19
OUTCOMES.
VERY FEW STUDIES FOUND
INFORMATION ON THIS, STUDIES
THAT WERE CONDUCTED ONLY LOOKED
AT MALES AND FEMALES, DIDN'T
LOOK AT ANYTHING BEYOND THE
BINARY CONSTRUCT AND THAT REALLY
LIMITED WHAT WE WERE ABLE TO SAY
ABOUT HOW THE COVID-19 PANDEMIC
IMPACTED PEOPLE.
SO, WITH ALL THESE GAPS, OUR
TEAM PRIORITIZED LOOKING HOW DO
DISPARITIES MANIFEST WITHIN
THESE POP EULOGIES, SO WHAT ARE
THE COMPLEX CAUSES AND
CONSEQUENCES AND WHAT CAN BE
DONE TO SUPPORT HEALTH AND WELL
BEING OF INDIVIDUALS DURING
COVID-19 AND FUTURE PANDEMICS
ASIDE FROM THE OBVIOUS BUT NOT
IMPOSSIBLE BARRIERS OF, ALL OF
THOSE.
SO WE PUBLISHED 1 OF THE FIRST
PAPERS THAT WAS REALLY A CALL TO
ACTION THAT OUTLINED WHAT PEOPLE
SHOULD BE DOING TO HELP ACHIEVE
HEALTH EQUITY DURING THE
COVID-19 PANDEMIC AND MOST OF
THE PEOPLE IN HERE, NONE OF
THESE SHOULD BE A SURPRISE AND
IT'S VERY MUCH IN ALIGNMENT WITH
WHAT'S BEEN DISCUSSED ALREADY.
SO HAVE BETTER TRAINED STAFF,
BETTER DATA COLLECTION, MORE
RESEARCH UPDATE DEMOGRAPHIC ON
LGBTQ+ PEOPLE, HAVE A PLAN SO
THAT WE'RE PROACTIVE RATHER THAN
BEING REACTIVE AND USING YOUR
VOICE FOR LGBTQ HEALTH.
SO, MOVING ON FROM THIS, WE
COLLECTED SOME DATA, SOME OF THE
FIRST DATA ON SEXUAL AND GENDER
MINORITY ADULTS.
WE WERE JUST LOOKING AT OVERALL
DISPARITIES WE HAD A REALLY
DIVERSE GROUP OF PEOPLE, WE
LOOKED AT INTEREST IN
VACCINATION, SAW INTERESTING
FINDINGS SO, TRANSGENDER
NONBINARY AND BISEXUAL, PAN
SEXUAL INDIVIDUALS WERE ALL MORE
INTERESTED IN GETTING A
VACCINATION, THIS WAS
PREVACCINATION, SO THIS WAS ALL
THEORETICAL, AND WHEN WE WERE
THINKING ABOUT TESTING AT HOME
FOR THOSE WHO WERE READILY
AVAILABLE WE SAW INTERESTING
THINGS WHERE WHERE INTERSECTS
AND INDIVIDUALS ARE GOING TO
TEST AT HOME SO POPULATION WE
KNOW ARE OFTEN OVERLOOKED AND
DISPROPORGATELY IMPACTED BY ALL
THESE FACTORS WERE MORE WILLING
TO ENGAGE IN NEEZ PREVENTIVE
BEHAVIORS.
AND THEN THIS PAPER WHICH WAS
LED BY DYLAN [INDISCERNIBLE]
TEAM, REALLY HELPED OUTLINE WHAT
THE FACTORS ARE WERE THAT LED TO
THE DISPROPORTIONATE OUTCOMES WE
WERE SEEING AMONG TRANSAND
GENDER DIVERSE POPULATIONS AND
HERE'S A REALLY GREAT CONCEPTUAL
MODEL THAT'S IN HERE PAPER, WE
SAW LOTS OF DIFFERENCES HERE IN
TERMS OF HOWESING INSTABILITY,
MEDICAL CARE INTERRUPTIONS, ALL
THESE FACTORS THAT ARE REALLY
TIED INTO THE STRUCTURAL FACTORS
THAT JUST DRIVE ALL OF THE
DISPARITIES.
ACE BASE ON ALL THAT WORK WE
WERE 1 OF THE FIRST GROUPS TO
FOCUS ON THE RADX-UP POPULATION
AND FOCUS ON THE POPULATIONS, WE
WERE FOCUSING ON YOUTH AND
ADULTS, I WON'T READ ALL THE
DATA HERE BUT WE RECRUITED ARK
DULTS BETWEEN 18-24 TO
PARTICIPATE IN QUANTITATIVE AND
QUALITATIVE INTERVIEWS WITH THE
HOPES OF DEVELOPING AN
INTERVENTION TO HELP IMPROVE
VACCINATION AND TESTING.
WE FOUND A LOT OF QUANTITATIVE
THINGS SO A LOT OF THIS ISN'T
SURPRISE.
THE BIG THINGS WE FOCUS ON ARE
THE MAINLIOR LIFE CHANGES SO,
11.5% HAD MAJOR CHANGES IN
INCOME OR EMPLOYMENT AND 9% HAD
SEVERE STRESS OR DISCORD WITHIN
THEIR FAMILY, AND THE THIRD HAD
TO SEVERE STRESS RELATED TO THE
PANDEMIC AND THESE ARE 2 OF THE
QUOTES FROM THE INTERVIEWS THAT
I HIGHLIGHTED THE STRESS THAT
PEOPLE EXPERIENCE WE ALSO
LOOKEDDA AT HOW STIGMATIZATION
IMPACTED PEOPLE WHICH WAS A
DROWN STREAM DISPROPORTIONATE
IMPACTS.
SO UNSURPRISINGLY WE FOUND LOTS
OF STIGMATIZATION ISSUES WITH
THESE YOUTH.
SO HAVING TO GO HOME TO
UNSUPPORTIVE ENVIRONMENTS,
HAVING TO BE AROUND PARENT WHO
IS DIDN'T SUPPORT THEM, HAVING
TO GO BACK IN THE CLOSET, NOT
BEING AROUND PEOPLE WHO USE
THEIR CORRECT NAMES WHO USE
THEIR CORRECT PRONOUNS WERE
REALLY STRESSFUL AND REALLY
CAUSED A LOT OF MENTAL HEALTH
IMPACTS AMONG THESE YOUTH.
BUT WE DID SEE A FEW POSITIVES
ABOUT THE PANDEMIC IS THAT THERE
WAS TIME TO FOCUSED ON FOCUS ON
SOME OF THESE, SO NOT HAVING TO
FOCUS OR STRESS OVER SCHOOL,
THEY HAD TIME TO THINK ABOUT
WHAT'S MYI DEBTITY, WHAT DO I
THINK ABOUT TRANSITIONING, ALL
THESE THINGS SO THERE'S A BIT OF
A POSITIVE BUT OVERALL LOTS OF
NEGATIVE IMPACTS ON YOUTH,
NEGATIVE IMPACTS ON SGM, THIS
ALL THEN LEADS INTO SOME OF THE
SAME THINGS WE WERE SEEING
WITHIN THE MPOX OUTBREAK THAT
STARTED LAST YEAR.
SO, THERE'S BEEN OVER 30,000
CASES IN THE UNITED STATES AS OF
EARLIER OR LATE FEBRUARY, NOT
VERY MANY DEATHS BUT IT STILL
HAD A HUGE IMPACT.
AS MANY PEOPLE KNOW, CASES
PEAKED DURING LATE SUMMER, EARLY
FALL, SOME OF THE CASES WERE
WITHIN SEXUAL NETWORKS AND MEN
WHO HAVE SEX WITH MEN.
SO WE PARTNER WIDE SOME
INVESTIGATORS HERE, IN CHICAGO
DRS. AUDRIE FRENCH AND
[INDISCERNIBLE] TO DO A
SUBSTUDY.
WE'VE BEEN VERY INVOLVED IN THE
CHICAGO'S RESPONSE TO THE MPOX
OUTBREAK AND WE'RE INTERESTED IN
HOW PEOPLE ARE EXPERIENCING NOT
JUST MPOX OUTBREAK BUT MESSAGES
AROUND IT AND WHAT THAT MEANT TO
THEM MOVING FORWARD.
WE'VE BEEN HEARING A LOT OF
ANECDOTA THINGS ABOUT STIGMA AND
BAD MESSAGES AND WE WANTED TO
REALLY EXPLORE THIS.
SO WE COLLECTED DATA FROM A
LITTLE OVER A FEW HUNDRED PEOPLE
AND WE WERE REALLY LOOKING AT A
NUMBER OF OUTCOMES.
SO THIS PAPER IS CURRENTLY
UNDERWAY, WE WERE LOOKINGA AT
NUMBER OF QUESTIONS REGARDING
STIGMA AND NOT SURPRISINGLY WE
SAW A LOT OF STIGMATIZING AND
NEGATIVE EXPERIENCES PEOPLE HAD
WITHIN THE SAMPLE.
SO THESE ARE 2 QUOTES THAT COME
FROM QUESTIONS THAT WE ASKED.
ARE THINGS YOU FEEL PUBLIC
HEALTH HAS DONE POORLY?
ONE WE HEARD A LOT IS
ASSOCIATION WITH GAY SEX,
SIGMAITIZATION AND
POLITICIZATION OF THE OUTBREAK,
PEOPLE FELT STRONGLY ABOUT HOW
CLOSELY TIED MPOX WAS TO GAY
SEX.
AND HOW DO WE AVOID DISCUSSING
MONKEYPOX IN A WAY THAT DOESN'T
CAUSE MORE STIGMA.
SOMEBODY SAID A VERY VALID QUOTE
THAT EVERYTHING ABOUT OUR
COMMITTEE IS STIGMATIZED WHY IS
THIS ANY DIFFERENT, JUST KNOW
THAT THINGS DON'T CHANGE.
SO UNSURPRISINGLY LOTS OF STIGMA
AGAIN.
WE ALSO LOOKED TO SEE HOW STIGMA
WAS ASSOCIATED WITH TRAUMATIC
STRESS.
WE FOUND LOTS OF PROXIMITY TO
MONKEYPOX, SO NOT JUST BEING
IMPACTED BY MONKEYPOX AND HAVING
PEOPLE IN YOUR LIFE WHO WERE
AFFECTED WITH MPOX WERE SOABT
ARE WIDE NEGATIVE OUTCOMES SO
PSYCHOLOGICAL DISTRESS, STIGMA
AGAINST THE PHYSICAL SIGNS OF IT
OR POTENTIAL SIGNS OF MPOX, FEAR
OF SOCIAL REJECTION, IDENTITY
BASED DISCRIMINATION, AND EVEN
THOUGH WE KNOW THAT MORBIDITY
AND MORTALITY WAS LOW, THE
IMPACT CAN BEENTIOUS SPECIALLY
HIGH WHEN PEOPLE MIGHT ASSUME
THAT YOU ARE IMPACTED OR
INFECTED WITH MP.O. BOX.
WE ALSO DID A BIT MORE
QUANTITATIVE WORK WE TURNED ALL
THE MEASURES THAT THE CDC USED
TO PREVENT FROM GETTING MPOX
INTO A SERIES OF QUESTIONS, NOT
ALL OF THE QUESTIONS WERE GREAT,
BUT WE USED EXACTLY WHAT CDC
HAD.
WE FOUND THAT PEOPLE BROKE OUT
INTO 2 DIFFERENT GROUPS, SO
PEOPLE WERE DEFINED BY DECREASES
IN SEX AND INCREASES IN
PREVENTIVE BEHAVIORS, WE SAW A
HUGE CHANGE IN A NUMBER OF SEX
PARTNERS, SO EVEN COMPARED TO
OTHER STUDIES, WE FOUND ABOUT
3-QUARTERS OF A SAMPLE HAD
REDUCED SEX OR STOPPED HAVING
SEX FROM WHEN THE PANDEMIC
STARTED, WHICH WAS MUCH LESS
THAN WE SAW IN OTHER STUDIES
LIKE THE AMOS STUDY, LIKE I SAID
WE HAVE THESE 2 FACTORS, THESE
ARE BOTH ASSOCIATE WIDE MPOX
VACCINATION SO WE SAW THE
DIFFERENT ENGAGEMENT AND
BEHAVIORS WERE RELATED AND NOT
IN THE WAYS WE EXPECTED MEANING
THERE IS VERY COMPLICATED AND
COMPLEX ASSOCIATIONS.
OUR TAKE AWAY FROM ALL OF THIS
WHICH I TALKED ON A BIT LAST
WEEK IS THAT WE DON'T WANT
PUBLIC HEALTH MESSAGES THAT'S
ANTIPLEASURE.
WE WANT PLEASURABLE AND HEALTHY
SEX MESSAGING TO BE COMPATIBLE
WITH PUBLIC HEALTH GOALS.
SOPHISTICATEDY TRYING TO MARRY
THE WORK OF PEOPLE WHO ARE
FOCUSED ON NONABSTINENCE ONLY
BUT HAVING SAFER AND HARM
REDUCTION IN YOUR SEXUAL
BEHAVIORS IS REALLY WHAT WE WANT
TO FOCUS ON, ESPECIALLY MODELING
AFTER A SUCCESSFUL CAMPAIGNS
LIKE PREP FOR LOVE THAT USES
LESS STIGMATIZING MESSAGES.
SO, LOTS OF QUICK DATA, NOT--A
LOT OF TIME TO GO OVER ALL OF
THIS, BUT MY TAKE AWAYS REALLY
THAT WE CAN, WE MUST DO BETTER,
WE KNOW THAT PANDEMICS WILL
CONTINUE TO OCCUR, SO, COVID-19
HAPPENED, WE DIDN'T LEARN FROM
THAT WE MOVE RIGHT INTO MPOX, WE
DIDN'T LEARN FROM THAT WE WILL
MOVE INTO WHATEVER THE NEXT
PANDEMIC IS, WE NEED TO HAVE A
BETTER FOCUS AND WE NEED TO BE
BETTER PREPARED FOR IT SO THAT
WE'RE ABLE TO WORK DIRECTLY WITH
SEXUAL AND GENDER MINORITY
POPULATIONS ESPECIALLY RACIAL
ETHNIC MINORITY, SEXUAL GENDER
MINORITY POPULATIONS.
AS I SAID EARLIER, RESEARCH
NEEDS TO BE PROACTIVE, NOT
REACTIVE, SO MUCH OF WHAT WE DO
IS VERY REACTIVE, BUT, IF WE'RE
PROACTIVE, WE WILL BE BETTER
PRACTICESY PAIRED SO THAT WE
DON'T GET INTO THE MIDDLE OF A
PANDEMIC AND REALIZE SHOULD HAVE
BEEN DOING SOMETHING
DIFFERENTLY.
COLLECTION OF SODPRKS I DATA
USING STANDARDIZED METHODS.
THIS NEEDS TO BE REQUIRED FOR
SURVEILLANCE ACTIVITIES.
I KNOW CERTAIN PLACES ARE DOING
A GREAT JOB WITH THIS, STILL IT
NEEDS TO BE STANDARDIZED AND IT
NEEDS TO BE DONE PROPERLY IN A
WAY THAT'S REFLECTIVE WHAT HAVE
COMMUNITY AGENCIES WANT OR MORE
OF TRANSGENDER, MORE OPTIONS FOR
GAY STRAIGHT TRANSFUNCTIONS, I
KNOW THESE ARE HARD TORE DO BUT
THESE HAVE A BIGGER IMPACT, SO
FOCUSING MORE ON STRUCTURAL
CHANGE, MULTILEVEL CHANGE, AND
HAS BEEN MENTIONED EARLIER,
COMMUNITY-LED APPROACHES ARE
NECESSARY TO MAKE SURE WE HAVE
ACCEPTABLE AND NONSTIGMATIZING
RESPONSES.
A LOT OF THE WORK IN CHICAGO
THAT HELPED STEM THE TIDE OF THE
MPOX OUTBREAK WAS COMMUNITY-LED
AND A LOT OF MESSAGING WE'VE
SEEN WASN'T COMMUNITY LED BUT
WAS RIGHTLY CALLED OUT BY XIEWNT
AS BEING STIGMATIZING.
SO THAT'S MY OVERVIEW, I WANT TO
THANK ALL MY TEAM WHO HELPED ME
PULL THIS TOGETHER, AND THERE'S
MY CONTACT INFORMATION.
>>THANK YOU SOPHISTICATEDY MUCH
DR. PHIL EPIGENETICS.
OUR LAST SPEAKER AND DR. MEGAN
SCHULER FROM THE RANDOMIZED
TRIAL KORCHERATION AND HER
PRESENTATION IS ENTITLED AN
OVERVIEW OF MENTAL AND
BEHAVIORIAL HEALTH INIQUITIES
AMONG LGBTQ+ INDIVIDUALS AND
AFTER THIS WE WILL HAVE Q&A
PANEL.
>>OKAY, SORRY ABOUT THAT.
DOES THAT WORK NOW?
>>YES.
>>OKAY, I HAVE A LOT TO COVER
AND I WILL TRY TO HIT THE
HIGHLIGHTS.
SO I WILL TALK ABOUT MENTAL AND
BEHAVIORIAL HEALTH INIQUITIES.
JUST TO START OFF WITH, YOU KNOW
SOME VERY, NOT SURPRISING TAKE
AWAY POINTS, MENTAL HEALTH
CONDITIONS AND SUBSTANCE USE
HAVE BEEN SHOWN TIME AND TIME
AGAIN TO BE SIGNIFICANTLY
ELEVATED AMONG LBGTQ+
INDIVIDUALS BUT WITH REALLY
IMPORTANT VARIATION IN THE
MAGNITUDE OF THESE DISPARITIES
BY FACTORS SUCH AS GENDER,
SEXUAL IDENTITY, RACE ETHNICITY
AND AGE AMONG RPGHTS SO I WILL
TRY TO HIGHLIGHT THAT
HETEROGENERATED AITY, DURING MY
TIME TODAY, AND ALSO AS
UNDERSCORED IN THE KEY NOTE, WE
KNOW MUCH LESS ABOUT THE
ETIOLOGY AND RISK FACTORS
UNDERLYING THESE DISPARITIES BUT
THEY LIKELY DIFFER, AMONG SGM
SUBGROUPS WHICH HAS IMPORTANT
IMPLICATIONS FOR THINKING ABOUT
IMPLEMENTING PREVENTION AND
TREATMENT EFFORTS.
SO, OF COURSE MINORITY STRESS,
FEAR IS A CONTRIBUTOR, 1 OF
PERHAPS MANY MULTIFACETED
DRIVERS OF THESE DISPARITIES SO
THAT INCLUDES OF COURSE
INDIVIDUAL DISCRIMINATION AND
HARASSMENT AS WELL AS SOCIETAL
AND STRUCTURAL INEQUALITIES, AND
YOU KNOW, WE KNOW THAT THERE'S
REALLY A PROFOUND DIVERSITY OF
EXPERIENCES AMONG LGBTQ+
INDIVIDUALS, BOTH WITH REGARD TO
INDIVIDUALS HOLDING DISTINCT AND
INTERSECTING IDENTITIES AS WELL
AS DISTINCT SOCIAL EXPERIENCES
IN THE FAMILY, SCHOOL,
COMMUNITY, STATE ENVIRONMENTS.
AND I WOULD BE REMISS IF ARE THE
STATE ASHES NOUNSMENT WE HAVE
THE ANTIBGTQ BILLS IN THE UNITED
STATES, TRYING TO MOVE THROUGH
STATE CONGRESS LEGISLATURES AND
ALTHOUGH THESE ARE--THESE ARE
PRIMARILY ANTITRANSBILLS, SO
THAT'S IMPORTANT TO NOTE.
I WANT TO TAKE A MOMENT TO
REVIEW THE PSYCHIATRY FAME WORK,
I LABEL THOSE HISTORICICAL, AND
NOT SO HISTORICAL CONTEXT.
SO, IN 1973, THE AMERICAN
PSYCHIATRIC ASSOCIATION REMOVED
HOMOSEXUALITY HAS A FORMAL
MENTAL DIAGINOSEIS FROM THE
SECOND ADDITION OF THE
DIAGNOSTIC AND STATISTICAL
MANUEL DSM AND THAT IN ITS PLACE
WAS ADDED SEXUAL ORIENTATION
DISTURBANCE AND SO THIS MEANT
THAT HOMOSEXUALITY PER SE WAS NO
LONGER A DIAGNOSED MENTAL
ILLNESS, BUT THE DISTURBANCE
DIAGNOSIS REFERRED TO
INDIVIDUALS WHO EXPERIENCED KIND
OF DISTRESS OR DISCORDANCE
RELATED TO THEIR SEXUAL
ORIENTATION AND IN THE
RAMIFICATIONS OF THIS BEING A
FORMAL PSYCHIATRIC DIAGNOSIS WAS
THAT PRIOR TO 1973, COULD BE
INSTITUTIONALIZED FROM THEIR
JOB, DIDN'T FIND A MORTGAGE, A
VARIETY OF OF CONSEQUENCES, AND
ALSO JUST A REMINDER THAT IT
WASN'T UNTIL 1995 THAT PRESIDENT
CLINTON ENDED THE FEDERAL POLICY
DENYING SECURITY CLEARANCES
BASED ON SEXUAL ORIENTATION.
SO, SEVERAL DECADES LATER, WITH
REGARD TO GENDER DISORDER, SO IT
WAS 2013 THAT GENDER IDENTITY
DISORDER WAS DROPPED FROM THE
DSM-5 WITH GENDER DYSPHORIA
ADDED IN ITS PLACE AND THIS
REQUIRED KIND OF COMPONENT OF
DYSPHORIA POINT, AT ONCE, NOT
JUST MERELY THE IDENTITY AND W.
H. O. FOLLOWED SUIT JUST IN
TWEBT 19, DROPPING GENDER
IDENTITY DISORDER FROM THE ICD
11 AND ADDING GENDER
INCONGRUENCE.
AND IT IS ALSO WORTH
HIGHLIGHTING THAT EVEN THOUGH IN
RECENT YEARS A NUMBER OF
JURISDICTIONS HAVE PASSED
LEGISLATION BANNING QUOTE
REPARAATIVE OR CONVERSION
THERAPIES WHICH ARE KIND OF
DISPROVEN INTERVENTIONS AIMED AT
CHANGING SEXUAL ORIENTATION OR
GENDER IDENTITY.
LGBTQ+ INDIVIDUALS TO THIS DAY
ARE SUBJECTED TO THESE
QUOTE-UNQUOTE THERAPIES.
SO TURNING NOW TO GIVE YOU AN
OVERVIEW OF THE STATUS OF MENTAL
HEALTH, SO MENTAL HEALTH WELL
DOCUMENTED, I WILL FOCUS ON
NATIONAL DATA, SO, THE NATIONAL
SURVEY ON DRUG USE AND HEALTH IS
KIND OF A LEADING SOURCE WITH
THE CLEAR LIMITATION THAT THIS
ONLY ASSESSES SEXUAL IDENTITY
AND WITH THE RESPONSE OPTIONS OF
LESBIAN GAY OR BISEXUAL AND
HETEROSEXUAL AND IT'S ONLY
ASSESSED AMONG ADULTS, SO THESE
RESULTS WILL BE FOCUSING ON
LGB ARK DULTS ONLY.
AND SO, THIS DATA INDICATES THAT
LGB ADULT VS MORE THAN TWICE THE
RATE OF MENTAL ILLNESS, COMPARED
TO HETEROSEXUAL ADULTS, IN TERMS
OF PAST YEAR PREVALENCE, THAT'S
37% COMPARED TO 17% OF
HETEROSEXUAL ADULTS AND OTHER
NATIONAL DATA INDICATES THAT
TRANSGENDER INDIVIDUALS ARE
NORMAL 4 TIMES AS LIKELY AS
CISGENDER INDIVIDUALS TO
EXPERIENCE MENTAL HEALTH
CONDITION, THE BULK OF THE WORK
HAS FOCUSED ON EATING DISORDERS,
SUICIDALLITY, AND PTSD, AND
AUTISM SPECTRUM DISORDERS AND
OTHER CONDITIONS.
SPECIFICALLY, ON DEPRESSION AND
ANXIETY, I'LL NOTE THAT
INDIVIDUALS IDENTIFY AS BISEXUAL
OR QUEER HAVE BEEN SHOWN TO HAVE
SIGNIFICANTLY HIGHER RATES OF
DEPRESSION THAN INDIVIDUALS
IDENTIFYING AS GAY OR LESBIAN.
THERE'S INTERESTING THINGS GOING
ON WITH AGE, WHERE IN THE
GENERAL POPULATION, RATES OF
DEPRESSION TEND TO BE HIGHEST IN
ADOLESCENCE AND EARLY ADULTHOOD
AND THEN AGAIN IN OLDER
ADULTHOOD, AND PRETTY NOTABLILY
DECLINING DURING MIDDLE
ADULTHOOD, WHEREAS AMONG LGBTQ+
FOLKS THAT DECLINE IN MIDDLE
ADULTHOOD IS NOT NEARLY AS
PRONOUNCED SO WE SEE KIND OF
SUSTAINED ELEVATED RATES OF
DEPRESSION IN MIDDLE ADULTHOOD
IN PARTICULAR.
SOME INTERESTING RESULTS FROM
THE RECENT CENSUS HOUSEHOLD
PULSE SURVEY DURING COVID
SHOWING STATE VARIABILITY WITH
REALLY STRIKING DIFFERENCES
STATE BY STATE IN TERMS OF RATE
OF DEPRESSION AMONG LGBTQ+
RESPONDENTS.
SO LOOKING AT AMONG HIGH SCHOOL
STUDENTS THE YRBS DATA WHICH IS
NIEMGHT THROUGH 12 GRADERS FOUND
THAT HIGH SCHOOL UNSUPPORTED
STUDENTS PREPORT THEY ARE MORE
THAN TWICE AS LIKELY TO PREPORT
PERSISTENT SADNESS AND
HOPEFULLESS SO 60% OF THE LGB
YOUTH COMPARED TO 32% OF
HETEROSEXUAL YOUTH.
TREVOR PROJECT HAD A RECENT
NATIONAL SURVEY ON YOUTH MENTAL
HEALTH FINDING THAT 3-QUARTERS
OF TRANSAND NONBINARY YOUTH
REPORTED SYMPTOMS OF ANXIETY AND
2/3RDS REPORTED SYMPTOMS OF
DEPRESSION, 2015 U.S.
TRANSGENDER SURVEY, HIGHLIGHTED
THAT NONBINARY INDIVIDUALS
REPORTED HIGHER RATES OF SERIOUS
PSYCHOLOGICAL DISTRESS SYMPTOMS
OF DEPRESSION AND ANXIETY
COMPARED TO TRANSGENDER WOMEN
AND MEN.
TURNING TO SUICIDALLITY, LGB
ASULTS WE SEE RATES OF
SUICIDALLITY THAT ARE 3-5 TIMES
HIGHER THAN HETEROSEXUAL ADULTS
AND AGAIN WE SEE THAT BI
BISEXUAL, CLEAR AND PAN SEXUAL
INDIVIDUALS HAVE ELEVATED RISK
EVEN ABOVE AND BEYOND GAY AND
LESBIAN INDIVIDUALS AND JUST
REALLY STRIKING DISPARITIES
AMONG TRANSFOLKS WITH SUICIDE
ATTEMPTS BEING 7 TIMES HIGHER
THAN THAN CISGENDER PEERS.
AND WE SEE AGAIN THESE
DISPARITIES EMERGE IN
ADOLESCENCE WITH LGBTQ PLUS
YOUTH ARE 4 TIMES AS LIKELY TO
REPORT CONTEMPLATING SUICIDE
COMPARES TO THEIR NONLGBTQ +
PEERS.
AND AGAIN FROM THE TREVOR
PROJECTS RECENT SURVEY, 45% OF
THE LGBTQ REPORTED HIGHER RATES
OF SUICIDALLITY OUTSTANDING
DEDICATION COME AND MEMBER
HEALTH SERVICE UTILIZATION AND
THAT OVER JUST THE LAST 3 YEARS
EVEN SUICIDAL THOUGHTS HAVE
SIGNIFICANTLY TRENDED UPWARDS
AMONG LGBTQ+ YOUNG PEOPLE.
RECENT REPORT FROM THE WILLIAMS
INNSITUTE FOUND THAT MORE THAN
60% OF SUICIDE ATTEMPTS AMONG
SEXUAL MINORITY INDIVIDUALS
OCCUR WITHIN THE FIRST 5 YEARS
OF INDIVIDUALS IESHES DENTIFYING
OR COMING OUT.
--IDENTIFYING OR COMING OUT.
SO TURNING TO SUBSTANCE USE, LGB
INDIVIDUALS AGAIN, WELL
DOCUMENTED EVIDENCE THAT THEY
EXPERIENCE ELEVATED RATES OF
MULTIPLE DIFFERENT SUBSTANCE USE
BEHAVIORS AND DISORDERS, THIS
INCLUDES ALCOHOL, AND TOBACCO.
THE 2015 U.S. TRANSGENDER SURVEY
ALSO SHOWS ELEVATED RATES OF
ILLICIT DRUG USE AMONG
TRANSGENDER RESPONDENTS COMPARED
TO THE GENERAL POPULATION.
THERE IS A FAIR AMOUNT OF
QUALITATIVE WORK THAT FINDS
LGBTQ+ INDIVIDUALS REPORTING
THAT SOME OF THE MOTIVATIONS FOR
SUBSTANCE USE INCLUDING TOBACCO
AND VOWEL USE IS TO COPE WITH
STRESS, BUT I JUST WANT TO
UNDERSCORE, YOU KNOW THAT
SUBSTANCE USE IS MOTIVATED BY A
WHOLE VARIETY OF FACTORS
INCLUDING SOCIAL FACTORS,
RECREATIONAL FACTORS, SEXUAL
PURPOSES, ET CETERA.
SO THIS CHART IS TRYING TO
UNDERSCORE THAT WE SEE
DIFFERENCES IN DISPARITIES,
AMONG LGB AACTUALITYS BY
SPECIFIC SUBSTANCE USE BEHAVIOR
AND SUBGROUPS.
SO GENERATED THIS IS COMES FROM
THE [INDISCERNIBLE] DATA, WE'RE
COMPARING THE DISPARITIES ARE
AMONG GAY AND BISEXUAL MEN ARE
DEFINED WITH RESPECT TO
HETEROSEXUAL MALE PEERS,
SIMILARLY FOR LGB WOMEN COMPARED
TO HETEROSEXUAL WOMEN PEERS.
AND 1 OF THE THINGS THAT WE SEE
HERE AND IS PRETTY CONSISTENT IN
THE LITERATURE IS WE SEE REALLY
PRONOUNCED DISPARS AMONG
BISEXUAL WOMEN WITH SOME OF THE
LARGEST DISPARITY MAGNITUDES AND
KIND OF--AND KIND OF
CONVERSIONLY, LESBIAN AND GAY
WOMEN SHOW MARKEDLY FEWER
DISPARITIES BUT WE SEE IMPORTANT
DIFFERENCES AGAIN CROSS
SUBGROUPS AND ACROSS SPECIFIC
SUBSTANCES.
ALSO, LOOKING BY RACE ETHNICITY
AND AGE, AGAIN IN THE DATA WE
SAW THAT SMOKING, BINGE DRINKING
AND CANNABIS USE DISPARITY WERE
GREATER FOR BLACK AND HISPANIC
LGB WOMEN COMPARED TO WHITE
WOMEN.
WE DIDN'T SEE SIMILAR
DIFFERENCES IN TERMS OF RACE
ETHNICITY AMONG MEN.
AND WE SEE QUITE A BIT OF
DIFFERENCES AMONG AGE IN TERMS
OF DISPARITIES.
WE DID NOT SEE EVIDENCE THAT,
YOU KNOW DISPARITIES ARE
CONSISTENTLY LARGER OR SMALLER
FOR OLDER OR YOUNGER LGB FOLKS
IT VARIES AGAIN BASED ON
SUBSTANCE AND SUBGROUP, BUT THIS
HAS ALREADY BEEN MENTIONED BUT I
WANT TO HIGHLIGHT AGAIN THAT
SMOKING AMONG YOUNG LGB ADULTS
AND ERESPONSIBLELY YOUNG
EMPLOYMENT PROGRAMS REMAIN
PROFOUNDLY ELEVATED DESPITE
GENERAL DECLINES IN SMOKING.
AGAIN, WE SEE THIS--THESE
DIFFERENCES EMERGING IN YOUNG
ADULTS, YRBS DATA FINDS THAT
TRANSGENDER DATA YOUTH, OF ALL
SUBSTANCES THAT ARE ASSESSED,
SOME EVIDENCE SUGGESTS THAT
SUBSTANCE USE IS MORE ELEVATED
AMONG TRANSWOMEN, COMPARED TO
TRANSMEN, FOR NONBINARY
INDIVIDUALS BUT THERE'S REALLY
BEEN VERY LIMITED RESEARCH
LOOKING AT HETEROGENERATED AITY
AMONG TRANSAND GENDER DIVERSE
INDIVIDUALS.
AND STUDIES AGAIN HAVE LINKED
EXPERIENCES OF VICTIMIZATION AND
DISCRIMINATION SPECIFICALLY TO
HIGHER LEVELS OF SUBSTANCE USE
AND ALSO FOUND ACCESS TO GENDER
AFFIRMING HEALTHCARE HAVE BEEN
FOUND TO BE ASSOCIATE WIDE
SMOAGING.
>>DR. SCHULER, COULD YOU WRAP
UP BRIEFLY?
THANK YOU.
>>YEAH, COUPLE CONCLUSIONS
HERE, THEY'VE KNOW ALL BEEN
REITERATED BEFORE, I WANT TO
UNDERSCORE THAT IT'S IMPORTANT
AGAIN TO ATTEND TO VARIATION IN
LGBTQ+ YOUNG ADULTS.
ADOLESCENTS AND YOUNG ADULTS ARE
A KEY GROUP AS ARE GENDER
DIFFERENCESSER AND TRANSGENDER
DIVERSE INDIVIDUALS,
EXPERIENCING PARTICULARLY
HEIGHTENED RISK, CLINICAL NEEDS
HAVE BEEN TOUCHED ON BEFORE,
JUST WANT TO END BY SAYING THAT
TO ADVANCE LGBT HEALTH, WE NEED
TO REALLY THINK ABOUT WAYS TO
CULTRATE SUPPORTIVE FAMILY
SCHOOL COMMUNITY ENVIRONMENTS,
PROMOTE SOCIAL BELONGING AND
STEM TIDE OF CURRENT LGBTQ+
BILLS.
THANK YOU.
>>THANK YOU SO MUCH
DR. SCHULER, WE WILL GO INTO OUR
QUESTION ANDA SESSION.
WE HAVE SOME QUESTIONS THAT WE
RECEIVED EARLIER ON THE FIRST 1
IS FOR DR. PRATT-CHAPMAN,
BASICALLY IF YOU COULD SPEAK
MORE TO THE CONCERNS YOU HAD
REGARDING THE NASEM REPORT ON
MEASURING SOGI AND MEN AND WOMEN
KINDS OF ISSUES THE WORKING
GROUP YOU ARE WORKING WITH PLANS
TO ADDRESS?
>>SURE.
YEAH, THANK YOU FOR THE
QUESTION, SO I THINK THE FIRST
THING THAT CAME UP FOR US WAS
THE ISSUE OF THE GENDER IDENTITY
QUESTION HAVING MALE FEMALE
TRANSGENDER SELECT 1.
SO, NOT BEING ABLE TO SELECT
MORE THAN 1 IS BOTH--THERE'S A
COUPLE OF PROBLEMS WITH THAT
QUESTION, THE FIRST IS THAT MALE
AND FEMALE OR TYPICALLY
CONSTRUCTS OF SEX AND NOT GENDER
WHICH MAKES THINGS CONFUSING AND
THEN THE OTHER IS THAT SELECTING
JUST 1, IF YOU ARE TRANSGENDER,
YOU ACTUALLY CAN'T DO THAT,
UNLESS YOU'RE NEITHER MALE MORE
FEMALE AND ONLY IDENTIFY AS
TRANSGENDER.
ANOTHER LIMITATION THAT HAS ONLY
RECENTLY COME UP AND I HAVEN'T
EACH BEEN ABLE TO TALK TO THE
WORKING GROUP ABOUT THIS YET IS
I WAS TALKING WITH A CLEG WHO
HAS DONE QUITE A BIT OF RESEARCH
IN THE SGM SPACE AND 1 OF THE
THINGS WE RECENTLY FOUND WHEN
TRYING TO RECRUIT PARTICIPANTS
FOR A STUDY, THAT EVEN ASKING 1
FOR THE SEXUAL ORIENTATION
QUESTION LED TO PARTICIPANT
AVOIDANCE IN RESEARCH BECAUSE OF
THE SENSE OF FEELING THE
RESEARCHER WAS NOT SAFE IF THEY
HAD TO ONLY SELECT 1.
WE ALSO ARE TRYING TO CRAFT SOME
ORGAN INVENTORY QUESTIONS, AND
THERE WAS ANOTHER QUESTION ABOUT
INTERSEX TRADES AND IN TERMS OF
THE WORKING GROUP THAT WAS IN
THE CHAT AND WE MOSTLY TOOK THE
QUESTION THAT WAS IN THE NASEM
REPORT FOR THE INNER SEX
QUESTION EXCEPT THAT WE TRIED TO
SIMPLIFY IT AND JUST TAKE THE
HALF OF THE FIRST QUESTION
BECAUSE IT WAS VERY LONG SO WE
WERE TRYING TO RISM SIMPLIFY
WORDING TO REDUCE THE COGNITIVE
LOAD.
SO REALLY OUR NEXT STEPS ARE
PUTTING ALL OF THE ISSUES OUT
THERE, OH ANOTHER LIMITATION IS
THAT ASEXUAL IS NOT REPRESENTED,
WHICH I THINK WAS A RESULT OF
JUST NOT HAVING THAT CONSTRUCT
STUDIED WHICH WILL PERPETUATE
THE PROBLEM NOT BEING ADENTIFIED
SO OUR HOPE IS TO PROVIDE MORE
COMPREHENSIVE RESPONSE OPTIONS,
AND SIMPLER WORDING FOR SOME OF
THE ITEMS AND THEN TEST THAT
AMONG A DIVERSE GROUP OF PEOPLE
BASED ON A RANGE OF SOCIOLOGICAL
DEMOGRAPHIC FACTORS, AND THEN 1
LAST THING, IESM NOT IN LOVE
WITH, WE HAVE A DISAGREEMENT
WITH THIS BUT I'VE ALSO GOTTEN
PUSH BACK WITH PEOPLE THAT I'VE
TRIED TO USE THE SEXUAL
ORIENTATION QUESTION IN CLINICAL
PRACTICE, IT HAS, THE ITEM
RESPONSE STRAIGHT THAT IS NOT
LESBIAN OR GAY, I DON'T LOVE THE
NAIS NOT LESBIAN OR GAY,
ALTHOUGH I KNOW IT'S NOT
CLARIFYING BUT IT ALSO REDUCES
THINGS DOESN'T INCLUDE
BISEXUALS, AND STRAIGHT PEOPLE
KNOW IF THEY'RE STRAIGHT.
SO THERE'S JUST A LOT OF THINGS
THAT I'M NOT SAYING THAT THE
WORK--THE WORKING GROUP, IT WAS
A HARD TASK THEY WERE GIVEN AND
THIS A STARTING POINT AND WE
STARTED THERE.
THIS IS WHERE WE STARTED BUT
WE'RE HOPING THAT THE ADDITIONAL
WORK WILL PROVIDE ADDITIONAL
DATA TO CONTINUE TO REFINE ITEMS
WITHOUT TELLING PEOPLE DON'T ASK
ANYTHING, DON'T STOP, DON'T
PAUSE, DON'T WAIT FOR WHAT WE'RE
DOINGS ARE, JUST KNOW THAT WE'RE
NOT THERE YET, IN TERMS OF KIND
OF BEING INCLUSIVE OR BEING
ACCURATE, I DON'T THINK.
>>OKAY.
>>YEAH, THANK YOU SO MUCH FOR
THE INSIGHTS.
WE HAVE 1 MORE QUESTION, FOR DR.
PHIL EPIGENETICS: WHY DO YOU
THINK BISEXUAL OR PAN SEXUAL AND
TRANSGENDER PEOPLE WERE MORE
WILLING TO GET VACCINATED AND
MORE WILLING TO TEST FOR
COVID-19 AT HOME COMPARED TO
OTHER POPULATIONS IN YOUR STUDY?
>>THAT'S A GOOD QUESTION AND 1
THAT WE STRUGGLE A BIT WITH JUST
KNOWING THE GROUPS, I THINK THE
FACT IS SINCE WE WERE USING OUR
SAMPLE IS ALL SEXUAL AND GENDER
MINORITY POPULATIONS SO WE
ASSUMED EVERYONE WAS AT SOME
DEGREE OF MEDICAL MISTRUST TO
BEGIN WITH SO WE DON'T KNOW IF
IT'S SOMETHING DUE TO WHO WE
RECRUITED OR SOMETHING DUE TO
RACIAL ETHNIC DIFFERENCES OR IF
IT'S JUST PEOPLE WHO AGREE TO
PARTICIPATE IN OUR SURVEY WERE
JUST MORE AWARE OF THE BENEFITS
OF THESE ACTIVITIES.
I THINK ALSO IN TERMS OF, AT
LEAST THE AT-HOME TESTING, I
THINK THE HIGHER RATES THERE
REFLECTED A WILLINGNESS TO HAVE
THINGS IN-HOUSE RATHER THAN
GOING TO A MEDICAL PROVIDER FOR
THE SERVICES.
I HAVE LOTS OF IDEAS BUT NO
PROOF FOR ANY OF QUESTIONS ABOUT
THE WILLINGNESS TO BE
VACCINATED.
>>THAT'S REALLY INTERESTING.
YEAH, VERY INTERESTING FINDING.
YOU KNOW THANK YOU SO MUCH FOR
SHARING YOUR INSIGHTS.
I DID WANT TO THANK ALL THE
PANELISTS FOR THEIR
PRESENTATIONS.
THEY WERE WONDERFUL, IT WAS
GREAT TO HEAR ABOUT THESE
DIFFERENT AREAS AND I WANT TO
THANK YOU IF ARE YOUR TIME
TODAY.
WE ARE GOING TO GO INTO OUR
LUNCH BREAK VERY SHORTLY BUT I
DID WANT TO SHARE THAT THE
PRESENTATION SLIDES WILL BE MADE
AVAILABLE ON THE EVENT WEBSITE
APPROXIMATELY 2 WEEKS AFTER THE
WORKSHOP CONCLUDES IN ABOUT 2
WEEKS, WE WILL COME BACK FROM
OUR LUNCH BREAK AT 1:45 P.M. TO
START SESSION 1:00 P.M., I HOPE
YOU DO STAY TUNED BECAUSE WE
HAVE A LOT MORE GROUND TO COVER
AND A LOT OF CONVERSATIONS TO BE
HAD.
THANK YOU SO MUCH.
>>I WANT TO WELCOME EVERYBODY
BACK FROM OUR LUNCH BREAK.
I'M SURE PEOPLE ARE JUST COMING
BACK.
AND WE'RE GOING TO ARE STARTING
OUR SESSION 1 B WHICH IS ON
METHOLOGICAL ISSUES AND SGM
RESEARCH.
THIS SESSION WILL FOCUS ON
METHOLOGICAL CHALLENGES IN
CONDUCTING SGM RESEARCH
INCLUDING DATA, ANALYTICAL
SAMPLING AND INTERSECTIONALITY
CHALLENGES--EXCUSE ME--SO OUR
FIRST SPEAKER WILL BE
DR. BLOSNICH, EXCUSE ME, FROM
UNIVERSITY OF SOUTHERN
CALIFORNIA AND HIS TALK IS
ENTITLED UNMET DATA NEEDS,
CONSIDERATIONS ON INCLUDING
SEXUAL ORIENTATION AND GENDER
IDENTITY AND ADMINISTRATIVE
SYSTEMS.
WE WILL ARE A Q&A PANEL AT THE
END OF THE PRESENTATIONS BUT CAN
YOU SUBMIT YOUR QUESTIONS IN THE
MEAN TIME THROUGH THE CHAT
BUTTON ON THE VIDEOCAST.
DR. BLOSNICH, AND I'M SORRY IF I
BUTCHERED YOUR LAST NAME.
>>NO THAT IS FINE, IT DOESN'T
ROLL OFF THE TONGUE AS MUCH AS
IT JUST FALLS OUT OF THE MOUTH
SO YOU DID A GREAT EXPWROB.
LET ME GET MY SLIDES UP TO
SHARE.
THANKS EVERYBODY FOR MAKING THE
TIME.
I WILL JUST JUMP RIGHT INTO THIS
TAWBLG BEING THIS ISSUE I'VE
BEEN MULLING OVER FOR A WHILE SO
HOW SOGI GENDER DATA ARE
REPRESENTATIVE IN ADMINISTRATIVE
SYSTEMS WHICH IS DIFFERENT THAN
WHAT WE HAVE TRADITIONALLY BEEN
THINKING ABOUT IN TERMS OF
SELF-REPORTED DATA THAT'S OFTEN
COLLECTED FROM SURVEYS.
SO HERE'S SOME OF THE STUFF I
WANT TO COVER TODAY.
I DO WANT TO MAKE SURE THAT ALL
THESE OPINIONS ARE MY OWN AND
NOT MY INSTITUTION OR FUNDERS.
I'M SURE THEY WOULD LOVE TO TAKE
CREDIT FOR THE SMART WORK BUT
CAN'T TAKE CREDIT FOR IT TODAY.
I WILL ALSO SHOW EXAMPLES OF
PHOTOS GATHERED PUBLICLY FROM
NEWS STORIES, SO I JUST WANT TO
MAKE SURE THIS THE PHOTOS AND
INDIVIDUALS HAVE BEEN IN THE
PUBLIC DOMAIN.
SO I WANT TO START BY ORIENTING
US WHEN WE THINK ABOUT THE A LOT
OF THE DATA THAT PROPELLED US
FORWARD IN THE LGBTQ RESEARCH
AND THAT'S PRACTICES THE
PREVIOUS SPEAKERS WE TAKE BODY
OF SOGI MEASURES IN VARIABLE
FORMS ACROSS FEDERAL HEALTH
SURVEILLANCE SURVEYS AND YOU CAN
SEE HERE, THIS MAY NOT BE ALL OF
THEM BUT THE BIGGER 1S I'VE
PICKED OUT AND HOPEFULLY
CORRECTLY GOT THE RIGHT OR
CORRECT YEAR, WHENEVER THESE
MEASURES WERE INTRODUCED AND
THIS IS FOR SEXUAL IDENTITY
MEASURES AND THEN THE NEXT SLIDE
HERE, OOPS, SORRY, YOU CAN SEE
FOR GENDER IDENTITY IT'S MUCH
SPARSER, THE DATA ARE MUCH
SPARSER.
AND FROM THESE SURVEY DATA
THEY'VE REALLY HELPED TO ELIM
NAT A LOT OF THE HEALTH
DISPARITIES WE HEARD ABOUT
ALREADY FROM SMOKING TO STRESS,
TO VIOLENCE TO, YOU KNOW
SUICIDALLITY WHICH YOU KNOW I'M
USING A SHORT HAND FOR SURVEYS
SIGH IDEATION, SUICIDE ATTEMPTS
THOUGHTS AND BEHAVIORS.
THIS IS SORT OF LINK INTO SO WE
THINK ABOUT THESE--WHICH IS
TYPICAL FROM [INDISCERNIBLE]
WORK, IF YOU ABOUT DETECTING
THIS DATA HAS BEEN INSTRUMENTAL
IN THIS DATA HAPPENING, WE HAVE
SOME WORK GOING FOR HOW DO WE
UNDERSTAND WHY ARE THESE
HAPPENING AND WE THINK THAT A
LOT OF IT HAS TO DO WITH
MINORITY STRESS AND ALTHOUGH WE
HEARD HEARD THAT MIGHT NOT BE
THE FULL IF I CANNURE, RIGHT?
THE PART OF THIS STORY.
BUT I WANT TO FECUS THIS, THIRD
GENERATION OF HEALTH DISPARITIES
RESEARCH WHAT ARE WE DOING TO
ADDRESS THEM AND IT GETS INTO
INTERVENTION BUT I WANT TO FOCUS
ON EVALUATION AND IMPLEMENTATION
WORK AND HOW ADMINISTRATIVE DATA
GIVE US A INTERESTED SPRING
BOARD FOR THINKING ABOUT THIS
NEXT STEP IN THE AREA WHERE WE
WORK.
A LOT OF YOU MIGHT BE FAMILIAR
WITH THIS PAPER, IT ILLUSTRATES
IT THERE IS A RARITY OF THIS
INTERVENTION STUDY, SO THIS IS
SGM POPULATIONS THERE ARE NOT
MANY AND THE EVERYDAYS IS
CURRENTLY PRETTY WEAK.
AND THAT'S WHERE I THINK
ADMINISTRATIVE DATA CAN HELP US
BUT THERE'S--I WILL TALK MORE
ABOUT WHY THIS IS NEW GROUND AND
IF IT HAS A BIT OF FRAUGHT
DETAILS THAT WE NEED TO IRON
OUT.
SO TO ORIENT PIEM TO THE
ADMINISTRATIVE RESEARCH THIS IS
TYPICALLY A UNIVERSE OF USERS
AND IT'S NOT SAMPLE OF RESEARCH
WHERE WE RELY ON SAMPLING, THESE
ARE USED FOR PRACTICES ESES ISS
WHERE THESE ARE ABOUT
GENERALIZABLE KNOWLEDGE,
MEASUREMENT WITH AN
ADMINISTRATIVE DATA ARE OFTEN
SORT OF LIMITED TO WHAT SORT OF
BUSINESS OR AGENCY OPERATIONS
ARE FUNCTIONS ARE WHEREAS
RESEARCHER REALLY CAN CHOOSE
WHAT INSTRUMENTS OR WHAT ITEMS
WE WANT TO PUT INTO A SURVEY.
ADMINISTRATIVE DATA, THE
INFORMATION IS OFTEN POPULATED
PRETTY MUCH IN NEAR REALTIME,
SOME ADMINISTRATIVE DATA SETS
TAKE LONGER SUCH AS MORTALITY.
WE HAVE A PRETTY BIG LAG ON
THAT.
AND FOR RESEARCH SOME SURVEY
STUDIES CAN TAKE YEARS FOR DATA
COLLECTION AND THEN THE DATA TO
BE AVAILABLE FOR PEOPLE TO
ANALYZE AND LASTLY
ADMINISTRATIVE DATA, THESE DATA
OFTEN REPRESENT SOME DELIVERABLE
OR SOME SERVICE.
SO THERE'S SOME TRANSACTION
THAT'S TYPICALLY HAPPENING WITH
THESE SERVICE SYSTEMS WHERE IN
RESEARCH IT'S REALLY NOT THE
CASE.
SOME PEOPLE MIGHT GET INCENTIVES
AND RANDOMIZED CONTROL TRIALS,
YOU MIGHT HAVE PEOPLE GETTING
TREATMENT BUT USUALLY RESEARCH
IS NOT AS TRANSACTIONAL AS ADMEN
ADMINISTRATIVE DATA PROCESSES
ARE.
AND ADMINISTRATIVE DATA SURROUND
US, RIGHT?
WE HAVE EDUCATIONAL SYSTEMS,
LEGAL JUDICIAL SYSTEMS ISSUES
HEALTHCARE SYSTEMS, YOU KNOW
FAMILY, FOOD SERVICE, HOUSING,
ALL SORTS OF ADMINISTRATIVE DATA
THAT ARE GETTING BETTER AT
COLLECTING DATA, YOU KNOW
SURROUND US.
BUT I WANT TO FOCUS ON THE
BOTTOM BUBBLE HERE ON THE
MORTALITY DATA AND THE WORK
WE'VE DONE IN MORTALITY SYSTEMS,
I WANT TO PREVENTIVE FASTHIS BY
THINKING ABOUT AN EXAMPLE,
HERE'S A PICTURE OF
CHANIECE WALLACE, AND SHE DIED
AT THE AGE OF 30 AFTER GIVING
BIRTH, SHE WAS NOT ALONE.
IN THAT THERE WAS ACTUALLY, YOU
KNOW A LOT OF BLACK AND AFRICAN
AMERICAN WOMEN DYING EITHER
DURING OR RIGHT AFTER PREGNANTY
AND THAT WITHOUT DATA ABOUT
RACE, WE WOULD NEVER HAVE KNOWN
THIS, WE WOULD HAVE TO STRING
TOGETHER WHAT WE COULD PULL LIKE
I DID FROM INTERNET NEWS STORIES
RIGHT VERSUS HAVING ACTUAL DATA
TO SHOW US THIS.
SO CAN YOU SEE HERE BECAUSE WE
COLLECT RACE AT THE TIME OF
DEATH, WE CAN ACTUALLY SEE JUST
HOW PRONOUNCED THIS DISPARITY IN
MATERNAL AND MORTALITY IS NEAR
BLACK AND AFRICAN AMERICAN
WOMEN.
WE DO NOT HAVE THAT CAPABILITY
FOR LGBT PEOPLE, WE DON'T KNOW
THE TOP 10 CAUSES OF DEATH.
WE DO NOT KNOW HAVING A TON OF
LITERATURE THAT IDEATION,
SUICIDE AATTEMPT IS OFF THE
CHARTS IF ARE THIS GROUP.
WE DON'T KNOW IF SUICIDE FOR
SURE, FOR SURE WE DON'T KNOW IF
SUICIDE DEATH IS HIGHER.
THAT'S WHERE WE NEED TO CATCH
UP.
SO WE ESTIMATE 3 MILLION
AMERICANS DIE EACH YEAR, NONE OF
THAT INFORMATION CAN BE USED TO
ANSWER QUESTIONS ABOUT LGBT
HEALTH.
SO IF YOU WOULD SUPPOSED THAT
MAYBE 5% OF THOSE PEOPLE ARE
LGB, AND ONLY 1.2% ARE
TRANSGENDER OR GENDER DIVERSE,
THAT'S A LOT OF DATA, A LOT OF
FOLKS WHOSE INFORMATION WE ARE
MISSING AND NOT CAPITALIZING ON
COME I HAVE THIS QUOTE HERE,
FROM JUDY BRADFORD, THAT IF
YOU'RE NOT COULD YOU WANTED, YOU
DON'T COUNT EMPLOY SO HOW DO WE
CATCH UP, I WILL GO QUICKLY
THROUGH EMPLOY ANDS WE TRIED TO
PULL TOGETHER FROM ADMINISTRATE
OF DATA, THIS IS AN EXAMPLE FROM
THE VA, DATA SYSTEM, SO HERE YOU
CAN SEE THAT WE'RE LOOKING AT
TRY TO GENERATE THE LEADING
CAUSE OF DEATH FOR TRANSAND
CISGENDER VETERANS.
SO HERE WE HAVE INFORMATION FROM
THE PATIENTS WHO ARE GETTING
CARE FROM THE VA SYSTEM, WHICH
IS 6-8 MILLION DEPENDING ON
DEFINITIONS OF UTILIZATION
VERSUS ENROLLEES.
YOU CAN SEE HERE THAT SUICIDE IS
A FORCED LEADING CAUSE OF DEATH
FOR VETERANS WHERE IT WAS THE
TENTH LEADING CAUSE OF DEATH FOR
THE GENERAL POPULATION WHICH IS
HERE IN THE GRAY LINE THAT GOES
DIVING DOWN THE GRAPH.
AND/OR CIS GENDER VETERANS WAS
THE TENTH LEADING CAUSE OF
DEATH.
WE SAW A SIMILAR PATTERN FOR LGB
VETERANS, AND THE WAY WE WERE
ABLE TO IDENTIFY PEOPLE FOR
TRANSGENDER WE HAD TO RELY ON
ICD CODES FOR LGB VETS WE LOOKED
AT NATURAL LANGUAGE PROCESSING
AND RELIED ON FOLKS BUT YOU CAN
SEE HERE THAT AUTOTHE FIFTH
LEADING CAUSE OF DEATH FOR LBB
VETERANS.
SO GIVEN THE IMPERFECTIONS OF
HOW WE'RE NEEDS TO CAPITALIZE ON
THE ADMINISTRATIVE DATA WE TRIED
TO GET AT THE SOURCE OF DAILY
BASIS THEA ESPECIALLY FOR
MORTALITY SYSTEMS, SO THIS
EFFORT REALLY TARTED BACK IN
2014 BY ANN [INDISCERNIBLE] WHO
USED TO BE WITH THE AMERICAN
ASSOCIATION FOR SUICIDE
PREVENTION AND ANDY LANE AT THE
JOHNSON FOUNDATION ABOUT HOW
COULD WE DEVELOP AT THE GROUND
LEVEL, GETTING DEATH
INVESTIGATORS TO GET INFORMATION
ABOUT SEXUAL ORIENTATION
IDENTITY THAT WOULD BE PUT INTO
A PIPELINE TO THE NATIONAL
TRAINING DEATH INVESTIGATION.
DEATH INVESTIGATORS MAYBE HAVE 1
OF THE WORST JOBS ON EARTH BUT
YOU CAN SEE HERE, SMOAOF THE OF
THEM SAID THEY HAVE HAD IRPT
ACTIONS WHERE THEY THOUGHT THE
DECEDENT WAS LGBT BUT MOST OF
THEM DON'T ASK ABOUT IT AND NONE
OF THEM HAD ANY TRAINING ABOUT
HOW TO GATHER SOGI DATA.
SO THIS IS HOW WE SORT OF
ENVISION OUR PIPELINE OF YOU
KNOW DEVELOPING THIS PROTOCOL,
TRAINING FOLKS IN THE MEDICAL
LEGAL DEATH INVESTIGATION
SPHERE, TO THEN GET THIS
INFORMATION IN THE ACTUAL
NARRATIVES THAT BECOMES ABSTRACT
AND PART OF MBDRS, NVDRS HAS
FIELDS BUT THIS BUT THERE'S 80%
MISSING IT'S A FIELD OF DREAMS
EFFECT WHERE THEY THOUGHT THEY
WOULD BUILD IT AND PEOPLE WOULD
COME AND THAT'S NOT EXACTLY WHAT
HAPPENED.
I WILL GIVE ANOTHER EXAMPLE FROM
ADMINISTRATIVE DATA, PROBABLY
NOT SURPRISING TO PEOPLE IN THIS
MEETING THAT HOUSING INSTABILITY
IS A MAGGOR PROBLEM FOR
TRANSGENDER INDIVIDUALS, YOU CAN
SEE HERE THAT VETERANS MUCH MORE
LIKELY TO SCREEN POSITIVE FOR
HOUSING INSTABILITY IN THE VA
BUT THIS IS WHERE THE PROMISE OF
ADMINISTRATIVE DATA REALLY COME
THROUGH, WHICH IS THE ALPHABET
SOUP AT THE BOTTOM, A DAY
WITHOUT THE ACRONYM IN THE VA IS
LIKE A DAY WITHOUT BREATHING,
THE POINT OF THIS IS TO SHOW
THAT THERE'S ALSO A DISPOETIC
PORTIONATELY HIGH UTILIZE OF
SUPPORT OF HOUSING SERVICES BY
TRANSGENDER SERVICE VETERANS IN
THE VA SO WE SEE THERE'S A
DISPARITY IN THE PROBLEM, THERE
SHOULD ALSO BE AT LEAST A
DISPARITY IN THE SOLUTION AND
IT'S SORT OF THE SIGNAL GETTING
HERE AND PUTTING US MORE TOWARDS
THAT THIRD GENERATION TYPE OF
STUDY.
SO ULTIMATE GOAL MITTLY A LACK
OF REPRESENTATION--ULTIMATELY A
LACK OF REPRESENTATION MEANSA I
LOT FOR US, WE CAN'T MEASURE OUR
BURDENS, IN MY CASE FOCUSING ON
MORTALITY, WE ESTIMATE SERVICE
UTILIZATION, WE CAN'T DIRECT
RESOURCES, WE CAN'T EVALUATE
INTERVENTIONS AT SCALE AND
THAT'S PROBABLY THE BIGGEST
ISSUE THAT KEEPS ME UP AT NIGHT.
IF I HAD TOMORROW, SOME SORT OF
PUBLIC HEALTH ORIENTED
PREVENTION, SUE SID PREVENTION
FOR LGBT PEOPLE I COULD NEVER
TELL YOU IF IT WORKS, I CAN'T
TELL YOU IF IT DROPS FOR SUICIDE
LGBT Q PEOPLE BECAUSE THEY DON'T
HAVE A PER RATE OF DEATH FOR
SUICIDE FOR LGBT PEOPLE.
WE'VE DONE THE BEST WE CAN
TRYING TO CAPITALIZE ON EXISTING
DATA BUT WE'RE LOSING TIME BY
WAITING FOR SURVEY DATA AND WE
KEEP FALLING FURTHER BEHIND.
SO I'M REALLY SORT OF HOPING
THAT THE QUESTIONS AND SORT OF
INTEREST IN HOW WE THINK ABOUT
THE ADMINISTRATIVE SYSTEMS, BUT
THERE ARE VERSE SERIOUS
QUESTIONS WE NEED TO WEIGH THAT
ARE VERY DIFFERENT THAN WHAT WE
THINK ABOUT FROM THE SURVEY.
PART OF OUR THINKING THAT'S BEEN
BEVOTED TO THIS.
THERE'S A CHILLING EFFECT THAT
WE HAVE TO WORRY ABOUT BECAUSE
LIKE I SAID ADMINISTRATE OF
DAILY BASIS THEA ARE TIED TO A
DELIVERABLE OR A SERVICE.
SO WOULD PUTTING THESE MEASURES
INTO ADMINISTRATIVE DATA SYSTEMS
INCREASE USE OF DISCRIMINATION
AND INCREASE COST AND
VISIBILITY.
LIKE I MENTIONED FOR THE FIELD
OF DREAMS EFFECT, IT WAS 1 OF
THOSE THEY BUILT IT BEFORE THEY
CAME.
MAKING SURE WE HAVE QUALITY
ASSURANCE AND EVALUATION OF
INPUTS, THE QUESTIONS ABOUT
WHETHER PUTTING THESE MEASURES
INTO THE SYSTEMS ACTUALLY JUST
CAME ON AND THEN SORT OF LIKE
THE WHO'S ON FIRST EFFECT.
WE CAN'T ASSUME PEOPLE MISSING
THESE DATA ARE CISGENDER OR
HETEROSEXUAL OR JUST NONSGM AND
WE HAVE TO MAKE SURE THE
RESPONSE ACTION WE ARE ARE
ACCEPTABLE TO FOLKS AND THIS IS
ONLY GOING TO COME FROM GETTING
IN THE TRENCHES WITH THE AGENCY
WORKFORCE TO SEE WHAT FOLKS WILL
BEAR BECAUSE IF WE JUST HAVE
THEM THERE, FOLKS WILL IGNORE
THEM, FOLKS WILL NOT FEEL SAFE
ANSWERING THEM AND WE CAN BUILD
THE BEST INSTRUMENT EVER, IF
THEY DON'T FEEL LIKE THEIR GOING
TO SAFE OR SERVICES WILL BE KEPT
FROM THEM, THEY WILL SKIP THAT
QUESTION.
I FLEW THRU IT, I WANT TO LEAVE
MORE TIME FOR Q&A AND FOR THE
NEXT SPEAKER.
SO THANK YOU.
>>THANK SO MUCH DR. BLOSNICH
ISSUES THAT WAS A REALLY GREAT
OVERVIEW AND I THINK IT WILL
COMPLEMENT OUR NEXT 2 TALKS FOR
THIS PANEL, OUR NEXT
PRESENTATION IS FROM DR. SUSAN
COCHRAN, FROM UCLA, FIELDING
SCHOOL OF PUBLIC HEALTH.
HER TALK IS ENTITLED:
METHOLOGICAL CHALLENGES IN
CLASSIFYING SEX XRUL AND GENDER
ORIENTATION IN VIOLENT DEATHS.
DR. COCHRAN, YOU HAVE THE FLOOR.
>>SO LET ME SHARE MY SCREEN.
HERE WE GO.
I WILL TALK A LITTLE BIT IN A
LITTLE BIT MORE DETAIL ABOUT THE
MBDRS, JOHN TOUCH OFFICE OF
DIVERSITY IT A LITTLE BIT BUT
THIS IS THE DATA SET WE'RE USING
IN OUR WORK CURRENTLY.
AND I'M GOING TO TRY AND FOCUS
ON THE NVDRA, THE STRENGTHS AND
WEAKNESSES AND SOME OF THE
SPECIAL CHAL ERVELGS IN THE
CLASSISK OF SECURITIZATION.UAL
AND GENDER ORIENTATION
POSTMORTEM.
AND FINALLY SHARE WITH YOU SOME
OF OUR PRELIMINARY RESULTS.
WE'RE STILL WORKING ON TRYING TO
GET THE MACHINE LEARNING
ALGORITHMS TO WORK
APPROPRIATELY.
SO THE NVDRS, BEGAN IN 2 THNTD
3.
IT IS EXPANDED OVER THE YEARS TO
NOW INCLUDE ALL 50 STATES, AND
PUERTO RICO AND SOME OF THE
TERRITORIES.
LAST YEAR, AN ARK DITIONAL 69,
ALMOST 67,000 VIOLENT DEATHS
WERE INCLUDED BO THIS DATABASE
AND THE DATA SET ITSELF, TRIES
TO TRACK ALL VIOLENT DEATHS IN
THE UNITED STATES AND VIOLENT
DEATHS ARE DEFINED AS A DEATH
THAT RESULTS FROM AN INTENTIONAL
USE OF FORCE OR POWER,
THREATENED OR ACTUAL AGAINST 1'S
SELF-OR ANOTHER PERSON.
SO THE DEATHS THAT ARE IN THE
DATABASE OF THE NVDRS, THERE'S
NOW ABOUT HALF A MILLION DEATHS
IN THIS VERY LARGE DATA SET ARE
ALL ABOUT SUICIDE, HOMICIDE,
SUICIDE-HOMICIDES, MASS
SHOOTINGS, AND SOME OTHER DEATHS
THAT ARE THOUGHT TO BE VIOLENT
DEATHS.
THE DATA SET INCLUDES BOTH
PRECODED VARIABLES AND SOME TEXT
DATA THAT'S GENERATED BY STATE
PUBLIC HEALTH WORKERS AS JOHN
INDICATED THESE PUBLIC HEALTH
WORKERS, AT THE STATE LEVEL GO
THROUGH ALL OF THE INFORMATION
THAT EXISTS ON A VIOLENT DEATH
AND THEN THEY FILL OUT A VERY
EXTENSIVE FORM THAT IS
TRANSMITTED TO THE CENTERS FOR
DISEASE CONTROL WHO ACTUALLY
CURATE THIS PARTICULAR DATA SET.
IN
IN TRYING TO THINK ABOUT HOW YOU
WOULD CLASSIFY VIOLENCE
WESTBOUND THIS DATA SET FOR
SEXUAL AND GENDER ORIENT AIGDZ
POSTMORTEM, YOU IMMEDIATELY COME
ACROSS 3 KEY ISSUES, AND BEFORE
I TALK IN MORE DETAIL ABOUT THE
NVDRS, I WANT TO ISSUE A WARNING
THAT I'M GOING TO BE PRESENTING
TEXT LEVEL DATA FROM THE DATA
SET, IT'S NOT ACTUALLY FROM THE
DATA SET BECAUSE THIS IS A
RESTRICTED DAILY BASIS AT SET AT
THE CDC, SO THESE ARE NARRATIVES
THAT I HAVE MADE UP BUT THEY'RE
VERY CLOSE TO WHAT YOU MIGHT SEE
IN AN ACTUAL NARRATIVE.
SO I JUST WANTED TO WARN FOLKS
THAT THIS IS A VIOLENT DEATH
DATABASE AND SO THEY THINKS I
DON'T THINK IT'S THAT INTENSE
BUT FOR THOSE OF YOU WHO MIGHT
THINK IT'S INTENSE YOU MIGHT NOT
WANT TO LOOK AT IT.
SO, TYPICALLY WHEN WE MEASURE
SEXUAL ORIENTATION SUCH AS IN
SURVEYS, WHERE WE'RE ASKING
PEOPLE TO TELL US THEIR OWN
SENSE OF IDENTITY, OF WHAT THEIR
SEXUAL ORIENTATION IS OR WHAT
THEIR GENDER IDENTITY IS, THIS
IS DONE BY SELF-REPORT AND I'VE
GIVEN AN EXAMPLE HERE FROM THE
NHANES OF A QUESTION THAT MIGHT
BE ASKED OF THEM.
IN THE NVDRS, THIS IS POSTMORTEM
DETERMINE NATION, SO IT'S NOT
REALLY AN INTERNAL IDENTITY THAT
A PERSON POSSESSES, IT'S A
PHENOTYPIC ASSESS OF AN
INDIVIDUAL OR AN ENVIRONMENTALAC
ASSESSES OF THE EVENT THAT
OCCURS SO I GIVE A COUPLE
EXAMPLES HERE THAT MIGHT BE IN
THE NVDRS WHERE THE VICTIM IS
DESCROIBED AS A YOUNG WHITE MALE
WHO HIS FAMILY THOUGHT HE MIGHT
BE GAY, WE DON'T KNOW WHETHER OR
NOT HE WOULD HAVE A SELF-IESHES
DENTITY OF BEING GAY, BUT THE
FAMILY IS REPORTING THAT.
IN THE SECOND EXAMPLE I GIVE YOU
HOMOSEXUALITY IS IN THE DEATH
NARRATIVE THAT SOMETHING WAS
GOING ON PROXIMAL TO THE DEATH
WHERE HOMOSEXUALITY WAS RELEVANT
BUT NOT THE IDENT OF THE VICTIM
WHO DIED IT IS IN FACT A FAMILY
MATTER WHO'S AFTER THE ACCIDENT
DENTIFIED AS BEING GAY.
SO THAT'S 1 ISSUE, THAT THE
MEASUREMENT OF SEXUAL
ORIENTATION IN THE NVDRS IS NOT
BY SELF-REPORT.
A SECOND ISSUE THAT COMES UP IS
THE CODING RULES THAT EXIST
WITHIN THE NVDRS CODE BOOK FOR
CODING OF SEXUAL ORIENTATION.
THE NVDRS BEGAN IN 2003.
IN 2013, THEY INCLUDED SOME
VARIABLES ALLOWING THE PUBLIC
HEALTH WORKERS TO ACTUALLY CODE
FOR SEXUAL ORIENTATION, THE
INSTRUCTIONS HAVE VARIED OVER
THE YEARS BUT THIS IS THE
CURRENT INSTRUCTIONS THAT THE
STATE PUBLIC HEALTH WORKERS GET.
THEY ARE ADVICED THAT THEY ONLY
CODE THIS VARIABLE, IF THE
INFORMATION IS REPORTED IN THE
LAW ENFORCEMENT OR CORONER
MEDICAL EXAMINER REPORT.
SEXUAL ORIENTATION SHOULD NOT BE
INFERRED FROM MARITAL STATUS, IF
THE INFORMATION IS NOT
EXPLICITLY REPORTED SELECT
UNKNOWN.
AND SO THE CONSEQUENCE OF THESE
ENSTRUKSS TO THE PUBLIC HEALTH
WORKERS IS THAT SEXUAL
ORIENTATION IS EXTREMELY RARELY
CODED WITHIN THE NVDRS, IN FACT,
ONLY 9% OF DEATHS HAVE A CODE
ASSIGNED TO THEM FOR SEXUAL
ORIENTATION.
AS YOU CAN SEE HERE IN THIS
SLIDE, THE INSERTION OF THE
SEXUAL ORIENTATION CODE IN 2013
ENDED UP HAVING STATE PUBLIC
HEALTH WORKERS ASSIGN A CODE TO
MOST DEATHS BUT THE MOST COMMON
CODE THAT IS ASSIGNED TO DEATHS
IS UNKNOWN, VERY, VERY FEW
DEATHS HAVE SEXUAL ORIENTATION
ASSIGNED TO THEM.
SO THAT'S A DIFFICULTY IN USING
THIS PARTICULAR DATABASE.
CAN THEN THE THIRD ISSUE I WANT
TO RAISE, AND HAD IS SOMETHING
THAT I THINK THAT MANY OF US WHO
WORK IN THIS FIELD ARE NOT
ALWAYS AWARE OF AND THAT IS THAT
THE BASE RATE OF THE SMALL
POPULATION YOU MIGHT BE TRYING
TO CLASSIFY HAS AN IMPACT ON
YOUR ABILITY TO DO SO.
SO HERE I SHOW A POPULATION OF
5000 INDIVIDUALS, I HAVE AN
ALGORITHM I SAY FROM MACHINE
LEARNING THAT,A LOWS ME TO
CLASSIFY THESE--ARK LOWS ME TO
CLASSIFY THESE INDIVIDUALS
PRETTY ACCURATELY.
I ONLY HAVE A 2% ERROR RATE
WHICH IS NOT SO BAD.
AND YOU CAN SEE THE IMPACT ON
THE MEASUREMENTS THAT I MIGHT
HAVE WHETHER OR NOT THERE IS A
GOOD ALGOGHT RHYTHM REALLY
VARIES BY THE BASE RATE OF THE
SIZE OF THE MINORITY POPULATION.
SO IN THE TOP POPULATION HERE,
5000 PEOPLE, WHERE YOU'RE TRYING
TO CLASSIFY THEM FOR MAJORITY OR
MINORITY STATUS, AND 33% OF THE
POPULATION HAS THIS MINORITY
STATUS, ALL OF THE MEASURES THAT
YOU MIGHT USE TO DETERMINE
WHETHER OR NOT YOU HAVE A GOOD
ALGORITHM ARE REALLY SOLID.
THIS REALLY SAYS, YOU KNOW
THERE'S VERY LITTLE
MISCLASSIFICATION OF PEOPLE
THIS, IS REALLY A GOOD TECHNIQUE
THAT YOU ARE USING.
IF WE CHANGE THAT POPULATION AND
WE HAVE IT BE THAT IT'S ONLY 2%
OF PEOPLE IN THIS POPULATION OF
5000, ACTUALLY HAVE THE MINORITY
STATUS WE'RE TRYING TO PREDICT,
YOU CAN SEE IN THE 2 RIGHT HAND
CELLS HERE THAT HALF OF THE
INDIVIDUALS WHO THIS ALGORITHM
CLASSIFIES AS MINORITY REALLY
BELONG TO THE MAJORITY
POPULATION.
AND SO YOUR POSITIVE PREDICTED
VALUE IS REALLY TERRIBLE.
AND THIS HAS NOTHING TO DO WITH
HOW GOOD YOUR TECHNIQUES ARE,
THIS JUST HAS TO DO WITH HOW
LARGE THE RARE GROUP IS THAT
YOU'RE TRYING TO ASSIGN TO A
PARTICULAR STATUS.
IT'S VERY DIFFICULT TO GET GOOD
CLASS IRVEGZ OF SMALL RARE
SUBPOPULATIONS.
AND THAT'S TYPICALLY WHAT WE'RE
TRYING TO DO WHEN WE'RE
CLASSIFYING FOR SEXUAL AND
GENDER ORIENTATION.
AND THEN TIENALLY I WILL LIKE TO
SHARE WITH YOU THE WORK WE'VE
BEEN DOING WITH THE NVKRS, WE
WERE INTERESTED IN WHETHER WE
COULD RECOVER FROM THE 2
NARRATIVES THAT THESE PUBLIC
HEALTH WORKERS RIGHT ABOUT THE
DEATH, WHETHER OR NOT WE COULD
RECOVER ADDITIONAL INFORMATION
ABOUT SEXUAL ORIENTATION, OTHER
THAN THE CLOSE ENDED CODING THAT
THEY'RE DOING FROM 2013 ON AND
SO THESE ARE THE SAME 2 DEATH
NARRATIVES THAT I SHOWED YOU
BEFORE AND YOU CAN SEE THERE'S
INFORMATION INSIDE THESE
NARRATIVES THAT MIGHT ALLOW US
TO CLASSIFY FOR SEXUAL
ORIENTATION WHETHER IT'S TRYING
TO CLASSIFY THE SEXUAL
ORIENTATION OF THE VICTIM, OR WE
MIGHT ALSO HAVE QUESTIONS ABOUT
IS SEXUAL ORIENTATION OR GENDER
ORIENTATION RELEVANT INSIDE OF
THIS PARTICULAR SUICIDE EMPLOY
SO WE HAD TO THINK ABOUT WHAT
KINDS OF INFORMATION DID WE HAVE
IN THE NVDRS FILE THAT WOULD ARK
LOW US TO USE THESE ALGORITHMIC
TECHNIQUES FROM MACHINE LEARNING
TO TRY AND FIND DIFFERENT CASES
WITHIN THE NVDRS DATABASE.
WE HAVE A GOLD STANDARD.
SOME OF THE CASES ARE CLASSIFIED
FOR LGBT STATUS, NOT MANY, BUT
WE HAVE ENOUGH NOW, THERE'S MORE
THAN 40,000 CASES.
AND THEN WE HAD TO THINK ABOUT
WHAT WOULD BE THE MARKERS OF
POTENTIAL LGBT STATUS WITHIN THE
DEATH RECORD.
ONE POTENTIAL FACTOR WOULD BE
RELATIONSHIP STATUS, EVEN
THOUGH, THAT'S NOT USED BY THE
PUBLIC HEALTH WORKERS TO
CLASSIFY FOR SEXUAL ORIENTATION
IS CLEARLY, CLEARLY HIGHLY
CORRELATED WITH SEXUAL
ORIENTATION.
AND THEN THERE'S ALSO A MENTION
IN THE NARRATIVES OF PARTICULAR
TERMS THAT WE CAN SEE OR CLEARLY
ASSOCIATED WITH BEING GAY,
LESBIAN OR TRANSGENDER.
THERE ARE PARTNERS MENTIONED
THROUGHOUT THESE NARRATIVES AND
SOMETIMES WE CAN DETECT WHETHER
OR NOT THE PARTNER IS SAME SEX
OR DIFFERENT SEX AND THEN, WE
HAVE SITUATIONS WHERE PARTNERS
ARE MENTIONED.
WE DON'T REALLY KNOW--WE KNOW
THE GENDER OF THE PARTNER FROM
THE TERM THAT IS USED AND WE
KNOW THAT IT'S A MALE VICTIM AND
THERE'S NOBODY ELSE BEING TALKED
ABOUT INSIDE THE PARTICULAR
DEATH THAT HAPPENED IN THIS
NARRATIVE.
AND WE MENTIONS OF HIV AND AIDS.
WHEN WE USE THIS INFORMATION
WITHIN OUR MACHINE LEARNING
APPROACH WE'RE GETTING PRETTY
GOOD AT BEING ABLE TO CLASSIFY
THESE DEATHS WE'RE STILL NOT AT
A LEVEL WHERE WE WOULD LIKE TO
BE, WE HAVE A FEW MORE MODELS UP
OUR SLEEVE AND WE WILL BE
CONTINUING TO DO THIS WORK TO
TRY AND CUM UP WITH VERY
ACCURATE CLASSIFICATION OF
SEXUAL ORIENTATION.
--SO THIS IS WORK THAT'S IN
PROPROGRESS AND WE WANTED TO
SHARE IT WITH YOU AT THIS MOMENT
AND THAT CONCLUDES MY
PRESENTATION AND DR. MAYS WILL
BE NEXT.
I WILL STOP SHARING.
>>THANK YOU SO MUCH
DR. COCHRAN.
DR. VIERK CKIE MAYS WILL BE
SPEAKING NEXT WITH THE UCLA
COLLEGE OF LETTERS AND SCIENCES
AND HER TALK IS ENTITLED:
METHOLOGICAL CHALLENGES IN
STUDYING INTERSECTIONALITY.
AFTER HER SESSION WE WILL HAVE A
Q&A SESSION FOR THE PANELISTS.
PLEASE PUT ANY QUESTIONS HAVE
YOU IN THE VIEDMANIOY CAST
MESSAGE SYSTEM AND WE WILL MAKE
SURE TO ADDRESS THOSE DURING THE
REQUEST, ANDA SESSION.
DR. MAYS YOU HAVE THE FLOOR.
OKAY, SO LET ME GET BACK ON
TRACK HERE AND THIS IS YOU KNOW
WHERE I WOULD START WITH
REMINDING US, RATHER THAN GOING
THROUGH A WHOLE DEFINITION OF
WHAT INTERSECTIONALITY IS, TO
REALLY TALK ABOUT IRPT
SECTIONALLITY IS ABOUT THIS
CONCEPT OF DES DISCRIMINATION WN
DESKRIM NATION, AND PROTECTING
MINORITIES THAT ARE WITHIN
MINORITIES.
SO PART OF WHAT'S IMPORTANT AND
I THINK IT'S 1 OF THE CRITICAL
THING SYSTEM THAT WHEN WE START
THINKING ABOUT PUBLICITY,
INTERSECTIONALITY DIFFERS FROM
DIVERSITY.
THERE ARE MODELS IN WHICH WE
KIND OF DO THIS, 1 OF THEM IS
LIKE THE ADDRESSING MODEL BUT AN
INNER SECTIONALLITY WHAT YOUR
MUCH MORE INTERESTED IN IS HOW
THESE INTERSECT AND IN THAT IRPT
SECTIONAL ANALYSIS, WHAT YOU ARE
ALSO INTERESTED IN IS BOTH RIFF
LEDGE AS WELL AS OPPRESSION, SO
IT OFTEN DEAL WITH THE
OPPRESSION PART AND LESS IN
TERMS OF THE PRIVILEGE AND YOU
WILL SEE THAT'S IMPORTANT WHEN
WE START TO TALK ABOUT THIS
ISSUE OF TRAVELING
INTERSECTIONALITY.
THE OTHER THING THAT'S IMPORTANT
HERE, IS THE CONTEXT IN WHICH
THE INTERSECTION OCCURS, AS WELL
AS THINKING ABOUT THE NOTION OF
RANK AND RANK IS A MEASUREMENT
TOOL THAT CAN BE USED WHEN
YOU'RE THINKING ABOUT THIS.
SO, IN THIS, WHAT I TALK ABOUT
IS THAT THERE IS CONFLICTING
IDENTITIES, SOMETHING FROM A
SUBJECTIVE POINT OF VIEW, MAYBE
AN ADVANTAGE OR A DISADVANTAGE
AND ALSO THIS ISSUE OF
PRIVILEGES IS IMPORTANT TO
EXPLORE IN THINKING ABOUT, YOU
KNOW HOW WE DO THIS.
THOU I'M GOING TO KIND OF USE
MYSELF HERE TO TALK ABOUT THE
DIFFERENCE BETWEEN
CLASSIFICATION VERSUS IDENTITY,
VERSUS POSITIONALLITY.
SO MY CLASS SKS WHEN YOU ASK ME
TO PARTICIPATE SOMETHING, YOU
TAKE MY RACE AS AFRICAN
AMERICAN, YOU TAKE MY AGES AND
YEARS AND MY GEOGRAPHICAL
CONTEXT TO BE LA, WELL IF YOU
ASK ME ABOUT MY IDENTITY, MY
IDENTITY IS I'M A SOUTHERN
AFRICAN AMERICAN WOMAN BECAUSE
MY FAMILY DID THE MIGRATION, MY
AGE IS MUCH MORE THINKING ABOUT
BEING A CHILD OF THE CIVIL
RIGHTS MOVEMENT, GEOGRAPHICALLY,
MY HEART MY THINKING, MY SHAPING
IS IN CHICAGO BEING PART OF A
GREAT MIGRATION NORTH.
SO, YOU CAN SEE THAT IF YOU WANT
TO CHANGE MY BEHAVIOR, IT HAS A
LOT MORE TO DO WITH NOT THE
CLASSIFICATION PART BUT HAS TO
DO WITH MY IDENTITY AS WELL AS
SOCIAL STRUCTURE IN WHICH I'M
OPERATING WHICH IS IN THE
CONTEXT OF PRIVILEGE AND
OPPRESSION WITHIN.
SO IN ACADEMIA WHERE I AMsA A
PREDOMINANTLY WHITE INSTITUTION,
I'M A BLACK WOMEN IN THAT
CONTEXT, THERE ARE POINTS AT
WHICH MY STATUS IS VERY LOW
DESPITE IF YOU PUT ME IN MY
PROFESSOR SERIES, I'M A
DISTINGUISHED PROFESSOR.
SO THIS IS HOW YOU SPEAK ABOUT 1
OF THIS 1 OF MY STUDENTS, I
THOUGHT I WOULD QUOTE HIM HERE,
HE SAYS WE REALLY CONFLATE THIS
NOTION OF INTERSECTIONALITY WITH
SOCIAL E DENTITY AND INSTEAD
WHAT WE NEED TO DO AND MANY YOU
YOU REALIZE THAT KIM CRENSHAW IS
AT UCLA AND I'VE PUBLISHED WITH
HER AND HAD THE OPPORTUNITY TO
BE ON MANY THINGS WITH HER AND
WE SHOULD LOOK AT THIS AS A
LENS, FOR SEEING THE WAYS IN
WHICH VARIOUS FORMS OF
INEQUALITY EXACERBATE EACH
OTHER.
SO LET'S TALK ABOUT WHAT SOME OF
THE CHALLENGES ARE TO THIS.
MANY OF YOU IF YOU'VE BEEN AN
HIV RESEARCHER OR IF YOU ARE IN
SOCIOLOGY, YOU WILL KNOW MY
COLLEAGUE JUDY ORAPP A S, THIS
LIST THAT YOU'RE LOOKING AT,
JUDY WENT TO GET A MASSAGE UP IN
THE BAY AREA AND 1 OF THE THINGS
THEY ASK PEOPLE TO DO IS TO
CHECK WHO THEY WERE, NOW WHAT I
WANT YOU TO THINK ABOUT IS,
THERE'S LIKE 16 DIFFERENT THINGS
HERE, AND IN THINKING ABOUT ALL
THESE THINGS IS HOW DO WE DEAL
WITH DATA QUALITY?
HOW DO WE DEAL WITH FLUIDITY?
WHEN WE'RE DOING LGBTQI + POP
EULOGIES, FLUIDITY IS SOMETHING
THAT REALLY LEADS US TO A
COMPLEXITY THAT I DON'T THINK
WE'RE ADDRESSING WELL ENOUGH,
WHEN WE'RE TRYING TO THINK ABOUT
INTERSECTIONALITY.
HERE WHAT YOU CAN SEE IS THAT,
YOU KNOW INTERSECTIONALITY IS
ABOUT MORE THAN JUST THINKING
ABOUT THAT STATUS AND THINKING
ABOUT THAT IDENTITY BUT IT
REALLY IS THINKING MUCH, MUCH,
MORE ABOUT THE CONTEXTURAL
THINGS THAT POSIT AND HERE WHAT
YOU'RE SEEING IS, YOU KNOW
RATIONALITY, I LOVE USING
HOPKINS WORK HERE BECAUSE WE
COLLECT INFORMATION BUT THE
QUESTION IS HOW TO MEANINGFULLY
UNDERSTAND IT USING AN
INTERSECTIONALITY THEORETICAL
FRAMEWORK.
THE THEORY SAYS THAT WE SHOULD
UNDERSTAND THE INTERSECTIONALITY
IS ABOUT THESE THINGS AND AGAIN
AS YOU CAN SEE, I HIGHLIGHT
COMPLEXITY AND IT GETS US BACK
TO FLUIDITY, BACK TO THE WAYS IN
WHICH WE KEEP SEEING THIS
CHANGING NOTION OF YOU KNOW HATE
AND OTHER TIMES OF PRIVILEGING,
THAT GOES ON IN TERMS OF THE
LBGTQ AYES + POPULATION, THE
OTHER THINK THIS I WANT TO POINT
OUT IS THAT THE RESEARCH ON AN
INTERSECTIONALITY REALLY TRIES
TO LEARN WHAT THE PRIVILEGES ARE
AND I THINK WE WERE PARTICULARLY
USEFUL IN DOING THIS WHEN WE'RE
DOING OUR WORK WITH
TRANSPOPPULATIONS.
TRANSITIONING, YOU KNOW BEING
VERY CLEAR ON THE WAYS WITHIN
THESE VARIOUS COMMUNITIES, THE
RACE, THE MALE FEMALE,
MASCULINITY, FELPSINITY, AND
TALK ABOUT COMPLEXITY, WE CAN
SEE IT.
SO, FOR KIM, AND OFTEN WHEN
PEOPLE ARE DOING THIS WORK, I
DON'T SEE THESE DIFFERENTIATION.
WHEN KIM TALKED ABOUT
INTERSECTIONALITY, SHE IS
ACTUALLY TALKING ABOUT DIFFERENT
FORMS OF IT.
SO FOR HER, THIS STRUCTURAL
INTERSECTIONALITY WHICH IS
REALLY ABOUT SOCIAL SYSTEMS, AND
HOW OUR SOCIAL CATEGORIES, YOU
KNOW TO INTERSECT AND INFLUENCE
OUR LIFE, SHE TALKED ABOUT
POLITICAL INTERSECTIONALITY
WHICH IS REALLY THE SILENCING OF
INDIVIDUALS AT THE INTERSECTION
OF THESE VARIOUS CATEGORIES TO
ACTUALLY KEEP THEM FROM
EXPRESSING THEIR VIEWS, AND
WE'RE SEEING THIS NOW AND DON'T
SAY GAY, WE SEE THIS IN TERMS OF
CRT, WE ARE SEEING IT IN TERMS
OF THE AFRICAN AMERICAN HISTORY
IN TERMS OF BEING ATTACKED,
THAT'S KIND OF POLITICAL
INTERSECTIONALITY AND
REPRESENTATION SHE REFERS TO THE
PRESENCE OF THE MULTIPLE
STEREOTYPES TO CULTURAL
PRESENTATION, CARE, MUSIC,
IDENTITY THAT ARE THESE KIND OF
DUAL ISSUE TRIPLE, ALL THESE
DIFFERENT THINGS THAT YOU KNOW
ARE BROUGHT TOGETHER.
SO, WE NEED TO KIND OF THINK
ABOUT CAN WE LABEL BETTER SOME
OF THE ASPECTS OF
INTERSECTIONALITY SO THAT WE
CAN, YOU KNOW GET AT WHAT I
THINK IS IMPORTANT TO BOTH
EXAMINE OPPRESSION BUT ALSO
EXAMINE PRIVILEGE.
THIS IS PROBABLY THE PART OF
INTERSECTIONALITY THAT I THINK
WE ALSO NEED TO THINK A LITTLE
MORE DEEPLY ABOUT AND I REALLY
WANT THESE QUOTES, THOUGH I'M
GOING TO TALK US THROUGH IT.
SO HERE WHAT YOU SEE IS THERE'S
AN ESSAY, VERY FAMOUS ESSAY IF
YOU DO ISHT SECTIONALLITY CALLED
TRAVELING THEORY AND WHAT IT IS
ENCOURAGING US TO THINK ABOUT IS
AS A THEORY TRAVELS, AS IT GOES
FROM 1 POPULATION TO ANOTHER,
FROM 1 COUNTRY TO ANOTHER, YOU
MIGHT ACTUALLY SEE THAT WHAT
YOU'RE DOING IS TRANSFERRING TO
SOME PLACE ELSE BUT IT'S NOT THE
REALITY OF THAT PARTICULAR
PLACE.
SO WHAT YOU HAVE TO REALIZE IS
WHEN KIM STARTED THIS, THIS IS
REALLY ENTRINCHED IN BLACK
FEMININITY.
AND SO, AS WE TRY AND DO OUR
WORK, THE QUESTION IS WHAT IS
THE CULTURAL CONTEXT FOR LGBTQI
POPULATION AND AGAIN IT GETS US
BACK TO THIS ISSUE OF KIND OF
THIS TRAVELING THEORY OF WHERE
THERE IS PRIVILEGE AND WHERE
THERE IS OPPRESSION.
IT GETS US INTO THINKING ABOUT
WHEN YOU'RE TRYING TO ADOPT
THIS, LIKE THINK ABOUT THIS IN
INDIA OR IN ANOTHER COUNTRY
WHERE WE DO RANK AND CLASS IN A
VERY PARTICULAR WAY, AND IN
ANOTHER PLACE IT MAY BE CAST AND
PRIVILEGE THAT MAY BE DIFFERENT
SO WE HAVE A LOT OF WORK TO DO
TO THINK HOW TO REALLY DO THIS
ISSUE OF RANK AND CONTEXT.
SO THAT WE'RE REALLY PROVIDING
PEOPLE WITH REALLY INSIGHTS INTO
HOW PRIVILEGE AND OPPRESSION
TRAVEL AROUND WITH THIS.
COMING TO MY LAST SLIDE I WANT
TO DO, AND I DON'T HAVE TIME TO
GO THROUGH ALL OF IT, BUT TO
REALLY THINK ABOUT, YOU KNOW
WHAT ARE SOME OF THE RESEARCH
APPROACHES HERE, AND AGAIN, IT'S
KIND OF LIKE, YOU KNOW THE
CANADIAN LEARNING NETWORK DOES A
GREAT JOB OF THIS IN TERMS OF
IT, SO WE HAVE TO REMEMBER THAT
WHAT WE WANT TO STAD, WE NEED TO
MAKE SURE THAT WE MATCH IT WITH
THE KIND OF LANGUAGE AS WELL AS
THE OUTCOME THAT WE'RE SEEKING
TO STUDY.
SO DON'T ASK YOUR QUESTIONS FOR
WAYS IN WHICH IDENTITY IS THE
SEPARATE CATEGORY EVEN THOUGH I
TROO TO STATISTICALLY TO GET IT
TO TELL YOU KIND OF HOW IT'S
WORKING, IT'S WORKING WITHIN
SOMETHING, YOU KNOW?
WHAT ARE THE FORMS OF OPPRESSION
RELATIONSHIP TO POWER INEQUALITY
RATHER THAN JUST SAY, WELL THAT
IS WHAT I FOUND IN TERMS OF THE
DIFFERENCES, BUT PUT IT BACK
INTO THE RELATIONALLITY,
POSITIONALLITY, ALL THE THINGS I
HAD IN SOME BROADER SLIDES.
YOU KNOW AVOID THESE LARGE GROUP
CATEGORIZATIONS, AND
UNFORTUNATELY, THIS IS THE KIND
OF THE GENDER WE OFTEN SEE WHEN
WE'RE FUNDED BY AGENCIES BECAUSE
THEY WANT CERTAIN SIZE NUMBERS,
THEY WANT US TO DO AS MUCH
WITHIN DIVERSITY AND IF WE'RE
GOING TO TRY AND DO NUMBERS, WE
ARE TRYING TO DO IT WITH LARGER
GROUPS OF PEOPLE, BUT YOU KNOW
AND AGAIN BECAUSE TIME WAS
SHORT, I COULD HAVE GONE
THROUGH, THERE'S DIFFERENT
RESEARCH APPROACHES, NARRATIVES
WHICH YOU SEE AS MY COLLEAGUE
SUSAN COCHRAN TALKED ABOUT THAT
WE'RE TRYING TO UTILIZE SO THERE
ARE A LOT OF OTHER DIFFERENT
WAYS, IT'S JUST PAY MATTER OF
CAN WE WITH FUNDED TO DO THOSE
OTHER KIND OF NONEXPERIMENTAL
WAYS.
FINAL COMMENT I WILL MAKE IS,
THERE IS A NEED, I THINK FOR A
SCIENCE OF SMALL GROUP DATA THAT
WOULD HELP US IN TERMS OF
INTERSECTIONALITY.
SO I'M GOING TO STOP SHARING
HERE, IT'S THE END OF MY SLIDES
AND THANK YOU VERY MUCH FOR THE
TIME.
>>THANK YOU VERY MUCH DR. MAYS,
FIELD FUNCTIONS COULD HAVE ALL
THE PANELISTS TURN ON THEIR CAM
ARE RAS.
WE RECEIVED A FEW QUESTIONS IF
ARE DR. COCHRAN AND I KNOW YOU
ADDRESSED THEM IN THE CHAT BUT I
KNOW OUR VIEWERS ON VIDEOCAST
CAN'T READ THE CHAT NECESSARILY,
SO JUST BRIEFLY 1 OF THE
QUESTIONS WE RECEIVED WAS ABOUT
THE KINDS OF SAFE GUARDS THAT
ARE IN PLACE TO KEEP THE
CLASSIFICATION FINDINGS
ANONYMIZED AND LGBT+
CLASSIFICATION METHODOLOGIES IN
SETTINGS AND WHAT MACHINE
LEARNING MODELS WERE USED AND
THERE'S A QUESTION ABOUT THE
ACCURACY AS WELL AS 1 OF THE
DATA POINTS.
SO DR. COCHRAN IF YOU WANT TO
ANSWER THOSE?
>>SURE.
SO 1 OF THE QUESTIONS WAS THE
SLIDE WHERE I SHOWED HOW MANY
DEATHS WERE CLASSIFIED FOR
SEXUAL ORIENTATION IT MIGHT LOOK
TO PEOPLE LIKE THERE WAS THIS
INCREDIBLE INCREASE IN THE
NUMBER OF VIOLENT DEATHS PER
YEAR AND THAT'S NOT REALLY TRUE.
WHAT'S HAPPENED WITH THE NVDRS
IS THEY BEGAN WITH A SMALL
NUMBER OF STATES AND OVERTIME
AND I THINK IT WAS FINALLY BY
2020 THEY HAD ALL 50 STATES
REPRESENTED WITHIN THE DATABASE.
SO AS YOU BRING ON MORE STATES
EACH YEAR, OF COURSE THE NUMBER
OF VIOLENT DEATHS INCREASE AND
THAT'S THE REASON WHY YOU SAW
THAT ESCALATION AND A NUMBER OF
VIOLENT DEATHS.
IT'S JUST DATABASE IS GETTING
BIGGER.
ANOTHER QUESTION HAD TO DO WITH
IDENTIFYING INDIVIDUALS WITHIN
THE DATABASE BY USING MACHINE
LEARNING, SO THIS IS A
RESTRICTED DATABASE.
YOU HAVE TO EXECUTE AN AGREEMENT
WITH THE CENTERS FOR DISEAZ
CONTROL TO USE THE DATABASE.
AND 1 AGREEMENT YOU MAKE AS A
RESEARCHER IS THAT YOU WILL NOT
LOOK OUTSIDE THE DAILY BASIS AT
BASE TO TRY TO IDENTIFY THE
VICTIMS INSIDE THE DATABASE.
THEN YOU WON'T LINK ANY OTHER
DATABASE TO THIS DATABASE UNLESS
YOU HAVE PERMISSION FROM THE
CENTERS FOR DISEASE CONTROL.
AND YOU KNOW OCCASIONALLY, YOU
MIGHT COME ACROSS A CASE WITHIN
THE DATABASE WHERE IT NEEDS TO
BE ANONYMIZED A LITTLE MORE BY
THE CENTERS FOR DEC CONTROL AND
IN THAT CASE, YOU ALWAYS RIGHT
BACK TO THE CDC AND YOU SAY I
THINK YOU WANT TO LOOK AT THIS
DATABASE AND ANON MYSELF IT A
BIT MORE, BUT PARTICULAR
ALGORITHMS THAT WE'RE CREATING,
WELL, NOT IDENTIFY ANYONE WITHIN
THIS DATABASE UNLESS YOU HAPPEN
TO HAVE THAT DATABASE AND HAVE
PERMISSION TO USE IT.
SO, THE ALGORITHM IS NOT GOING
TO DEANON MYSELF ANYBODY.
AND THEN, THE QUESTION--ANOTHER
QUESTION WAS HOW WERE WE ABLE TO
TEST THE ACCURACY OF THESE
ALGORITHMS?
BECAUSE ABOUT 9% OF THE CASES DO
HAVE SEXUAL ORIENTATION CODED SO
WE'RE TRYING TO PREDICT TO THE
CODED SEXUAL ORIENTATION IN THE
DATABASE.
WE HAVE OTHER TECHNIQUES WHERE
WE GO BACK AND CASES WHERE WE
ARE PREDICTING THAT THEY ARE A
SEXUAL OR GENDER MINORITY TO SEE
HOW ACCURATE OUR ALGORITHMS ARE.
SO WHY DON'T I STOP THERE.
THIS, THANK YOU DR. COCHRAN, WE
HAD ANOTHER MESSAGE IS THIS IS
FOR ALL THE PANELISTS, HOW CAN
WE BE MORE INCLUSIVE OF 2 SPIRIT
AND INDIgE QUEER PEOPLE IN
THIS DATA?
>>IN THE NVDRS, THE ONLY WAY
YOU COULD BE ENCLUESIVE IS IF
IT'S TALKED ABOUT INSIDE THE
NARRATIVES.
SO THIS IS NOT--YOU KNOW, I
DON'T I DON'T THINK THIS WOULD
BE THE RIGHT DATABASE TO TODAY
THIS PARTICULAR ISSUE.
>>LET ME JUST ALSO COMMENT IF I
CAN BECAUSE I WOULD AGREE, THIS
IS WITHOUT ADDITIONAL THINGS
WITH THIS DATABASE, THIS WOULD
BE A HARD 1 TO DO IT I MEAN
THERE ARE OTHER DATABASES IN
WHICH WE CAN PROBABLY DO BETTER
BUT WHAT IT IS IS THAT EVEN IF
WE WERE USING AI, WE WOULD HAVE
TO BE ABLE TO DETERMINE SOME
UNIQUE WAYS OF TALKING ABOUT IN
TERMS OF THE LANGUAGE, IN TERMS
OF THE RELATIONSHIP, BUILD KINDS
OF THINGS, SO IF THOSE WERE
THERE, AND YOU NEED UNIQUE TO
THE POPULATION, WE COULD USE
ALGORITHMS TO FIND IT BUT OUR
WORK THAT WE'VE DONE, YOU IF YOU
DON'T KNOW I'M WORKING WITH THE
DR. ON THIS PARTICULAR
[INDISCERNIBLE], WE HAVEN'T
FOUND A UNIQUENESS, TO BE ABLE
TO DO THAT.
>>LET ME JUST ADD QUICKLY IN
TERMS OF HOW WE COVER THIS WITH
THE DEATH INVESTIGATORS TRYING
TO GET THEM TO ASK THESE
QUESTIONS AND THEN JUST REFLECT
WHAT THEY HEAR FROM FOLKS IN THE
FIELD, DEATH INVESTIGATION IS
REALLY AN UNIEWSH AND REALLY
HARD JOB, I THINK I SAID THAT
BEFORE, IT DESERVING
HIGHLIGHTING SOME MORE, YOU
KNOW, THERE ARE TALKING TO
SOMEBODY AND OFTEN THEY ARE THE
FIRST PERSON TO TALK TO THE NEXT
OF KEN KIN TO LET THEM KNOW THAT
THEIR LOVED 1 IS DEAD.
SO THEY'RE GETTING THE
INFORMATION THEY HAVE TO GET FOR
THE CORONER AND MEDICAL EXAMINER
SO HAVING THEM SORT OF BEING
ABLE TO I THINK DR. COCHRAN'S
POINT IS SPOT ON, IT'S A GAME OF
TELEPHONE.
IT GETS FURTHER AND FURTHER AWAY
THAT WE'RE GETTING THE DEATH
INVESTIGATOR HEARING FROM THE
FAMILY MEMBER ABOUT THE PERSON
THAT THEN GOES TO A NARRATIVE
THAT GOES TO AN ABSTRACTOR THAT
GOES TO A SYSTEM.
SO, A SELECTION OF VERY SPECIFIC
IDENTITIES, I AGREE I DON'T KNOW
THAT THIS SIZE OR THESE DATA
WOULD BE ABLE TO CAPTURE THAT
JUST GIVEN MY OWN EXPERIENCE IN
TRYING TO GET DEATH
INVESTIGATORS TO JUST ASK YOU
KNOW, PARTNERSHIP INFORMATION
AND GENDER IDENTITY INFORMATION
IT IS A CHALLENGE.
I DON'T THINK IT'S
INSURSURMOUNTABLE BUT I THINK
THAT WE'RE JUST AT THE BEGINNING
OF UNDERSTANDING HOW THESE
SYSTEMS MIGHT WORK AND WE
PROBABLY NEED--THERE'S NO 1
SOLUTION FOR THIS, AND THERE ARE
GOING TO BE MULTIPLE APPROACHES.
>>THANK YOU.
OUR NEXT QUESTION, FROM THE
AUDIENCE IS ABOUT HOW CAN LARGE
HEALTH SURVEY DAILY BASIS THEAS
BETTER COLLECT DATA ON SOGI AND
OTHER SOCIAL IDENTITIES THAT SO
THAT RESEARCHERS HAVE THE DATA
NECESSARY TO UNDERSTAND AND
ADDRESS HEALTH DISPARITIES FROM
A STRUCTURAL AND INTERSECTIONAL
LENS?
AND THEY'RE PARTICULARLY
INTERESTED IN WHAT
DRS. BLOSNICH AND MAYS MAY HAVE
TO SAY ABOUT THIS.
>>DOLLAR?
>>DOCTOR?
>>YOU GO FIRST.
>>THIS MIGHT BE WHERE MY
INSTITUTION'S LIKE, WE DON'T
CLAIM HIM.
I THINK WE JUST MEASURE THE
WRONG THING.
YOU KNOW WHEN WE--I LIKEN THIS
TO LIKE HOW ASTRONOMERS DON'T
KNOW IF THERE'S A PLANET AROUND
THE STAR, DOES THE STAR WOBBLE
OR THE LIGHT DIMS AND THAT'S A
SIGN THAT THERE'S A PLANET
AROUND THAT STAR BUT WE CAN'T
SEE THAT PLANET, WITH ALL OF
THE, YOU KNOW--HOW WE MEASURE
THINGS LIKE INTERGENERATIONAL
POVERTY, INSTITUTIONALIZED
RACISM, SEXISM, WE DON'T MEASURE
ANY OF THAT STUFF.
WHAT WE SEE, WHAT WE MEASURE IS
PEOPLE'S IDENTITIES AS THE
PRODUCT OF ALL OF THIS SORT OF
LEGACY, BUT TO ACTUALLY MEASURE
THAT LEGACY, WE'VE NEVER, TO MY
KNOWLEDGE BEEN VERY GOOD AT
MEASURING THAT.
AND SO ALL OF THESE WICKED
PROBLEMS WE HAVE, GET
UNFORTUNATELY SORT OF SIDLED TO
PEOPLE'S IDENTITIES AND WITHOUT
REALLY ACCURATE CAREFUL
QUALIFICATION BY RESEARCHERS, WE
ARE REALLY CIRCUMSPECT IN WHAT
OUR RESULTS ARE TALKING ABOUT,
IT CAN SEND UNFORTUNATE MESSAGES
OR OFTEN BE TWISTED IN THE
PUBLIC.
>>I'M GOING TO AGREE WHOLE
HEARTEDLY WITH DR. BLOSNICH,
WHICH ISN'T SURPRISING, I DON'T
THINK WE CAN MEASURE SOME OF
THESE THINGS YET BECAUSE WE LACK
THE LANGUAGE, WE ALSO AND I'M
GOING TO USE MY STUDENTS, WE ARE
CONFLATING THINGS.
SO FOR EXAMPLE, I HAVE STEPPED
BACK FROM SUCH A FOCUS ON
STRUCTURAL ISSUES, BECAUSE, I'M
NOT SURE THAT WE HAVE WHAT WE
NEED IN ORDER TO KNOW, WELL,
WHAT PART OF THE STRUCTURE?
LIKE AS AN EXAMPLE, MOST DATA
SETS WILL COLLECT EDUCATIONAL
ATTAINMENT, THAT'S ACTUALLY NOT
THE STRUCTURAL ASPECT BECAUSE
YOU HAVE THIS KIDS IN FIFTH
GRADE AND THIS KID'S IN FIFTH
GRADE SO WE SAY THEY'RE EQUAL,
AND I WANT TO GO TO FIFTH GRADE
IN A RURAL AREA AND A FIFTH
GRADE THAT'S IN BELL AIR IN LA,
THER NOTHING ALIKE AND WE KEEP
THINKING WE'VE DONE SOMETHING
WHEN WE DO THIS SO I'M REALLY
STARTING TO DO MORE BRICK BY
BRICK WORK WHERE I START TO LOOK
AT WHAT ARE SOCIAL
VULNERABILITIES AND SOCIAL RISK
AND THEN AT THE INDIVIDUAL
LEVEL, AT THE COMMUNITY LEVEL, I
TRY AND BUMP THOSE UP IF WE'RE
TALKING ABOUT HEALTH WE'RE
TRYING TO COME UP WITH THE SOGI
CHARACTERISTICS THAT ARE GOING
TO BE IN ELECTRONIC HEALTH
RECORDS, I DON'T KNOW HOW YOU DO
THAT WITHOUT MISCLASSIFICATION
AND BOX BEING SOMEONE IN.
AGAIN THE ISSUE, WE ARE NOT
ADDRESSING THE ISSUE OF FLUIDITY
AND HOW IN THIS COMMUNITY IT'S
NOT LIKE ANY OTHER COMMUNITY NOW
AS AN AX FRIC ARN AMERICAN IN
THE UNITED STATES, I'VE HAD
DIFFERENT NAMES THAT WE'VE BEEN
CALLED BUT THAT'S USUALLY OVER
10 YEARS, AND 20 YEARS AND A
MOVEMENT WITH IT THAT HELPS YOU
TO UNDERSTAND, THAT'S NOT WHAT'S
HAPPENING.
THIS IS MOVING QUICKLY, SO THIS
16 THINGS THAT I SHOWED YOU THAT
JUDY WAS FACED WITH, IT'S LIKE
NO ELECTRONIC HEALTH RECORDS
SYSTEM IS GOING TO GET IT
STRAIGHT AND THEN WE HAVE A DATA
QUALITY PROBLEM.
SO IT REALLY IS THAT WE NEED TO
USE DIFFERENT APPROACHES OTHER
THAN JUST THIS LARGE SCALE DATA
WE NEED TO HAVE FOCUS GROUPS AND
YOU NEED RIGHT NOW ALL OF THEM
BECAUSE I THINK WE KNOW A LOT
ABOUT LGBTQI COMMUNITIES BUT
WHAT WE DON'T KNOW IS ABOUT
RURAL 1S AND BEING WITHIN,
WITHIN, WITHIN AND STARTED THIS
PURPOSELY BECAUSE IT'S THE WHIFF
END THAT WE DON'T KNOW VERY WELL
AND THAT'S WHO'S SUFFERING THE
MOST WHEN WE LOOK AT HEALTH
OUTCOMES.
>>WOW, VERY EXCELLENT POINT.
>>I HAD A QUESTION WHICH
YOU--YOU KNOW YOU BOTH ALLUDED
TO IN YOUR PRESENTATIONS AND
ALSO IN THESE CONVERSATIONS AND
YOU KNOW I WAS CURIOUS WHAT YOU
SEE ARE SOME OF THE BENEFITS AND
CHALLENGES GOING INTO YOU KNOW
AS WE GO MORE INTO DATA SCIENCE,
ARTIFICIAL INTELLIGENCE WHARKS
THESE POPULATIONS, WHAT ARE SOME
THINGS THAT WE SHOULD BE
COGNIZANT OF THAT YOU KNOW OR
CONSIDER OR WHAT ARE SOME
BENEFITS THAT MAY OPEN DOORS.
>>ANY OF US OR PARTICULAR 1 OF
US?
>>ANY OF YOU.
I THINK YOU WOULD HAVE GREAT
INSIGHTS?
>>WHY DON'T YOU START THAT 1.
>>OH, WELL, YOU KNOW
THERE'S--PEOPLE IMAGINE THAT
DATA SCIENCE IS THE PANACEA FOR
ALL OF THESE QUESTIONS THAT
WE'VE PRESENTED HERE TODAY THAT
WE'RE STRUGGLING WITH AND DATA
SCIENCE STRUGGLES WITH MANY EVER
THESE QUESTIONS, TOO, SO I MEAN
IN FROM THE PUBLIC VIEW, IT'S AN
EASY ANSWER, IT WILL WORK AND
EVERYTHING WILL WORK, BUT IN
ACTUAL DATA SCIENCE, THEY
STRUGGLE WITH THINGS LIKE THE
KOREFERENCE PROBLEM.
WE CAN READ A NARRATIVE FOR
EXAMPLE AND KNOW IMMEDIATELY
WHOSE IN THIS NARRATIVE, HOW
MANY PEOPLE ARE THERE, WHO'S
RELATED TO WHOM AND IT'S VERY
EASY FOR A HUMAN BEING TO READ
THE NVDRS NARRATIVES AND DETECT
THE SEXUAL ORIENT OF AN
INDIVIDUAL IF THE INFORMATION IS
IN THE NARRATIVE BUT A 99 TRYING
TO READ THIS REALLY HAS TROUBLE
WITH FIGURING OUT FIGURING OUT
WHAT PERSON IS BEING REFERRED TO
BY A PARTICULAR NOUN OR A
PARTICULAR ADGATIVE OR
PARTICULAR ADVERB AND THERE ARE,
WE HAVE AN ENGINEER THAT WE WORK
WITH THAT'S HIS WHOLE RESEARCH
AREA, TRYING TO FIGURE OUT HOW,
THIS KOREFERENCEING WITHIN A
PARTICULAR EDESCRIPTION OF
EVENTS ENDS UP WITH A BIASED
OUTCOME SO YOU'LL SEE THAT THE
MACHINE WILL SAY OH IT'S A
PHYSICS PROFESSOR, IT MUST BE A
MALE.
THAT'S SOME OF THE THINGS THAT
MACHINES DO WHERE WHEN WE READ
IT WE HAVE NO TROUBLE FIGURING
IT OUT, SO I HOPE THAT DATA
SCIENCE WILL ANSWER THESE
QUESTIONS FOR US AND WE WON'T
HAVE TO THINK ABOUT THEM VERY
DEPRIVATIONLY, I DON'T THINK IT
WILL I THINK IT WILL, ALL THE
QUESTIONS THAT DR. MAYS
PRESENTED AND DR. BLOSNICH, WE
WILL HAVE TO DO THE HARD LABOR
OF FIGURING OUT WHAT IT IS IN
DATA SCIENCE ISSUES IT JUST
BASICALLY ARK PLIES WHAT WE
ALREADY THINK IS THERE, SOME
REALLY GOOD TECHNIQUES IT ALSO
NEEDS ENORMOUSLY LARGE DATABASES
TO BE ABLE TO DO IT SO IF YOU
WANT TO STUDY SMALL SUBGROUPS
WITHIN THE LGPTQ COMMUNITY AND
YOU WILL NEVER GO IT WITH DATA
SCIENCE.
JUST BECAUSE YOU KNOW YOU NEED A
COUPLE MILLION PEOPLE TO DO
SOMETHING EFFECTIVELY SO I HOPE
THAT WE DON'T DEPEND TOO MUCH ON
DATA SCIENCE TO HELP US TO DO
THE HARD WORK WE HAVE TO DO.
>>THANK YOU.
ANY OTHER THOUGHTS FROM THE
PANELISTS?
I HAVE 1 MORE QUESTION.
>>LET ME COMMENT ON DATA
SCIENCE BECAUSE, 1 OF THE THINGS
I CAN SAY WAS A REAL PLESESSING
IS THAT WHEN WE WERE FUNDED BY
NIMH TO PUT A TEAM TOGETHER WHAT
I LEARNED WAS A LOT ABOUT DATA
SCIENTISTS WHO WERE ENGINEERS,
COMPUTATIONAL PEOPLE AND THEY
REALLY DON'T HAVE A LOT OF
EXPERIENCE WITH HUMAN DATA SO I
THINK A LOT OF PEOPLE FORGET
THEY ACTUALLY NEED US, SO IF
THERE'S ANY POPE YOU NEED THIS,
IT HAS TO BE IN COLLABORATION
AND I THINK IT'S A DEMAND WE
REALLY HAVE TO DO BECAUSE WHAT
THEY DO IS USE THE TOOLS THEY
HAVE AND MACHINES AND DOING
EXACTLY WHAT SUSAN SAYS AND
AGAIN I'M GOING TO SOUND LIKE
I'M BEATING I DEAD HORSE HERE
BUT ISSUES WITH FLUIDITY AND
BEDDING RELATIONSHIPS IS
PROBABLY THE MOST CRITICAL
ASPECT OF SUCCESSFULLY USING
DATA SCIENCE AND IT STARTED WHEN
I FIRST STARTED IN HIV, THE
FIRST PAPER I DID WAS 1 WE WERE
WORKING ON WAS A PAPER OF BLACK
MEN WHO HAVE SEX WITH MEN
BECAUSE THEY HAVE TO COME UP
WITH THE RELATIONSHIPS BECAUSE
THE TYPICAL NOTION OF HOW THE
RELATIONSHIPS WERE TALKED ABOUT
DID NOT FIT IN THE
DISCRIMINATORY ENVIRONMENT IN
WHICH THEY LIVED AND COMMUNITIES
AND NEEDED TO BE KIND OF HIDDEN
SOEE WE HAD TO SAY HERE'S HOW
THEY ASK ABOUT THIS AND I THINK
IN MACHINE SCIENCE WE NEED THAT
AT THIS POINT IN TIME, IT'S THE
HUMANNESS FROM THE THAT THE
SOCIAL SCIENCE PEOPLE AND PEOPLE
IN CLINICAL HEALTH CAN BRING TO
THE FOREFRONT OR ELSE THE TOOL
WILL LEAD US THE WRONG WAY.
>>WELL SAID, AND GREAT POINTS.
>>WE HAD 1 MORE QUESTION ABOUT
CLASS APPROACHES FOR LATENT
ANALYSIS TO GENERATE INFORMATION
ABOUT INTERSECTIONAL INIQUITIES
AND EXPERIENCES?
>>SURE, THAT'S A GOOD
TECHNIQUE, IT WOULD BEPEND ON
THE DATABASE BUT THAT IS A
REASONABLE APPROACH TO TRY TO
FIGURE OUT HOW TO CLASSIFY
CASES, IT DEPENDS ON WHAT YOUR
UNDERLYING ASSUMPTION IS ON
CLASSIFICATION.
SO FOR EXAMPLE, LATENT CLASS
ANALYSIS IS PARTICULARLY GOOD
WITH FEATURES THAT ARE ORGANIZED
IN A WAY THAT FLOW--LET ME GIVE
YOU AN EXAMPLE SO IF YOU HAD,
YOU'RE TRYING TO FIGURE OUT THE
DEVELOPMENTAL, YOU KNOW THEY
SMILE BEFORE THEY CAN ROLL OVER,
OR THEY ROLL OVER BEFORE THEY
CAN SMILE AND/OR THEY CAN SIT
BEFORE THEY RUN OR WALK, IF THEY
CAN RUN, THEY CAN DEFINITELY
SIT, YOU KIND OF KNOW THESE
THINGS, LATENT CLASS ANALYSIS IS
PERFECT FOR THAT KIND OF
SITUATION.
SO IF YOU HAVE A DATABASE WHERE
YOU THINK THERE'S THIS
DEVELOPMENTAL PHASE OR THAT'S
YOUR THEORY THAT YOU'RE WORKING
FROM, THAT WOULD BE A
PARTICULARLY GOOD TECHNIQUE TO
USE.
IT WAS A LITTLE WONKY BUT I HOPE
YOU GOT IT.
>>THANK YOU SO MUCH FOR THIS,
THIS IS SUCH A WONDERFUL PANEL,
WE HAD GREAT QUESTIONS, I WANT
TO THANK OWEVER PANELISTS FOR
OUR PRESENTATIONS AND THEIR TIME
AND I WANT TO NOW HAND IT OVER
TO MY COLLEAGUE DR. RADA D AGHER
WHO WILL MODERATE THE NEXT
PANEL.
ALL RIGHT SO NOW WE GET TO
SOCIAL AND STRUCTURAL DRIVERS OF
SGM HEALTH DISPARITIES.
THIS SESSION WILL DISCUSS SOCIAL
AND STRUCTURAL DRIVERS OF SIS
PARITIES SUCH AS RACISM,
DISCRIMINATION, ACCESS TO
HEALTHCARE, QUALITY OF CARE,
STRESSORS AND OTHER SOCIAL
DETERMINANTS OF HEALTH.
SO OUR FIRST PEEKER WILL BE
DR. MORGAN PH ILBIN, SHE WILL
DISCUSS HOW SOCIAL MOLL SEES
SHAPE THE HEALTH AND BEING OF
SEX IMRUL AND GENDER-MINORITY
YOUTH AND LIMPLICATIONS FOR LIFE
COURSE TRAJECTORIES.
DR. PH ILBIN,.
>>THANK YOU SO MUCH.
LET ME SHARE MY SLIDES.
>>CAN YOU SEE MY SLIDES.
>>YES NTHANK YOU.
FIRST I WANT TO THANK NIMHD, AND
AND TODAY I WILL TALK ABOUT THE
VARIOUS WAYS THAT POLICIES
ACCIDENT PARTICULARLY SOCIAL
POLICIES SHAPE THE HEALTH AND
WELL BEING OF SGM YOUNG PEOPLE.
SO JUST BRIEFLY TO START, AND TO
MAKE SURE WE'RE ALL ON THE SAME
PAGE, I WANT TO TALK ABOUT WHY
SOCIAL AND STRUCTURAL FACTORS
MATTER.
SO BREFLY AS YOU ALL KNOW THEY
SHAPE NEARLY EVERY ASPECT OF OUR
LIVES AND THAT INCLUDES POLICIES
THAT EXPLICITLY REGULATE HEALTH
AS WELL AS BROADER SOCIAL
POLICIES AROUND URBAN PLANNING
OR HOUSING AND THIS CAN INCLUDE
UNIVERSAL POLICIES THAT AFFECT
EVERYBODY AND THEN TARGETED
POLICIES THAT ARE AIMED DIRECTLY
AT SEXUAL AND GENDER MINORITY
INDIVIDUALS SO THINKING ABOUT
NONDESCRIMINATION POLICIES AND
EMPLOYMENT FOR EXAMPLE.
AND POLICIES ARE IMPORTANT
BECAUSE THEY SIRVE AS SYMBOLIC
MARKERS OF WHO BELONGS OR
MEMBERS OF THE SOCIETY.
SO THINKING ABOUT MARRIAGE
EQUALITY OR IMMIGRATION POLICIES
OR STRUCTURAL RACISM MORE
BROADLY.
IT'S IMPORTANT TO STUDY THESE
BECAUSE THEY HAVE DIRECT AND
LARGE SCALE IMPACTS ON THE
PUBLIC'S HEALTH.
MUCH MORE SO THAN CHANGING
INDIVIDUAL BEHAVIORS AND THEY
CAN MAKE THE HEALTH PROMOTERS A
DEFAULT.
SO IT'S IMPORTANT TO THINK ABOUT
POLICIES BECAUSE THE PATHS ARE
CROSSED SO MANY DIFFERENT LEVELS
BECAUSE THEY'RE CITIES, STATES
AND FEDERAL POLICIES AND THEN
ALSO THEIR MULTISECTORRAL O THE
PATHS OF SCHOOLS HAVE POLICIES,
CLINICAL GUIDELINES AND THIS IS
PARTICULARLY IMPORTANT BECAUSE
ITY MEANS THAT LOCAL POLICIES
CAN BUFFER THE FEDERAL POLICIES
SO WHAT WE SAW WITH MARRIAGE,
QUALITY AND WHAT WE'RE CURRENTLY
SEEING WITH IMMIGRATION OR THE
FALL OF ROW V. WADE.
AND THEN LASTLY AND MOST
IMPORTANTLY, THIS HIGHLIGHTS THE
NEED TO CREATE EVIDENCE BASE TO
SHOW WHICH POLICIES TO TARGET
AND HOW TO COLLABORATE WITH
ADVOCATES AND KEY STAKEHOLDERS
AND POLICY MAKERS TO SUPPORT THE
ADOPTION OF POLICIES THAT
IMPROVE DAILY LIFE FROM
MARGINALIZED INDIVIDUALS AND
COMMUNITIES.
SO WHAT I WILL TALK ABOUT TODAY
ARE THE DIFFERENT PERMIAITATIONS
THROUGH WHICH STRUCTURAL FACTORS
WHICH INCLUDE POLICIES CAN
AFFECT SGM HEALTH.
SO I WILL LIST THEM BRIEFLY HERE
AND I WILL TALK THROUGH EXAMPLES
IN THE REST OF THE TALK, SO THE
FIRST AND MOST OBVIOUS THAT
PEOPLE THINK ARE ARE POLICIES
THAT TARGET SGM HEALTH SO
THINKING ABOUT HATE CRIMES OR
SAME SEX ADOPTION.
THEN THIS WORK HAS BEEN EXTENDED
TO EXPLORE HOW THE POLICY
CLIMATE MORE BROADLY AFFECTS SGM
INDIVIDUALS AND I WILL TALK MORE
ABOUT WHAT I MEAN BY THE POLICY
CLIMATE.
AND THEN LASTLY, I WILL TALK
ABOUT HOW UNIVERSAL POLICIES
THAT ARE NOT SPECIFICALLY
DESIGNED TO TARGET SEXUAL AND
GENDER MINORITY INDIVIDUALS CAN
DIFFERENTIA
DIFFERENTIALLY AND IMPACT THEIR
HEALTH.
SO I KNOW HOW OTHER PEOPLE HAVE
SPOKE ON THESE POINTS BUT
THERE'S A LARGE BODY OF RESEARCH
THAT PASS SGM POLICIES AND POOR
HEALTH OUTCOME AND THIS INCLUDES
STATES THAT BAN MARRIAGE
EQUALITY, LGB INDIVIDUALS LIVING
WITHIN THEM HAD MOOD DISORDERS
AND ANXIETY DISORDERS, ORGT
FOUND INCREASE IN ALCOHOL AND
TOBACCO USE AFTER THE PASSAGE OF
DISCRIMINATORY POLICIES AND IN
THOSE POLICIES THEY DID NOT SEE
SIMILAR CHANGES AMONG
HETEROSEXUAL OR SIS GENDER
INDIVIDUAL, SUGGESTING THEY HAVE
AN TARGETED IMPACT ON SGM
INDIVIDUALS SPECIFICALLY.
SO I WILL SPEBD MORE TIME
TALKING ABOUT POLICY CLIMATES,
SINCE RESEARCH IS MOVING
FORWARDS USING MULTIPLE POLICIES
AS A SINGULAR EXPOSURE AND WE
REFER TO THIS AS THE POLICY
CLIMATE AND BY THAT I MEAN,
USING A COMPOSITE MEASURE OF
DRIVERS AND FUNDING AND
POLITICAL DETERMINANTS AMONG
OTHER THINGS AND USING THAT AS A
SINGULAR EXPOSURE.
SO FOR SGM POLICIES THAT COULD
INCLUDE POLICIES THAT FOR
EXAMPLE REGULATE HATE CRIME,
SAME SEX ADOPTION AND MARRIAGE
AND EQUALITY DISRIM NATION AND
I'M SHARING THE MAP SO CAN YOU
SEE THE VARIATION ACROSS THE
CLIMB CLIMATES AS THEY RELATE TO
GENDER AND MINORITY INDIVIDUALS,
AND SIMILAR TO MANY OTHER MAPS
THEY IT WORSE IN THE SOUTH AND
MORE SUPPORTIVE IN THE NORTHEAST
AND WEST.
AND LOOKING AT POLICY CLIMATE IS
IMPORTANT BECAUSE IF WE ONLY
LOOK AT THE IMPACT OF A SINGULAR
POLICY WE MAY MISS THE FACT INTO
WHICH THE POLICY IS PASSED
ACROSS STATES AND MAY BE ALSO
AFFECTERRING THAT OUTCOME OF
INTEREST, SO TO SHOW WHAT THIS
LOOKS LIKE IN A RESEARCH SENSE,
I WORKED WITH COLLEAGUES AT
NORTH WEFERN UNIVERSITY
INCLUDING GREGORY PHILLIPS WHO
PRESENTED EARLIER TODAY TO
EXPLORE HOW SCHOOL BASED POLICY
PRACTICE RESEARCHS AFFECT SEXUAL
BEHAVIOR, AND WE THOSE THIS
BASED ON HOW MANY HOURS A DAY
YOUNG PEOPLE SPEND AT SCHOL AND
THE POLICIES CAME FROM THE CDC
COOL HEGHT PROFILES AND HER
CEIVED SEXUAL ORIENTATION, AND I
WANT TO AS YOU CAN SEGREEN
SPECIAL IS MORE INCLUSIVE AND
THERE IS LESS SO AND THERE IS
VERYIATION, AND WE LINK THESE TO
THE SURVEY I WILL DISCUSS IN THE
NEXT SLIDE, BUT AS YOU WILL SEE
HERE A LOT OF STATES NEAR GRAY
BECAUSE THAT'S BECAUSE THE YRBS
DOES NOT MANDATE THE STATE ASK
ABOUT SEXUAL IDENTITY OR
ORIENTATION.
AND BECAUSE OF THAT WHEN WE THIS
SOCIAL WORK, WE ARE BEHOLDEN TO
THE EXPOSURE TO GET THE POLICY
OUTCOME FOR EVERY STATE BUT ALSO
INDIVIDUAL OUTCOMES AND IT'S
HARD TO FIND NATIONAL LEVEL
STATE WEIGHTED SURVEYS THAT ASK
ABOUT SEXUAL GENDER IDENTITY AND
PREVLY WHAT WE FOUND AS I SAID
WE USE DATA FROM THE YOUTH RISK
BEHAVIOR SURVEILLANCE SURVEY AND
THEN OUR OBESE CHILDREN POSURE
WAS DAT ON THE LGB SCHOOL
CLIMATE FROM THE PROFILES AND WE
USE MULTILEVEL, MULTIVALID AND
RELIABLEIATE REGRESSION TO LOOK
AT ASSOCIATION BETWEEN LGBT
SCHOOL CLIMATE AND SOCIAL
BEHAVIORS AND AS CAN YOU SEE,
JUST BRIEFLY WE FOUND THERE WAS
A SIGNIFICANT ASSOCIATION
BETWEEN THE SCHOOL CLIMATE
OVERALL AND YOUNGER AGE AT FIRST
SEX AND LESS CONDOM USE FOR SEX
AND THAT WAS FOR EVERYBODY, AND
THEN WE FOUND EFFECT
MODIFICATION SHOWING THAT THESE
RELATIONSHIPS WERE STRONGER FOR
PEOPLE FOR SEX FOR EXAMPLE THAT
WERE NOT SURE OF SEXUAL IDENTITY
AND CONDOM USE AT LEFT SEX WAS
LOWER AMONG PEOPLE WHO WERE
LOWER AND GAY BISEXUAL AHEAD OF
THEIR SECURITIZATION.UAL PEERS
EMPLOY SO I WANT TO SHIFT NOW TO
THINK BEING SOCIAL POLICIES MORE
BROADLY, IN THIS MAP SHOWS
STATES CANNABIS POLICIES AND
INITIAL RESEARCH LOOKS AT
SOAKERS BETWEEN CANNABIS AND
POLICY OVERALL BUT MORE RECENT
RESEARCH HAS LOOKEDDA IMPACTS
LIKE RACE, SEXUAL IDENTITY AND
GENDER SO IN WORKING WITH
COLLEAGUESA THE COLUMBIA, WE
FOUND THEY HAD A DIFFERENTIAL
IMPACT ON CANNABIS USE PATTERNS
BY GENDER, PARTICULARLY AMONG
BISEXUAL WOMEN AND WE
HYPOTHESIZE THIS WAS DUE TO
ELEVATED RATES OF CANNABIS USE
AHEAD OF SEXUAL WOMEN PRIOR TO
CANNABIS LAW THIS IS LIKELY TO
SELF-MEDICATION AS A RESULT OF
LIVING IN STIGMATIZING
ENVIRONMENTS.
AND LOOKEDDA HOW THEY SPILL OVER
AND AFFECT GENDER MINORITY YOUTH
AROUND FEARS OF REST AND JAIL
FOR CANNABIS USE.
SO KEEPING WITH THE CLED OF
UNIVERSAL POLICIES I WANT TO
THINK ABOUT HOW THESE ORPHLAP IN
WAYS THAT CAN DIRECTLY CARINGET
SEXUAL AND GENDER MINORITIES SO
WE DEVELOP THIS FIGURE BASED ON
INTERVIEWS WITH 30 SEXUAL GENDER
AND MINORITY AND YOUTH IN
NEW YORK AND OTHERS ACROSS THE
U.S. TO FIND OUT HOW POLICIES
AFFECT THE HEALTH AND WELL BEING
OF SGM, AND YOU CAN SEE THE WELL
BEING IN THE MISDZ AND HOW
THEY'RE IMPACTED BY BROADER
SOCIAL POLICIES SO THINKING
ABOUT ECONOMIC POLICIES OR FAITH
BASED INITIATIVE SO THINKING
ABOUT THE WAYS THAT POLICY SHAPE
THE LIVES OF THESE YOUNG PEOPLE.
SO NOW I WILL SHOW YOU A MODEL
WE DEVELOPED TO THINK ABOUT THE
PATHWAYS THROUGH WHICH THIS
POLICY CLIMATE AFFECTS THESE
OUTCOMES SO KEEP THIS FIGURE IN
MIND AND NOW IMAGINE IT'S
LOCATED AT THE TOP WHERE IT SAYS
TARGETED AND UNIVERSAL POLICIES
THAT AFFECT SGMY.
AND WE FOUND THERE WERE DIRECT
PATHWAYS THROUGH SGM RELATED
AFFECTED STRESS AND STIGMA WHIH
WE KNEW, BUT THEY WERE ALSO
SHAPED THROUGH INSTITUTIONAL
SUPPORT AND INCLUSION.
AND THOSE PATHWAYS APPEAR INDEED
THE HOUSING, EDUCATION AND
EMPLOYMENT AND I'M SHOWING THE
MODTOLL HELP DEMONSTRATE THE
NEED TO THINK BEYOND
ASSOCIATIONS BETWEEN POLICIES
AND OUTCOMES TO CAPTURE HOW, TO
REALLY GET AT THOSE PATHWAYS AS
TO HOW WE GET FROM THE STRUCTURE
AND OFTEN TIMES STATE POLICY
CLIMATE TO THE DIRECT OUTCOMES
THAT AFFECT THE LIVES OF YOUNG
PEOPLE, PARTICULARLY THEIR LIFE
COURSE.
SO 1 OF THE POLICIES THAT CAME
UP A LOT WAS HOUSING SO I WANT
TO SHARE AN EXAMPLE QUOTE
BECAUSE THESE HOUSING AND
SHELTER POLICYINGS PERPETUATE
STRESS AND INEQUALITY FOR SEXUAL
AND GENDER MINORITY YOUTH AS
THEY RESULT IN HOMELESSNESS, SO
AS 120 YEAR-OLD THAT WE SPRUED
NOTED, LOOK WHEN I SAW THE
SHELTER POLICIES, THEY'RE NOT
GOOD TOWARDS YOUTH.
THEY SHOULDN'T STOP AT 21, THEY
SHOULD STOP AT 25 BECAUSE IF
WE'RE STILL WALLIFIED ON YOUTH
FOR FINANCIAL AID UNTIL THEN WE
SHOULD HAVE HOUSING, TOO.
I FEEL LIKE NEW YORK IS SO FULL
OF ITSELF IT DOESN'T KNOW HOW TO
HELP OTHER PEOPLE AND THE OTHER
ISSUE THAT CAME UP WITH WAS
FAITH BASED ORGANIZATIONS NEAR
EMERGENCY SHELTERS NATIONALLY
BUT THEY'RE EXEMPT FROM HOUSING
LAWS AND OFFER A GENDER TO
SEXUAL AND MINORITY YOUTH.
SO BRINGING THIS ALTOGETHER, I
WANT TO SHARE A LOST FEW
EXAMPLES OF HOW THE POLICY
CLIMATE CAN GET MEASURED SO WHAT
I MENTIONED BEFORE WAS SGM
POLICIES, SPECIFICALLY SOME OF
THE BROADER UNIVERSAL POLICIES
BUT THEN THINKING QUANTITATIVELY
HOW DO WE LOOK AT THESE TOGETHER
TO BETTER CAPTURE THE POLICY
CLIMATE AS A WHOLE SO FOR
EXAMPLE, AROUND SEXISM OR RACISM
OR CLASS EMPLOY CAN THERE'S A
FIELD HERE, IF THAT WORK IS MADE
MAJOR KRIEWKS OF KNOWLEDGE AND
HEALTH INIQUITIES BY THESE
INTERLOCKING SYSTEMS OF
STRATIFICATION, SUCH AS GENDER,
RACE, CLASS AND SEXUAL
IDIDN'TITY AND THERE ARE A
NUMBER OF CHAL ERVELGS TO THIS
WORK AS WE'VE BEEN ABLE DO IT SO
FAR, LIKE I MENTIONED, CLIMATE
RESEARCH FOCUSED ON A SPECIFIC
CATEGORIES OF POLICY CLIMATE, SO
THINKING ABOUT SGP STIGMA,
STRUCTURAL XENOPHOBIA OR
STRUCTURAL RACISM OVER TIME.
AND WE LOOK AT IT AT 1 AT A
TIME.
SO THINKING ABOUT RACE, GENDER
SEXUAL IAT IDENTITY, AND SEXUAL
GENDER MINORITY STIGMA AND SO
ON, AND SO THIS MEANS WE'VE ONLY
BEEN ABLE TO MEASURE HEALTH
DISPARITIES THROUGH INDIRECT
APPROACHES SO 1 OF THE THINGS
THAT A LOST US HAVE BEEN WORKING
ON AND LUCKILY SRO BEEN
INCREASING CALLS FROM THE NIH TO
DO THIS IS THINK THROUGH HOW WE
CAN MEASURE THIS AT A STRUCTURAL
LEVEL.
THERE'S A LOT OF CHALLENGES WITH
THIS BUT THE WORK I WANT TO
HIGHLIGHT IS THAT WE ARE MOVING
FORWARD, SO THERE'S A PAPER,
THAT WAS LED BY DR. BETHANY
EVERETT WHO IS PRESENTING LATER
AND I HAD THE PLEASURE OF
WORKING WITH HER ON NAIRP AND WE
REALLY WORKED TO CAPTURE
VARIATIONS AND STATE LEVEL
SYSTEMS OF OPPRESSION, BY
FOCUSING ON STRUCTURAL
DISCRIMINATION THAT TARGETS
WOMEN AND SEXUAL MINORITY
INDIVIDUALS.
SO WE CREATED A POLICY CLIMATE
MEASURE THAT INCLUDED LGB
COLPEES, STRUCTURAL SEXISM AND
FAMILY PLANNING POLICIES AND WE
REFERRED TO THIS OVERARCHING
MEASURES AS HETEROPATRIARCHY AND
A LOT OF OTHER KEYINGS OF OURS
HAVE BEEN, WOOING IN THIS SPACE
AND LOOKINGA THE IRPT SECTIONS
AROUND SAY FOR EXAMPLE, LGB
STIGMA AND STRUCTURAL RACISM AND
STRUCTURE AT RACISM, SO IT'S
IMPORTANT TO TRY TO THINK ABOUT
HOW TO DO THIS AND TO PAIR IT
WITH QUALITATIVE RESEARCH IN
TOARD TORE THINK ABOUT THOSE
PATHWAYS BECAUSE AS MANY OTHER
PRESENTER VS TALKED ABOUT TODAY,
IT IS HARD TO ACTUALLY GET AT
EXACTLY WHAT IS GOING ON WOREEE
SAY IN ANOTHER PANEL, A FIFTH
GRADE CLASS IS 1 CITY IS NOT THE
SAME AS ANOTHER.
SO REALLY TRY FOCUSED ON FIGURE
OUT WHAT HAPPENING ON THE
GROUND.
I WANT TO WRAP UP BY
HIGHLIGHTING CHALLENGES IN
STRUCTURE AT SGN.
SO FIRST IT IT'S WHAT CONITUTES
FACTOR OR POLICY. AND SO MUCH
OF THAT TAKES THE CANNABIS
OUTCOMES BUT THIS FAILURES TO
CAPTURE HOW THEY HAD UNINTENDED
OR SPILL OVER CONSEQUENCES THAT
MIGHT HARM SEXUAL GENDER
DIFFERENCESSER ANDINORRITY
HEALTH AND IT ALSO HELPS FAIL TO
CAPTURE THAT THE CLIMATE WHICH
WHICH IT'S PATIONZED CAN CAPTURE
FROM STATE TO STATE AND OTHER
POLICIES MAY BE AFFECTING THE
OUTCOME AND IT'S IMPORTANT WHEN
WE THINK ABOUT POLICIES WE TEND
TO USE THAT TERM INTERCHANGEABLY
WITH SGM, BUT IT'S IMPORTANT TO
THINK ABOUT WHAT ELSE CAN DRIVE
THESE SO IT CAN BE ATTITUDES,
CLINICAL GUIDE LINES AND FUNDING
STREEMENTS FOR EXAMPLE, AND IT'S
ALL INTO MEASURES MORE BROADLY.
AND THEN ANOTHER ISSUE IS THAT
WORK ON STATE POLICIES USES DATA
SETS THAT ARE STATE WEIGHTED AND
INCLUDE ALL 50 STATES.
HOWEVER, MANY EVER THESE DATA
SETS COME AT THE FEDERAL LEVEL
AND THEY LACK THE VARIABLES WE
NEED FOR STUDYING SEXUAL AND
GENDER MINORITY HEALTH.
SO FOR EXAMPLE, THE NATIONAL
DRUG USE ON ADDED IDENTITY IN
15, AND VERY FEW NATIONAL LEVEL
DATA SETS EACH ASK ABOUT GENDER
IIT OR IF THEY DO IT'S NOT
ASKING THE PERSON BUT SAYING OH
IDENTIFY THEM BASED ON THEIR
VOICE OR WHAT THEY LOOK LOOK OR
THINGS LIKE THAT AND THESE DATA
SETS ARE ALSO HARD TO ACCESS SO
FOR EXAMPLE, THE NATIONAL USE
WITH HEALTH REQUIRES MULTIPLE
LAYERS CLIEWRANCE, EVEN THOUGH
I'M LOOKINGA AT STATE WEIGHTED
DATA, IT'S EXPENSIVE AND YOU
HAVE TO GO TO REMOTE RESEARCH
DATA CENTERS THAT ARE HOURS AWAY
SO IT LIMITS ACCESS.
AND LASTLY OUR STATISTICAL
MODELS AND POLICIES HAVE TO MAKE
ASSUMPTIONS THAT THE POLICIES
ARE IMP LEMED AND ENFORCED AND
THAT IMPLEMENTATION IS THE STAIM
ACROSS STATES SO IT'S IMPORTANT
TO CONDUCT MIXED METHODS
RESEARCH TO SHOW HOW THESE
VARIATIONS IN POLICY IMPLEMENT
FINDINGS.
AND THEN LASTLY, MIXED METHODS
WORK SO WE CAN SHARE PEOPLE'S
LIVED EXPERIENCE AND EFFECT
CHANGE AND PUSH PER POLICIES TO
SUPPORT THE HEALTH AND WELL
BEING OF INDIVIDUALS WE WORK
WITH SO WE NEED TO CONTINUE TO
ADVIDEOICATE FOR FUNDING FOCUSED
ON SGP POPULATIONS, INCLUDING
YOUNG ACROSS THE LIFE CORS AND
IT WAS JUST LAST YEAR THAT I
NOSI WAS ISSUED LAST YEAR ON
WOMEN AND WE NEED TO KEEP MOVE
FIGURE FORWARD NOT JUST FOCUSED
ON FIGHT FOR POLICIES THAT
SUPPORT HEALTH BUT ALSO TO MAKE
SURE WE HAVE FUNDING AND DATA
ACCESS TO CONTINUE THIS
RESEARCH.
SO THANK YOU AGAIN FOR LISTENING
AND I LOOK FORWARD TO THE REST
OF THE PANEL AND SHARING
DISCUSSIONS LATER.
THANK YOU DR. PH ILBIN FOR THE
LECTURE, VERY THOUGHT PROVOKING.
NOW I WOULD LIKE TO WELCOME
DR. DAPH NA SIT, ROUMSA, WHO
WILL TALK ON IMPROVING ACCESS TO
GENDER ARK FIRMING CARE:
THREATS AND OPPORTUNITIES.
NTHANK YOU VERY MUCH.
LET ME SHARE MY SLIDES.
SORRY ABOUT THAT.
>> SO I WANT TO ADD A FEW
STRUCTURAL ISSUES TO ACCESSING
CARE THAT SPECIFICALLY GENDER
AFFIRMING CARE FOR TRANSAND
NONBINARY PEOPLE.
I WILL USE THE TERM TRANSOR
TRANSGENDER AS AN UMBRELLA TERM
TO INCLUDE ALL PEOPLE WHO'S
GENDER IDENTITY DIFFERS FROM
THEIR SEX ASSIGNED AT BIRTH.
AND JUST--I HAVE NO FINANCIAL
DISCLOSURES.
SO I WILL DIVIDE THIS TALK INTO
3 PARTS, FIRST I WILL TALK ABOUT
THE FRAMEWORK AND SOME OF THIS
WILL OVERLAP WITH OTHER TOWKS
WITH HOW WE THINK ABOUT THIS AND
THEN SOME THREATS AND TIEWPTS.
SO TO START OFF WITH THE
FRAMEWORK, I THINK AN IMPORTANT,
REALLY IMPORTANT PAPER THAT HAS
SHAPED THE WAY MANY OF US THINK
ABOUT TRANSHEALTH AND THE WAY
TRANSHEALTH IS EFFECTED BY
STIGMA, IS THAT DR. WHITE HUGHTO
FROM 2019 AND IN THAT PAPER THEY
DIVIDED THE WAY STIGMA AND
TRANSPEOPLE EFFECT HEALTHOT
INDIVIDUAL AND INTERPERSONAL AND
STRUCTURAL LEVELS AND AS WE'LL
SEE TODAY, THE STRUCTURAL LEVEL
REALLY PERMEATES BOTH THE
INTERPERSONAL AND THE INDIVIDUAL
LEVELS AND IT'S BACK TO THAT
STRUCTURAL LEVEL THAT WE NEED TO
TURN IN ORDER TO IMPROVE CARE
AND ACCESS TO CARE.
SO SPECIFICALLY WHEN YOU'RE
THINKING ABOUT PEOPLE ACCESSING
HEALTHCARE, YOU ARE THINKING
ABOUT THE HEALTHCARE SYSTEM SO
NOT JUST KIND OF THE SPECIFICS
OF ACCESSING GENDER AFFIRMING
CARE COME DOWN TO THE INDIVIDUAL
OF LEVEL OF COURSE.
THE PROVIDERS, THE HELT SYSTEM
WITH WHICH THEY WORK AND OF
COURSE THE STRUCTURAL KIND OF
BIGGER STRUCTURES AFFECTED BY
SOCIETAL TRANSPHOBIA.
ON THE INDIVIDUAL LEVEL, A
COUPLE OF EXAMPLES WHERE
TRANSPEOPLE ARE AFFECTED BY
STIGMA, AND THAT AFFECTS THEIR
AIBLGHT TO ACCESS CARE IS THIS
DIRECT DISCRIMINATION, WHICH IS
OF COURSE IS INTERSECTIONAL, SO
OF COURSE, YOU HAVE TO THINK
ABOUT THEIR DISCROSS EXAMINE
NATION NOT JUST BECAUSE THEY'RE
TRANS, BUT OTHER IDENTITIES AND
LIFE EXPERIENCES AND THINGS THEY
BRING TO CARE.
AND THAT OFTEN LEADS DIRECTLY TO
CARE AVOIDANCE.
SO WHETHER OR NOT YOU'RE
AVOIDING CARE, YOU MAY WELL
RECEIVE SUBPARCARE AND THAT'S
JUST A COUPLE OF EXAMPLES THERE.
OT PROVIDER LEVELS YOU THINK
ABOUT WHAT INHIBITS PROVIDERS
FROM PROVIDING CARE TO
TRANSPEOPLE AND PROVIDING THE
RIGHT KIND OF AFFIRMING CARE AND
THAT'S OF COURSE THE KNOWLEDGE
THEY HAVE BUT AS WE'LL SEE IN A
COUPLE OF SLIDES LATER, THAT IS
DRIVEN BY TRANSPHOBIA THAT IS
BOTH IMPLICIT AND OVERT THAT IS
BOTH ON INDIVIDUAL AND
STRUCTURAL LEVEL.
ON THE HEALTH SYSTEM LEVEL, OF
COURSE THERE ARE MANY EXAMPLES
THERE, THERE ARE BILLING
MECHANISMS THAT DISCRIMINATE
AGAINST TRANSPEOPLE, ELECTRONIC
MEDICAL RECORDS, THAT ARE OFTEN
ILSUITED FOR TRANSPEOPLE,
INSURANCE POLICIES AND WE WILL
TALK ABOUT THAT LATER, AND
UNSAFE STRUCTURES SO FOR
EXAMPLE, NOBODY WANTS TO GO TO
THE EMERGENCY ROOM AND HAVE TO
BE SEEN IN AN OPEN TRIAGE AREA
WHERE WHERE YOU DON'T HAVE
PRIVACY BUT FOR TRANSPEOPLE THAT
LACK OF PRIVACY CAN ACTUALLY
CAUSE DANGER AND DIRECT HARM SO
THAT LACK OF SAFETY CAUSED BY
THE STRUCTURE IS MUCH MORE
DIRECT OR BATHROOMS ARE ANOTHER
EXAMPLE THERE.
AND OF COURSE THE KIND OF BIGGER
STRUCTURAL ISSUES ON THE
ECONOMIC LEVEL, ON THE INSURANCE
AND EMPLOYMENT LEVELS,
SUSCEPTIBILITY TO VIOLENCE, I
WILL HAVE DIRECT EFFECT ON
PEOPLE'S ABILITY TO ACCESS CARE.
AND SO REALLY IT'S THE
STRUCTURAL TRANSPHOBIA AND THE
STIGMA, THAT PERMEATES INTO THE
HEALTH SYSTEM AND TO THE
PROVIDER LEVEL CREATING BARRIERS
TO CARE, AND THEREBY CREATING
HEALTH DISPARITIES FOR THE
INDIVIDUAL JUST TO BE VERY CLEAR
WHEN I SAY GENDER AFFIRMING
CARE, I'M REFERRING TO 2
SPECIFIC THINGS ACTUALLY.
FIRST IS THE GENERAL ABILITY OF
TRANSPEOPLE TO GET CARE THAT IS
RESPECTFUL AND SUPPORT OF THEIR
GENDER IDENTITY IT'S TRUE FOR
ANY PERSON BUT FOR CISGENDER
PEOPLE TAKE IT FOR GRANDED THAT
THEIR GENDERS ARE AFFIRMED BUT
ALSO WE'RE TALKING SPECIFICALLY
ABOUT TRANSITION RELATED CARE
WHICH CAN INCLUDE HORMONES,
SURGERY, SIN SILLARY SERVICES
AND SO OF COURSE INCLUDES A WIDE
VARIETY OF HEALTHCARE SETTINGS
AND PROVIDERS THAT TRANSPEOPLE
NEED TO ACCESS FROM
ESTHISITITIONS TO
ENDOCRINOLOGIST TO PLASTIC
SURGEONS TO PRIMARY CARE TO
MENTAL HEALTH, ET CETERA.
NOW THIS IS A GROWINGISSIBLELY
GROWING POPULATION, SO DATA FROM
FLORESC ET ALL FROM 2011 SAID IT
WAS .3%, THAT HAS TABLIZED
AROUND .6% FROM MORE RECENT DATA
AND THE YOUNGER POPULATION AND
MWR BASED ON 2017 DATA PLACED
THAT AS 1.8% OF HIGH SCHOOLERS,
5% OF YOUNGER ADULTS BASED ON
MORE RECENT PEW DATA.
AND OF COURSE WE KNOW ALL THE
SOCIAL DISADVANTAGES AND JUST TO
GIVE A HANDFUL OF EXAMPLES,
POVERTY IS GREATER, UNEMPLOYMENT
IS GREATER, HOMELESSNESS IS
GREATER AMONG TRANSPEOPLE
COMPARED TO THE GENERAL
CISGENDER POPULATION.
AND OF COURSE THIS IS HIGHER
AMONG PEOPLE OF COLOR AND OTHER
INTERSECTIONALLY DISADVANLTAGED
GROUPS, AND ALL OF THESE
DISADVANLAGES LEAD DIRECTLY TO
VIOLENCE, SUCH AS VERBAL
HARASSMENT, SEXUAL ATTACK AND
PHYSICAL ATTACK AND ALL THESE
TRANSLATE INTO THE CLINICAL
SPACE TO EITHER AVOIDANCE OF
CARE, INABILITY TO GET TO THE
PLACE WHO GETS CARE OR
INSUFFICIENT CARE EITHER BECAUSE
YOU DON'T DISCLOSE, OR AN
INDIVIDUAL DOESN'T FEEL SAFE
DISCLOSING THEIR IDENTITY OR
BECAUSE THEY RECEIVED
SUBPARCARE.
AND SO, WHAT ARE KIND OF SOME OF
THE STRUCTURAL LEVEL THREATS
THAT CREATE THIS ENVIRONMENT.
WESP ET ALL CREATEAD I VERY
INTERESTING MODEL THAT
DISCIPLINARY VIDS THE WAY WE
THINK ABOUT TRANSHEALTH JUSTICE
AND NOT JUST TRANSHEALTH FROM AN
INTERSECTIONAL PERSPECTIVE AND
THEY CREATED 3 LAYERS WE NEED TO
THINK OF.
FIRST IS STRUCTURED OF
DOMINATION, THE SECOND IS
INSTITUTIONAL SYMPTOMS, AND THE
THIRD IS SOCIAL STRUCTURAL
PROCESSES, AND THINKING THROUGH
THESE LAYERS, GIVES US TOOLS TO
UNDUE SOME OF THE HARM CREATED
THROUGH INJUSTICE ON AN
INTERSECTIONAL LEVEL.
SO FOR EXAMPLE, NAMES
INTERSECTING POWER RELATIONS,
WHITE SUPREMACY AND RACISM,
CAPITALISM, THE WAY PEOPLE IN
OUR SOCIETY ARE DEPENDENT UPON
HEALTH INSURANCE TO ACCESS
HEALTHCARE IS 1 EXAMPLE THERE.
ON THE STATE AND FEDERAL LEVEL
IF WE THINK STRUCTURALLY WE
DIVIDE THAT IN SOCIAL AND STATE
AND FEDERAL LEVELS THINKING
ABOUT STRUCTURAL THREATS TO
TRANSPEOPLE ACCESSING CARE,
THERE HAVE BEEN A SLEW
OF--THERE'S BEEN A SLEW OF
LEGISLATION ACROSS THE COUNTRY
TARGETING DIRECTLY TRANSPEOPLE
VERY DIRECTLY TRANSPEOPLE AND
THEIR ABILITY TO ACCESS CARE.
MOSTLY FOCUSING ON YOUTH BUT
WITH AN INCREASING AMOUNT OF
EFFORT BEING PUT INTO TARGETING
TRANSADULT ANDS THEIR ABILITY TO
ACCESS CARE.
AND TO STAY AT THE FOREFRONT OF
THAT IS FLORIDA WHERE IT WAS
ACTUALLY THE MEDICAL BOARDS WHO
BANNED GENDER AFFIRMING CARE FOR
TRANSYOUTH SO THIS IS IT'S A
POLICY THAT VERY DIRECTLY BLOCKS
PEOPLE FROM ACCESSING THE CARE
THEY NEED AND SIMILARLY IN TEXAS
ABBOTT'S CALLED TO INVESTIGATOR
AND INVESTIGATE GENDER AFFIRMING
CARE.
SO THOUSANDS IF NOT NOR, 10S OF
THOUSANDS PROBABLY OF
TRANSPEOPLE WHO ARE FINDING
ALTERNATIVES TO CARE OR JUST
UNABLE TO REACH THE CARE THAT
THEY NEED.
THE FEDERAL GOVERNMENT HAS SOME
ABILITY TO MITIGATE SOME OF THIS
HARM OR MODEL CITIZEN MAKE IT
WORSE POTENTIALLY SO OVER THE
PAST FEW ADMINISTRATIONS THERE
VISIT BEEN SOME BACK AND FORTH
ON THE RULES REGULATING SECTION
1557 OF THE AFFORDABLE CARE ACT
WHICH IS THE NONDESCRIMINATION
SECTION OF THE AFFORDABLE CARE
ACCOUNT AND THAT HAS BROAD
IMPLICATIONS ON WHAT PROVIDERS
DO AND DON'T DO AND WHAT PAYORS
DO AND DON'T COVER WITHIN STATES
AND SO DIRECTLY, DIRECT
IMPLICATIONS ON
PEOPLE'S--TRANSPEOPLE'S ABILITY
TO ACCESS CARE, THIS CAN GO BOTH
WAYS, THE FEDERAL GOVERNMENT CAN
LIMIT, CAN INCREASE ACCESS, OF
COURSE, THERE ARE POSSIBILITIES
FOR LEGISLATION, AND THROUGH
FEDERAL LEGISLATION AS WELL, BUT
THIS IS ALL THROUGH RULES AND
REGULATIONSA THE THIS POINT.
AND I WANT TO GIVE 1 EXAMPLE OF
THE WAYS WHEN WE THINK ABOUT THE
INTERPERSONAL LEVEL, WE NEED TO
REMEMBER THAT IT'S NOT
DISCONNECTED FROM THE STRUCTURAL
AND SOCIAL LEVELS.
SO WE KNOW THAT THERE ARE MANY
BARRIERSA THE PROVIDER LEVEL TO
ACCESSING CARE.
WE KNOW FROM THE U.S.
TRANSGENDER SURVEY, THAT MANY
TRANSPEOPLE HAVE BEEN REFUSED
CARE HAVE EXPERIENCED HARASSMENT
IN A MEDICAL SETTING, HAD TO
TEACH THEIR PROVIDERS ABOUT CARE
FOR TRANSPEOPLE AND WE KNOW THAT
TEACHING YOUR PROVIDER, IF YOU
WERE SOMEONE WHO HAD TO TEACH
YOUR PROVIDER ABOUT GENDER
AFFIRMING CARE, THAT WAS
CORRELATED WITH MORE LIKELIHOOD
OF HAVING DELAYED CARE YOU
NEEDED IN THE PAST YEAR.
SO AGAIN, DIRECTLY CORRELATION
THERE.
BUT WHAT'S IMPORTANT TO REMEMBER
IS THAT WHEN--THIS IS AN EXAMPLE
OF A STUDY WE DID WITH PRIMARY
CARE PROVIDERS AND WE SURVEYED
THEM ON THEIR KNOWLEDGE OF BAKE
ASPECT OF GENDER AFFIRMING CARE
SO CARE FOR TRANSGENDER PEOPLE
AND TRANSITION RELATED CARE.
AND THE HYPOTHESIS WAS THAT IF
WE WERE ONLY TO INCREASE THE
FORMAL EDUCATION OF PHYSICIANS
AND OTHER PROVIDERS, THE
KNOWLEDGE WOULD EVENTUALLY IN
CREASE OR THAT PROVIDERS WHO HAD
MORE FORM HOURS OF FORMAL
EDUCATION WOULD HAVE GREATER
KNOWLEDGE.
BUT WHAT WE FOUND IS NOT ONLY
DID FORMAL EDUCATION NOT
CORRELATE WITH KNOWLEDGE BUT
NEITHER DID ANY OF THE POTENTIAL
CONFOUNDERS; TRANSPHOBIA WAS
REALLY THE ONLY VARIABLE THAT WE
FOUND THAT CORRELATED WITH
KNOWLEDGE.
SO PROVIDERS WHO SCORED HIGHER
ON TRANSPHOBIA SCALES HAD LOWER
LEVELS OF KNOWLEDGE AND THIS
REALLY BRINGS HOME KIND OF HOW
WE CAN SEPARATE THE PROVIDERS
ARE NOT DISTINCT FROM THE
SOCIETY THEY LIVE IN.
SO HOW CAN WE FIX THESE.
WHAT ARE OPPORTUNITIES TO
IMPROVE THE ACCESS.
I'LL CIRCLE BACK TO DR. WHITE
HUGHTO HERE AND WHAT THEY DID
THERE WAS IN THE KIND OF POOLS
OF STRUCTURAL INTERPERSONAL AND
INDIVIDUAL STIGMA THERE ARE
DIRECT INTERVENTIONS THAT CAN BE
OFFERED SO FOR EXAMPLE ON THE
STRUCTURAL LEVEL,
NONDESCRIMINATION POLICIES LIKE
RULES TO SECTION 1557 ON THE
FEDERAL LEVEL, OR STATE LEVEL,
NONDESCRIMINATION POLICIES,
ACCESS TO CARE POLICIES AGAIN
LINK THEIR TRANSHEALTH CONTENT
AND MEDICAL SCIEL RICK LA AND WE
KNOW THAT KNOWLEDGE AGAIN IS NOT
SUFFICIENT IF IT COMES WITHOUT
ADDRESSING KIND THE TRANSPHOBIA
OR STIGMA THAT'S ASSOCIATE WIDE
TRANSNESS.
SORRY THIS IS AN EXTRA SLIDE
THERE, SO WE NEED TO KIND OF
CIRCLE BACK AND ADDRESS BOTH THE
STRUCTURAL LEVEL ON HEALTH
SYSTEM AND PROVIDER LEVEL, AND
THAT IS REALLY NECESSARY FOR FOR
US TO BREAK DOWN THE BARRIERS TO
CARE.
WHAT CAN WE AS RESEARCHERS DO?
WELL ON EACH OF THESE LEVELS
THERE'S A SLEW OF QUESTIONS THAT
WE CAN--THAT HAVE KNOW BEEN
UNANSWERED YET AND CAN BE
ANSWERED TO DIRECTLY EFFECT
POLICIES AND THAT MEAN NEEDS TO
LAND ON POLICY MAKERS DESKS IN
ORDER FOR THEM TO MAKE BETTER
POLICIES, SO A FEW EXAMPLES, OR
A FEW POINTERS TO THINGS I
SUGGIEST TO INCOMING RESEARCHERS
TO THE FIELD TO THINK ABOUT,
FIRST IS THE METHODOLOGY USED,
REMEMBER TO THINK AND STUDY
INTERSECTIONALLY.
REMEMBER THAT THE TRANSCOMMUNITY
IS NOT A MONOLITH, SO WE WILL,
ONCE YOU THINK INTERSECTIONALLY,
OF COURSE YOU WILL REMEMBER
THAT, IT IS VERY DANGEROUS TO GO
DOWN A PATHWAY WHERE WE SAY
TRANSPEOPLE ARE OR AREN'T AND WE
FORGET THAT THAT'S IT'S ACTUALLY
HUGELY DIVERSE POPULATION WITH
HUGE LOW DIVERSE NEED, AND I
THINK 1 OF THE MOST IMPORTANT
LESSONS THAT KIND THE RESEARCH
COMMUNITY HAD TALKED ABOUT IN
PAST DECADES AND MORE RECENTLY
WITH THE TRANSCOMMUNITY IS TO
COMMIT TO COMMUNITY-DRIVEN
RESEARCH.
TRANSPEOPLE KNOW BEST WHAT THEY
NEED BOTH IN TERMS OF CARE BUT
ALSO IN TERMS OF THE QUESTIONS
THAT NEED TO BE ANSWERED AND HOW
BEST TO ANSWER THEM.
AND COURSE, THIS IS GOING TO
PERMEATE EVERYTHING WE TALK
ABOUT TODAY AND TOMORROW, IS
THAT, NEEDS FOR SOGI DATA
COLLECTION AND IMPLICATIONS OF
HOW GIVEN THAT, DATA IS
COLLECTED AND THE WAYS THAT IT
IS NOW, TO BE THOUGHTFUL ABOUT
WHAT THE IMPLICATIONS ARE OF
THOSE METHODOLOGIES.
FROM A CONTENT PERSPECTIVE, I
THINK THERE ARE MANY QUESTIONS
ON THE POLICY LEVEL THAT NEED TO
BE ANSWERED, CARE DELIVERY
MECHANISMS, COSTS OF CARE AND
VARIATIONS THEREOF, FEDERAL AND
STATE PROTECTIONS, MANY CLINICAL
QUESTIONS THAT ARE COMPLETELY
UNKNOWN, AND BRINGING THAT DATA
BACK TO POLICY MAKERS, IS
EXTREMELY IMPORTANT.
SO OUTCOMES OF CARE, THERE ARE
ALREADY SOME DATA BUT POLICY
MAKERS APPEAR TO BE WANTING MORE
OF THAT.
A WORD OF CAUTION AROUND GOING
DOWN THE GREAT DEEP TRANSITION
AND RE TRANSITION ROUTE, NOT
THAT THERE ISN'T STUFF TO STUDY
THERE BUT BE THOUGHTFUL ABOUT
THE IMPLICATIONS OF YOUR WORK
WHEN YOU'RE WORKING WITH VERY
TARGETED MINORITIZED POPULATION.
SO THESE ARE JUST SOME OF MY
TIPS ABOUT KIND OF THINGS THAT
WE CAN DO AS RESEARCHERS AND WE
WILL END THERE, THANK YOU VERY
MUCH.
>>THANK YOU VERY MUCH
DR. STROUMSA, VERY
THOUGHT-VOAKING AND ISSUES WE
NEED TO THINK ABOUT AS WE
IMPRIEWEVER CARE FOR TRANSGENDER
POPULATIONS.
NOW I WOULD LIKE TO WELCOME
DR. LISA DIAMOND WHO WILL TALK
ABOUT TRAUMA INFORMED APPROACHES
TO SEXUAL AND GENDER STIGMA AT
DIFFERENT STAGES OF DEVELOPMENT.
PLEASE GO AHEAD.
>>SUCH A PLEASURE TO BE WITH US
THIS GROUP OF INDIVIDUALS AND I
WANT TO SHIP THE 1S OF WHAT
WE'RE TALKING ABOUT A LITTLE BIT
TO FOCUS ON DEVELOPMENT ON THE
DEVELOPMENTAL PSYCHOLOGIST AND
IF YOU WERE EVER IN DOUBT ABOUT
THE FACT THAT DEVELOPMENT
MATTERS, I'M SURE THAT COVID HAS
DIFFUSED YOU OF THAT NOTION
BECAUSE WE'RE SEE NOTHING
REALTIME VERY, VERY DIFFERENT
EFFECTS OF A WORLD WIDE STRESSOR
ON INDIVIDUALS BASED UPON
DEVELOPMENTAL TIMES.
WE'RE SEEING DIFFERENTIAL
EFFECTS OF THE CHANGES THAT
HAPPEN WITH COVID, IN SECOND
GRADERS, IN TEENAGERS, IN YOUNG
ADULTS AND THAT IS NOT
ACCIDENTAL, IT'S BECAUSE WE HAVE
VERY PLASTIC SLOW DEVELOPING
BRAINS AS A SPECIES AND THE
TIMING AND NATURE OF DIFFERENT
THREATS MATTERS A LOT, PROBABLY
THE BIGGEST CHANGE IN RESEARCH
AND DEVELOPMENTAL PSYCHOLOGY
OVER THE PAST SEVERAL DECADES
HAS BEEN OUR INCREASED
UNDERSTANDING OF THE NEURAL
PLASTICITY THAT THE BRAIN IS NOT
FINISHED WHEN WE ARE BORN AND
THE PERIOD OF TIME OVER WHICH IT
IS DEVELOPING IS QUITE LONG AND
THE PORE WE KNOW ABOUT IT, THE
MORE THAT DEPRIVATIONMENTAL
WINDOW COMES AND IT BEGINS
PREINATEALLY.
WE NOW KNOW THERE ARE EPIGENETC
CHANGES THAT ARE AFFECTED BY
ENDOCRINEOLOGICAL FACTORS BY
THEIR MOTHERS, INTERGENERATIONAL
OPPRESSION IS A THING AND WE
HAVE NOW IDENTIFIED THE
MECHANISMS THROUGH WHICH THAT
TAKES PLACE.
WE ALSO KNOW THERE'S A BIG
PLASTICITY IN THE FIRST YEAR OF
LIFE WHICH IS WHEN THE
ATTACHMENT SYSTEM COMES ONLINE
AND IERKTS DEPTIFYS THE CARE GIR
AS A SOURCE EVER PROTECTION.
THEN THERE IS ANOTHER BIG WINDOW
OF PLASTICITY IN THE FIRST 5
YEARS THAT A LOT OF
ENVIRONMENTAL EXPOSURES DURING
THAT PERIOD OF TIME FOR EXAMPLE,
SIMPLY WHETHER YOU ARE LIVING IN
A HOME OR A RENTED ENVIRONMENT,
EVEN THAT IN THE FIRST 5 YEARS
HAS BIG PREDICTIVE EFFECTS AND
IT CONTINUES EARLY AND MIDDLE
CHILDHOOD ANOTHER WINDOW OF
PLASTICITY, ESPECIALLY FOR
SOCIAL RELATIONSHIPS BECAUSE
THAT AT THE AGE AT WHICH
CHILDREN START TO INTERACT IN
PEER GROUPS.
AND THEN WE HAVE THE PIEWBURAL
TRANSITION AND THERE'S ANOTHER
INCREASE IN PLASTICITY THAT
BEFEINBERGS AROUND THE TIME OF
PIEWBITTAL MATURATION AND GOES
UP TO AGE 25 AND A LOT OF THE
CHANGE THAT HAPPENS AT THIS
PERIOD OF TIME IS RELATED TO
WHAT WE NOW CALL THE SOCIAL
BRAIN, THE ASPECTS OF THE BRAIN
THAT ARE SENSITIVE TO SOCIAL
JUDGMENT, TO SELF-PERCEPTION, TO
PERACCEPTINGS OF WHAT THE SOCIAL
GROUP THINKS OF YOU, THIS HAS
GOTTEN A LOT OF ATTENTION
RECENTLY WITH REGARD TO SOCIAL
MEDIA USE, AND THE FACT THAT
YOUTHS APPEAR TO BE PARTICULARLY
VULNERABILITY, TO THE NEGATIVE
EFFECTS OF SOCIAL JUDGMENT ON
SOCIAL MEDIA BUT THESE EFFECTS
GO BEYOND THAT, THESE ARE JUST
LARGER KIND OF BRAIN PLASTICITY
EFFECTS AND 1 OF THE THINGS THAT
I THINK IS REALLY IMPORTANT TO
UNDERSTAND IS THAT BY THE TIME
YOU ARE SEEING ANY SOURCE OF
STRESS EXPOSURES OR ANYTHING
YOU'RE MEASURING IN,A DULT WHICH
WHEN WE NORMALLY ASSESS SEXUAL
GENDER DIFFERENCESSER AND
IDENTITY IS IN ADULTHOOD SO IF
YOU'RE PLEASURING SOMEONE
EXPERIENCING SOMETHING IN THEIR
LIFE AND HAVING CERTAIN HEALTH
EFFECTS AT AGE 25 OR 828 OR IN
THEIR 30S.
ORALATEER ON, BY THE TIME YOU
GET THERE THERE HAS ALREADY BEEN
A VERY LONG PERIOD OF BRAIN
ENVIRONMENTAL SENSITIVITY THAT
GOES UNASSESSED EVEN THOUGH WE
KNOW THOSE THINGS HAVE PRETTY
PROFOUND EFFECTS.
THE OTHER REASON WE REALLY HAVE
TO PAY SUCH CLOSE ATTENTION
THORS THIS IS THAT ALL FORMS OF
CHILD ADVERSITY,
DISPROPORTIONATELY AFFECT
MARGINALIZED GROUPS AND THAT IS
TRUE FOR SEXUAL AND GENDER
MARGINALIZATION AS WELL AS
ETHNIC RACIAL SOCIOECONOMIC
MARGINALIZATION.
THESE, YOU KNOW DATA OVER THE
YEARS HAVE HAD VARIED DEGREING
OF QUALITY, BUT THE DATA QUALITY
AS REALLY GONE UP, SO THIS IS
DATA THAT WAS RECENTLY AND
MULTISTATE DATA, REVIEWED BY
AUSTIN AND COLLEAGUES AND 1
THING THAT'S IMPORTANT TO POINT
OUT IS THAT NOT ALL FORMS OF
CHILDHOOD ADVERSITY ARE
DIFFERENTIAL BETWEEN SEXUAL AND
GENDER DIVERSE FOLKS AND
HETEROSEXUAL AND CISGENDER FOLKS
FOR EXAMPLE, PARENT SEPARATION
AND DIVORCE.
THERE ARE NO LARGE SCALE
DISPARITIES THERE, BUT YOU START
TO SEE DISPARITY WHEN YOU LOOK
MORE CLOSE LOW AT DIFFERENT
TYPES OF ADVERSITY, THAT EFFECT
SOCIAL CONDUCK, SEXUAL ABUSE
HISTORICALLY AS GOTTEN THE
LION'S SHARE OF ATTENTION PARTLY
BECAUSE OF CULTURAL STEREOTYPES
THAT PEOPLE ARE TURNED GAY
THROUGH SEXUAL
PREDOMINANTLIATION, AND THERE IS
NO EVIDENCE OF THAT AT ALL AND
ALSO, A LOT OF THOSE EARLY
SUPPOSITIONS WERE NOT REALLY
LOOKING AT THE WHOLE PICTURE AND
WHEN YOU LOOK AT MORE BROADLY
YOU FIND WELL, IT'S NOT JUST
SEXUAL ABUSE THAT IS MORE
PREVALENT IN MARGINALIZED
POPULATIONS, IT'S ALSO PHYSICAL
ABUSE, IT IS ALSO EMOTIONAL
ABUSE.
THAT'S A CATEGORY THAT REFERS TO
SEVERE NEGLECT IN THE
CAREGIVERRING ENVIRONMENT,
SPURNING, PARENTAL SPURNING,
REYEKS, HOSTILITY, INSULTING OR
SHAMING THE CHILD OR
INVALIDATION.
INTERESTINGLY IT USED TO BE THAT
WE DIDN'T REALLY CONSIDER THOSE
THINGS OF ABUSE AND I THINK
GENERATIONALLY, YOU KNOW MY
MOTHER'S GENERATION WOULD HAVE
SAID THAT'S NOT ABUSE THAT'S
JUST GROWING UP IN A HARD
ENVIRONMENT.
NOW THAT WE KNOW A LITTLE BIT
MORE ABOUT THE DEVELOPMENT OF
THE SOCIAL BRAIN, WE UNDERSTAND
THAT THAT SORT OF MALTREATMENT
FOR A SOCIAL BRAIN IS IN FACT AS
IMPACTFUL AS THE PHYSICAL
VIOLENCE.
THERE'S ALSO SEXUAL MINORITY AND
GENDER MINORITY HEALTH
DISPARITIES IN THE PRESENCE OF A
CAREGIVER WHO IS A CHRONIC
SUBSTANCE ABUSER.
THE PRESENCE IN THE HOME OF AN
ADULT OR CAREGIVER WITH SERIOUS
MENTAL ILLNESS, PARTICULARLY
DEPRESSION, AND HAVING A
HOUSEHOLD OR A FAMILY MEMBER
THAT IS IN CARCERATED, AND
WITNESSING VIOLENCE IN THE HOME
AND ALL OF THESE ARE
SIGNIFICANT, THEY'RE PROBABLY
UNDER REPORTS GIIVE THAT ALL
THESE ARE UNDERREPORTED AND
THESE DISPARITIES WHICH ARE
ROUGHLY, BY A FACTOR OF 2 SEXUAL
MINORITIES HAVE GREATER RACE OF
THESE DISPARITIES, GENDER
DIVERSE INDIVIDUALS AND
DISPARITIES ARE EVEN GREATER AND
SOME IS STUDIES SUGGEST THEY
HAVE ROUGHLY TRIPLED THE RATES
OF SOME OF THESE ADVERSITIES.
WHY?
THAT IS THE BIG QUESTION THAT
PEOPLE ALWAYS ASK.
TO SOME DEGREE DIFFERENTIAL
REPORTING PLAYS A ROLE HERE.
INDIVIDUALS WHO GO THROUGH A
PROCESS OF SEXUAL AND GENDER
QUESTIONING OFTEN ASK THEMSELVES
WHAT HAPPENED TO ME, WHY AM I
LIKE THIS?
WHY AM I DIFFERENT?
SO THEREYA A GREATER LIKELIHOOD
OF INDIVIDUALS GOING THROUGH
SEXUAL GENDER QUESTIONING
PROCESS OF FOCUSING IN ON THEIR
BACKGROUNDS, LOOKING AT THEIR
CHILDHOOD, BECOMING MORE
CONSCIOUSLY AWARE OF JUST WHAT
THEIR CHILDHOOD WAS LIKE.
CAN CONVERSELY INDIVIDUAL WHO IS
HAVE EXPERIENCED ADVERSITY
ESPECIALLY FORMS OF ADVERSITY
THAT INVOLVE SHAME OR
DEGRADATION OR SHUNNING AND
SPURNING OFTEN THEM ASK
THEMSELVES WHY, WHY ME?
WHAT IS WRONG WITH ME?
WHY IS THIS HAPPENING TO ME?
AND AGAIN TURNING INWARD AND
LOOKINGA THE SELF, THAT CAN
ACCELERATE THAT.
SO A LOT OF YOUTH, ADVERSITY CAN
SPEED UP THE PATHWAY TO WHICH
THEY BRING IT INTO CONSCIOUS
AWARENESS.
ANOTHER THING THAT'S BEEN SHOWN
IS THAT KIDS WHO APPEAR TO BE
DIFFERENT FROM OTHER KIDS ARE
OFTEN TARGETED BY ADULTS, BEING
DIFFERENT CAN OFTEN ELICIT
MALTREATMENT FROM PARENTS OR
CAREGIVERS, SO THERE ARE THESE
BI-DIRECTIONAL EFFECTS, WHAT THE
KID IS PUTTING OUT TO THE
ENVIRONMENT, WHAT THE ADULTS IN
THE ENVIRONMENT ARE DOING IN
RETURN, THAT STILL LEAVES IN
QUESTION OF ARE THERE ANY
EFFECTS OF ADVERSITY ONCE IT
OCCURS ON YOUTH DEVELOPMENT.
AND ABSOLUTELY THERE ARE.
BECAUSE THE HUMAN BRAINL IS A SO
DEVELOPING SOCIAL BRAIN AND WHEN
A CHILD DEVELOPS, THE BRAIN DOES
WHEN IT'S BEEN DOING FOR 60,000
YEARS, IT ADAPTED, IT FIGURING
OUT UTR HO TO SURVIVE IN THIS
PARTICULAR ENVIRONMENT AND WE
KNOW THAT MANY OF THOSE
ADAPTATIONS CAN BE VERY LONG
LASTING.
WE ALSO KNOW THAT DIFFERENT KIDS
ARE DIFFERENTIALLY SENSITIVE TO
WHAT'S GOING ON IN THEIR
ENVIRONMENT.
WE KNOW THAT THERE ARE GENES
THAT ARE RELATED TO ENVIRONMENTS
IN SUSCEPTIBILITY AND WE ALSO
KNOW THAT YOUR SUSCEPTIBILITY TO
ENVIRONMENTAL INFLUENCE CAN BE
CALIBRATED BY EXPOSE TOWER
DIFFERENT ENVIRONMENTS.
YOUR SENSITIVITY TO THE NURTURE
ANT TO THE ENVIRONMENT CAN BE
DIALED UP OR DOWN, BASED ON WHAT
IS MOST ADAPTIVE TO THAT BRAIN
AND THAT ENVIRONMENT.
SO I'M GRAD THAT VICKI MAYS
TALKED ABOUT FLUIDITY BECAUSE
THAT APPLIES TO THE BRAIN AND
DIFFERENT FOLKS ARE GOING TO BE
MORE OR LESS SENSITIVE TO WHAT'S
HAPPENING AROUND THEM AND SO
THAT CREATES A LOT OF DIVERSITY
IN DEVELOPMENTAL OUTCOMES.
ONE OF THE THINGS WE DO KNOW
WITH REGARD TO EFFECTIVE
ADVERSITY ON SEXUAL DEVELOPMENT
IS THAT THERE'S--ALTHOUGH
THERE'S NO EVIDENCE THAT
ADVERSITY CHANGES THE GENDER
PATTERNING OF AN INDIVIDUAL'S
SEXUAL DESIRES, IT DOES APPEAR
TO SPEED UP MATURATION.
INDIVIDUALS WHO HAVE BEEN
EXPOSED TO A LOT OF ADVERSITY
TEND TO REACH PUBERTY A LITTLE
EARLIER, OFTEN THEY'RE ENTRY
INTO SEXUAL RELATIONSHIPS
DEVELOPMENTALLY, COMES EARLIER,
THERE ARE MORE LIKELY TO HAVE
MULTIPLE SEXUAL PARTNERS, THEY
ARE MORE LIKELY TO PURSUE SEX IN
NONCOMMITTED OR CASUAL
RELATIONSHIPS AND WHAT
DEVELOPMENTAL EVOLUTIONARY
DEVELOPMENTAL PSYCHOLOGISTS HAVE
THEORORRIZED IS THAT REFLEBS A
SORT OF ORIENTATION TOWARD AN
UNCERTAIN FUTURE.
THAT WHEN THE BRAIN IS GETTING
THE MESSAGE DEVELOPMENTALLY,
THAT THE FUTURE IS
UNPREDICTABLE, IT SPEEDS UP
DEVELOPMENT IN THIS FAST LIFE
HISTORY STRATEGY.
FIGURE OUT WHERE THE REWARDS
ARE, GET THEM, AND IF THERE ARE
RISKS JUST DO IT ANYWAY, SO IT'S
A SORT OF SHORT-TERM STRATEGY,
YOU KNOW IN THIS UNCERTAIN WORLD
GET WHAT YOU CAN AND GIVEN THAT
WE KNOW THAT MARGINALIZED
COMMUNITIES HAVE HIGH LEVELS OF
RISK BEHAVIORS, IT'S IMPORTANT
TO THABD THAT'S NOT A PARKER OF
BEING UNCONTROLLED OR
UNREGULATED TO SOME DEGREE, THAT
IS ADAPTIVE, THAT IS ADAPTIVE
FOR A BRAIN THAT'S EXPOSED TO
ADVERSITY.
THIS OF COURSE, IS WHERE THE
HEALTH IMPLICATIONS COME IN.
BECAUSE ALL OF THOSE CHILDHOOD
EVENTS SO UP NOT JUST
IMMEDIATELY, BUT OVER THE LIFE
COURSE AND THERE'S A LOT OF
LONG-TERM DEVELOPMENTAL STUDIES
SHOWING YOU CAN IDENTIFY
LONG-TERM HEALTH EFFECTS OF
EARLY EXPOSE TOWER CERTAIN
ADVERSITIES.
IN PEOPLES 50S AND 60S IN THEIR
RESPONSES TO MEDICATION, IN
THEIR RESPONSES TO CHEMO THERAPY
AND SO IN ORDER TO FIGURE OUT
WHAT'S HAPPENING WITH HEALTH
DISPARITIES IN ADULTS, WE HAVE
TO ATTEND TO SOME OF THE
MEDIATING EFFECTS, SOME OF WHAT
ARE CALLED BIOLOGICAL EMBEDDING
EFFECTS, EFFECTS OF ADVERSITY ON
THE WAY THE STRESS RESPONSE
SYSTEM FUNCTIONS AND CASCADE
EEIVETS THAT CERTAIN BEHAVIORS
FEED FORWARD TO CHANGE THE
ENVIRONMENT EVENT FURTHER SO YOU
HAVE TO THINK OF DEVELOPMENT AT
THIS SPIRAL THAT IT'S ADAPTING
AND CHANGING AND ADAPTING AND
READAPTING OVER TIME AND THAT
YOU HAVE TO SORT OF LOOK AT THAT
PROCESS IF YOU WANT TO TRY TO
UNDERSTAND WHAT'S GOING ON BY
THE TIME HAVE YOU AN ADULT.
AND IN TERMS OF BIOLOGICAL
MECHANISMS, AND BRIAN
[INDISCERNIBLE] SAID EARLIER ON
THAT THERE'S MUCH MORE RESEARCH
THESE DAYS ON BIOMARKERS AND
BIOLAGEICAL MECHANISMS, AND I
THINK THE MOST IMPORTANT
EMERGING SORT OF FOCUS OF
ATTENTION FOR BIOLOGICAL
MECHANISMS IS THE IMMUNE SYSTEM
AND SPECIFICALLY SYSTEMIC
INFLAMMATION WHICH IS A BROAD
PROCESS IN THE BODY THAT IS
TRIGGERS BY PERCEPTIONS OF
SOCIAL THREAT, AND WHICH TENDS
TO EXACERBATE OVER TIME SO THAT
EARLY EXPOSURE TO THREAT
TIGHTENED THE INFLAMMA TORPRO
ASSESSES IN THE BODY AND THAT
CAN DOUBLE AND TRIPLE RISK LATER
ON AND THE REASON IT'S SO
IMPORTANT IS THAT'S A PRETTY
BROADLY PATHOGENIC PROCESS IN
THE BODY THAT THAT IS
RESPONSIBLE FOR ABOUT 50% OF THE
DEATHS WORLD WIDE: INFLAMMATION
IS RELATED TO CARDIOVASCULAR
DISEASE, ARTHRITIS, CANCER,
RESPIRATORY PROBLEMS, ASTHMA,
ALL OF THE DISPARITIES THAT WE
HAVE SEEN IN SEXUAL AND GENDER
MINORITY PATHWAYS INCLUDING
DEPRESSION AND SUICIDALLITY.
THERE'S BEEN A LOT OF DEBATE
OVER THE WHETHER THE LINK
BETWEEN INFORMATION AND SUICIDAL
8 IS BI-DIRECTIONAL, CAUSAL WE
KNOW THAT YOUTHS WITH COMPLETED
SUICIDE HAVE HIGHER LEVELS OF
INFLAMMATION IN THE BRAIN THAN
ATTEMPTED SUICIDE.
THERE'S A LOT INFORMATION, I
WILL PUT THIS OUT HERE, I DIDN'T
KNOW ANYTHING ABOUT THE IMMUNE
SYSTEM 10 YEARS AGO.
I--AS I STARTED TO REALIZE HOW
CENTRAL THIS PROCESS WAS I GOT
UP TO SPEED FAST--TO COLLECT
VERY HEALTH RELEVANT MECHANISMIC
BIOLOGICAL DATA I WOULD
RECOMMEND THAT PEOPLE REALLY,
REALLY FOCUS ON THE IMMUNE
SYSTEM AND INFLAMMATION, SO 1 OF
THE IMPORTANT THINGS TO REMEMBER
WHEN WE THINK ABOUT ADITY -
-ADVERSITY IS NOT
NONAPOPTOTIC WILLAL.
IT'S NOT JUST WHETHER ADVERSITY
OCCURS, IT'S THE TYPE AND THE
TIMING.
MOST EVOLUTIONARY PSYCHOLOGISTS
HAVE FOCUSED ON THE FACT THAT
THE HUMAN BRAIN AS A VERY
PARTICULAR TASK.
IT NOT ONLY HAS TO RESPOND IN
THE NOW BUT IT HAS TO PREDICT
THE FUTURE AND SO SOME FOLKS
HAVE TALKED ABOUT THE BEIGE AND
BRAIN, USING PAST
EXPERIENCES--UNPREDICTABILITY
WHICH DID NOT USED TO FOCUS A
LOT OF ATTENTION ON, WE NOW KNOW
THAT FOR EXAMPLE HAVING A
CAREGIVER, WHO IS A SUBSTANCE
USER WHO HAS DEPRESSION CHANGES
THE CHILD'S ABILITY TO SEELET
THE FUTURE AS SAFE AND
PREDICTABLE AND THAT TRIGGERS
ADAPTATIONS, ADAPTATIONS FOR THE
MOMENT AND THAT WILL BE USEFUL
LATER ON.
ONE OF THE REASONS I THINK IT'S
SO IMPORTANT IS IT HELPS TO PULL
ADVERSITY IS THE SOURCE OF
PROBINGNESS, THAT A CHILD WHO
HAS BEEN ABUSED IS JUST DONE
FOR.
OUR SPECIES IS DESIGNED TO COPE
WITH THESE THINGS BY ADAPTING
BUT THOSE AX DATA
PROTECTIONATIONS HAVE
CONSEQUENCES SO HYPER VIG LANSZ,
HYPER PROTECTIVENESS, SOME OF
THE THINGS YOU SLEEP APNEA AND
OBESITYY IN KIDS EXPOSED TO
ADVERSITY ARE VERY ADAPTIVE FOR
THE NOW AND THEY HELP TO PREPARE
FOR AN UNCERTAINTY FUTURE BUT
THEY HAVE COSTS, WHEN THERE'S A
MISMATCH WITH THE ENVIRONMENT.
AND O SOME CLINICAL
PSYCHOLOGISTS TALK ABOUT THE
ADAPTED CHILD ARE THE CHILD THAT
LEARNS TO DEAL WITH THE
ALCOHOLIC PARENT OR THE
UNPREDICTABLE ENVIRONMENT AND
THEN AS A AN ARK DULT YOU MAY
HAVE THESE ADAPTATIONS THAT NO
LONGER SERVE YOU.
SO IF ALL OF THAT IS TRUE THEN
WHERE DOES THIS NOTION OF TRAUMA
FIT IN, IF ADVERSITY IS NORMAL,
WHAT--WHAT IS TRAUMA, WHAT'S THE
DIFFERENCE BETWEEN TRAUM AND
ADVERSITY RESEARCH WHAT MOST
WOULD SAY IS THAT TRAUM IS ABOUT
PRIME AT THREAT, THREAT TO LIFE,
WHICH HISTORICALLY IN A LOT OF
THE INITIAL PTSD RESEARCH WAS
FOCUSED ON BIG EVENTS CALLED
KRIST FERIA A EEIVETS
DIAGNOSTICALLY, AN ASSAULT,
SOMETHING THAT POSED AN
IMMEDIATE THREAT TO LIFE, THAT
CAUSES SELF-PROTECTIVE
ADAPTATION AND TRAUMA
SYMPTOMOLOGY AND I STAY STICKY
BECAUSE THEY'RE THOORD GET RID
OF.
THAT'S WHAT A TRAUMA THERAPY IS
FOR AND THEY OFTEN DON'T MAKE A
LOT OF SENSE.
THESE ARE ADAPTATIONS TO DANGER
THAT ARE SELF-PROECTOMYOSIN
ITIVE AND THEY SOMETIMES DON'T
MATCH THE CURRENT SITUATION
BECAUSE THE BRAIN HAS ADAPT
INDEED A WAY TAKEN--THEY DIDN'T
SERVE IT WHEN WHEN IT'S IN A
DANGER ENVIRONMENT.
PROTECT 1S SELF-FROM DANGER,
HYPER PROTECTION AND THAT
INCLUDES SELF-SOOTHING BEHAVIOR,
AND THEN HYPER SUBMISSION, GIVE
IN, GIVE IN TO THE THREAT TO
PROTECT YOURSELF FURTHER IN
DANGER.
ONE OF THE THINGS THAT'S REALLY
BEEN MOST INTERESTING AND SORT
OF LITERATURE ON RESEARCH ON
TRAUMA, IS THAT AS MORE RESEARCH
GOT DONE, ESPECIALLY IF IT
INCLUDE TD EXPOSURES WHO HAD
EXPOSED TO CHILDHOOD DIVERSITY
WE FOUND A LOT OF FOLKS HAVE
THESE SORTS OF SYMPTOMS, BUT
WITHOUT THE CRITERIA A EVENT.
THEY WEREN'T PHYSICALLY
THREATENS, THEY WEREN'T AT RISK
OF DEATH.
AND THE CATEGORY OF COMPLEX
TRAUMA OR OF LITTLE CPTSD HAS
EMERGED IN THE LITERATURE AS AN
EXPLANATION OF THIS.
BASICALLY SOME INDIVIDUALS WILL
DEVELOP THESE DEFENSIVE
ADAPTATIONS NOT BECAUSE OF A
SINGLE ADVERSE EVENT, BUT
THROUGH A LONG-TERM ADAPTATION
TO CHRONIC UNCONTROLLABLE FEAR.
UN PREICTIBILITY IS REALLY
IMPORTANT HERE BECAUSE IF IT
WERE A MEMBER OF YOUR PSYCHE
101, INTERMITTENT REINFORCEMENT
IS A REALLY POWERFUL
CONDITIONING MECHANISM IN THE
BRAIN.
SO FEAR THAT IS UNPREDICTABLE,
TRIGGERS EVEN MORE SOURCE OF
ASBESTOS DATA PROTECTIONATIONS
BECAUSE IF ADDITION TO
RESPONDING TO THE THREAT, WE
HAVE TO TRY AND PREDICT IT, WE
YOU HAVE TO TRY AND WATCH FOR
IT, YOU HAVE TO TRY AND SEE HOW
TO ESCAPE IT, AND WHAT IS THAT
FEAR OF?
IT'S MORE THAN JUST VIOLENCE AND
I THINK 1 OF THE THINGS WE
REALLY LEARNED IN THE WHOLE
MINORITY TRADITION IS THAT, IT'S
NOT JUST THE IMMEDIATE THREAT OF
PHYSICAL VIOLENCE, IT IS SOCIAL
VIOLENCE AS WELL.
BECAUSE HUMANS ARE AN ALTRICIA
AND WERE BORN VULNERABLE AND
DEPENDENT ON SOCIAL TIES.
SOPHISTICATED ARERY DR. DIAMOND,
IF YOU CAN WRAP UP PLEASE?
>>NO PROBLEM.
I LET ME GET MY MOUSE TO WORK,
SOCIAL REJECTION, IS A PRIMAL
THREAT, WHICH MEANS THAT THERE'S
NO SUCH THING AS BEING OVERLY
SENSITIVE TO REJECTION,
MICROAGGRESSIONS ARE NOT MICRO,
FROM THE PERSPECTIVE OF THE
SOCIAL BRAIN, THEY ARE HIGH
PRIORITY SIGNALS AND WHEN WE
THINK ABOUT THE STRESSORS THAT
ARE FACING SEXUAL AND GENDER
MINORITY YOUTH, WE HAVE TO
REMEMBER FROM THAT DEVELOPING
BRAIN, REJECTION FEELS LIKE
IMMINENT DANGER TO THE BRAIN AND
PROVOKES AN ADAPTIVE RESPONSE.
SO YOU KNOW, THE MAIN POINT OF
THIS, IS THAT STIGMA IS
ACTUALLY--IT BEHAVES IN THE
BRAIN LIKE TRAUM A. WE NEED TO
STOP THINKING ABOUT STIGMA AS A
STRESSOR AND THINK ABOUT STIGMA
AS A FORM OF TRAUMA THAT
PROVOKES DEFENSIVE ADAPTATION
AND VIGILANCE, HYPOPROTECTION
WHICH INCLUDES OBSESSIVE
SELF-SOOTHING WHICH RELATES TO
SUBSTANCE USE, HYPER SUBMISSION,
WHAT FINISHES WOULD CALL THE
FOND RESPONSE AND THESE SYMPTOMS
WILL LOOK CRAZY IF YOU JUST
THINK ABOUT THEM AS RESPONSE TO
STRESS BECAUSE IT'S OFTEN NOT
OBSERVABLE BUT IF YOU THINK
ABOUT IT DEVELOPMENTALLY,
THEY'RE ADAPTATIONS TO FEAR AND
THOSE ADAPTATIONS THROUGH THE
PROCESS OF INFLAMMATION, HAVE
BOTH MENTAL AND PHYSICAL
DESCRIPTIONS THAT SOMETIMES ARE
NOT EVIDENT RIGHT AWAY WILL SHOW
UP, 10, 20, 30 YEARS LATER.
>>THANK YOU VERY MUCH.
THIS WAS AN AMAZING TALK.
BUT SORRY, WE HAVE TO--WE HAVE
TO MOVE ON BECAUSE, YOU KNOW
THERE IS ANOTHER LECTURE AGAIN.
SO, I WILL WOULD LIKE TO INVITE
DR. BETHANY EVERETT WHO WILL
TALK ABOUT THE STRUCTURAL
DETERMINE NABTS OF SEXUAL
MINORITY WOMEN'S REPRODUCTIVE
HEALTH.
>>HI, CAN YOU ALL SEE MY
SCREEN?
>>NOT YET.
>>SORRY.
SHARE SCREEN.
ALL RIGHT, HOW ABOUT NOW.
>>YES, WE CAN SEE IT.
>>OKAY, GREAT.
THE ZOOM BUTTONS ARE GETTING IN
THE WAY OF ME BEING ABLE TO HIT
THE SHARE SCREEN BUTTON.
SORRY ABOUT THAT.
OKAY, THANK YOU.
THANK YOU FOR BEING HERE, I
APOLOGIZE I WOKE UP SICK THIS
MORNING, BUT IF YOU'RE A
PATIENT, YOU KNOW IT'S BEEN A
TOUGH YEAR FOR KIDS BEING SICK
AND I THINK IT'S BEEN ALSO HARD
FOR THEIR OLDER PARENTS WITH
WEAKER IMMUNE SYSTEMS SPEAKING
OF IMMUNE SYSTEMUNE FUNCTIONING
SO PLEASE BEAR WITH ME.
SOIME GOING TO ZOOM IN ON 1 SET
OF RESULTS RELATED TO STRUCTURAL
DETERMINANTS OF HEALTH BY
LOOKING AT SEXUAL MINORITY WOMEN
PERINATAL AND OBSTETRICAL
OUTCOMES.
AND THIS I THINK IS REALLY GOING
TO RELATE TO SOME OF THE THINGS
WE TALKED ABOUT ALREADY SO WE
SHOULD HAVE A NICE RICH
DISCIPLINARYIS CUSHION AT THE
END.
SO THE SEXUALITY LITERATURE
TELLS US THAT SEXUAL ORIENTATION
IS MULTIDIMENSIONAL AND DYNAMIC
SO DEPENDING ON THE DATA SET YOU
ARE USING, THE SIZE OF THE
POPULATION IS AROUND 20-25% OF
U.S. WOMEN WHO ARE IN THE
REPRODUCTIVE AGE CATEGORY.
AND JUST A NOTE - LANGUAGE
REALLY QUICKLY, I'M GOING TO BE
USING THE WORD WOMEN TO TALK
THROUGH THE RESULTS IN MY
STUDIES THAT I'M GOING TO BE
PRESENTING HERE BECAUSE THESE
ARE INDIVIDUAL WHO IS IDENTIFY
AS FEMALE AND WHO HAVE GIVEN
BIRTH AT LEAST ONCE OR
EXPERIENCED AT LEAST 1
PREGNANCY.
THIS IS NOT TO SAY THAT ALL
PEOPLE WHO HAVE PREGNANCY, ARE
WOMEN AND FAST FORWARD TO
LIMITATIONS AND HOW WE CAN BE
MORE GENDER INCLUSIVE IN GENDER
IDENTITY IN PREGNANCY RESEARCH.
SO AROUND 2025% OF THE U.S.
FEMALE PRODUCTIVE POPULATION CAN
BE CATEGOR EYED TO SEXUAL
MINORITY.
WE KNOW THE SIZE OF THIS
POPULATION IS GROWING AMONG
YOUNGER COHORTS.
AND SOME OF THE PIONEERING WORK
BY DR. LISA DIAMOND WHO JUST
SPOKE BEFORE ME AND MY COLLEAGUE
SHOWS US THAT IT'S FLUID ISSUES
IT'S MULTIDIMENSIONAL, IT'S
DYNAMIC AND CHANGES OVER TIME.
SO DEPENDING ON THE DAT SET YOU
ARE LOOKING AT, I FOUND IN THE
DATA I USED TO 20% OF THE FEMALE
MOPPULATION REPORTS IDENTITY
CHANGES IN THEIR SEXUAL
ORIENTATION OVER TIME AND AT
LEAST 1 AND WHEN YOU LOOK AT
POPULATIONS OF SEXUAL MINORITY
WOMEN THAT 50% OF THAT
POPULATION WILL REPORT AT LEAST
1 CHANGE IN THEIR SEXUAL
ORIENTATION IDENTITY OVER TIME
AND THIS FLUIDITY IS NOT JUST
EMILYED IN CHAIMPLES IN IDENT I
BUT IT'S ALSO RELATED TO THE
GENDER OF PARTNERS, SO
NATIONALLY REPRESENTATIVE DATA
SUGGESTS THAT 80% OF THE
BISEXUAL WOMEN AND 25% OF
LESBIAN WOMEN REPORT HAVING HAD
SEX IN WITH A MAN IN THE PAST 12
MONTHS.
SO IN 2012 I WAS AWARDED AN NIH
BELLING FELLOWSHIP, WHEN I GOT
IT I WAS SURROUND BIDE OBGYN AND
THEY WERE TALKING ABOUT
PREGNANCY AND PREGNANCY RISK AND
IT GOT ME THINKING ABOUT SEXUAL
ORYEBTATION AND FLUIDITY AND
OPPORTUNITIES FOR PREGNANCY THAT
I SHOULD TECH OUT WHAT EXISTED
AND WHAT I FOWNTD WAS BASICALLY
2 STREAMS OF RESEARCH.
THE FIRST FOCUSED ON
TECHNOLOGIES ON LESBIAN WOMEN
WITH SAME SEX PARTNERS AND THE
WAY I THOUGHT ABOUT THOSE 2
LINES OF RESEARCH MATCHED UP
WITH TRADITIONAL MODELS OF
SEXUAL ORIENTATION DEVELOPMENT
THAT PIONEERS IN THE 80S AND 90S
THAT SUGGESTED IT DIDN'T IN
ADOLESCENCE, THERE'S AN EXPECTED
AMOUNT OF EXPERIMENTATION THAT
HAPPENS AS PEOPLE ARE SORT OF
TRYING TO SOLIDIFY SEXUAL
ORIENTATION AND YOU WOULD SEE A
RISK FOR TEEN PREGNANCY THEN BUT
BY THE TIME THESE KIDS GROW UP
THEY TURN INTO 100% EXCLUSIVELY
LESBIAN WOMEN WHO ARE ONLY
PARTNERED WITH OTHER WOMEN AND
THE ONLY WAY THEY WOULD GET
PREGNANT WOULD BE IN THE SORT OF
HYPER PLAN CONTEXT.
THIS DIDN'T MATCHUP SO WITH
COLLEAGUES WE THOUGHT TO
COMPLICATE THIS.
WE WERE INTERESTED IN A FEW
THINGS, 1, WHAT ABOUT BISEXUAL
WOMEN, THEY WERE COMPLETELY
EXCLUDED FROM THESE 2 STREAMS OF
RESEARCH.
ALSO,LE MOTHERS, SO WOMEN WHO
ARE NOT PARTNER WIDE ANYBODY ARE
NOT CAPTURED IN THOSE LEVEL DATA
SETS AND ALSO SEXUAL 9ORITY
WOMEN WHO ARE PARTNER WIDE MEN.
SO WE PUBLISHED STUDIES USING
THE NATIONAL SURVEY FAMILY
GROWTH.
SO THIS FIRST 1 WE LOOK AT
WHETHER SEXUAL MINORITY WOMEN
RECEIVED SEXUAL AND REPRODUCTIVE
HEALTHCARE COUNSELING IN
CLINICAL SETTINGS AND WE FOUND
THAT BISEXUAL AND WOMEN WERE
LESS LIKELY TO REPORT STIs,
CONCONDUSE, RELACES AND THAT
HELD IF THEY HADN'T SEX WITH THE
MAN IN THE PAST 12 MONTHS.
WE THEN LOOKED AT
SECURITIZATION.UAL ORIENTATION
DISPARITIES AND TIME ON UNWANTED
PREGNANCIES AMONG WOMEN, SO WE
USE IT AGAIN AS SEXUAL
ORIENTATION LOOKING AT COUPLE
STATUS AND WE FOUND THAT IN
ADULTHOOD, SO MOVING OUT OF THIS
PERIOD OF ADOLESCENT
EXPERIMENTATION THAT SOME CITIES
CLASSIFY THIS AS, WE FOUND THAT
BISEXUAL AND LESBIAN WOMEN WERE
CHARACTERIZED THEIR PREGNANCY AS
MISTIMED OR UNWANTED COMPARED TO
HETEROSEXUAL WOMEN.
AND FINALLY WE WERE INTERESTED
IN, OKAY, WE KNOW THAT
CONTRACEPTIVE CARE COUNSELING
ISN'T HAPPEN, WE KNOW THAT
MISTIMED AND UNWANTED
EGULATION--REGULATORY
PREGNANCIES ARE HAPPENING AND WE
KNOW FROM THE BROADER LITERATURE
ON SEXUAL ORIENTATION AND HEALTH
BEHAVIORS THAT THERE COULD BE A
WHOLE HOST OF POTENTIAL PRENATAL
RISK FACTORS THAT ARE SETTING
THESE WOMEN UP TO HAVE POOR
PREGNANCY OUTCOMES.
SO USING THAT NATIONAL SURVEY
FAMILY GROWTH AGAIN, WE FOUND
THIS WAS INDEED THE CASE THAT
BISEXUAL AND LESBIAN WOMEN WERE
MORE LIKELY TO HAVE PREGNANCIES
THAT WERE PRETERM, LOW BIRTH
WEIGHT AND MORE LIKELY TO HAVE
MISCARRIAGES AND STILL BIRTH
INFANTS.
SO, WE THEN WANTED TO KNOW,
WELL, ONCE WE'VE GOT THESE
DISPARITIES DOCUMENTED, WHAT
WILL WE DO ABOUT IT, WHAT ARE
THE MECHANISMS AND THE PROBLEM
WITH NATIONAL SURVEY OF GROWTH,
WHILE IT WAS 1 OF THE FIRST
REPRODUCTIVE HEALTH STUDIES TO
INCORPORATE MEASURES OF SEXUAL
ORIENTATION, THE WAY THE DATA
STRUCTURE IS SET UP IS THAT AT
THE TIME OF INTERVIEW, WOMEN ARE
ASKED THEIR SEXUAL ORIENTATION
IDENTITY AT THE TIME OF
INTERVIEW AND ALL PREGNANCY
HISTORIES ARE RETROSPECTIVE SO.
WE CAN'T BE SURE THAT THE SEXUAL
IDENTITY MEASUREDDA THE TIME OF
THE VIEW, MATCHES AT THE TIME OF
PREGNANCY ESPECIALLY GIVEN WHAT
WE KNOW ABOUT SEXUAL FLUIDITY IN
THIS POPULATION, THE SECOND
THING IS WE GET GET AT PRENATAL
OR PERINATAL, CAN THESE INFANCY
AND OUTCOMES BECAUSE THE HEALTH
BEHAVIORS ARE ALSO ASKED THE
TIME OF INTERVIEW, AND WE KNOW
THAT PREGNANCY AND PARENTS
CHANGE AMONG BEHAVIORS IN WOMEN
SO WE COULD NOT GET THAT CORRECT
TIME ORDERING HAPPENING THERE.
SO I ASKED NICHD, VERY NICELY TO
GIVE ME SOME MONEY TO STUDY THIS
USING THE NATIONAL LONGITUDINAL
STUDY OF ADOLESCENT TO ADULT
HEALTH WHICH IS NOT BUT FOR
BEFFITY SAKE I WILL LEAN ON THAT
SO THE REASON WHY WE ASKED TO
USE THE NATIONAL LONGITUDINAL
STUDY OF ADOLESCENT TO ADULT
HEALTH IS A FEW REASONS, 1 THE
DATA SET IS LONGITUDINAL SO
WE'RE ABLE TO GET AT THAT DIRECT
TIME ORDERING ISSUES, IT STARTED
IN 19, AND 95, IT'S A POPULATION
SAMPLE OF MIDDLE SCHOOLERS AND
HIGH SCHOOLS WHO HAVE BEEN
FOLLOWED UP FOR 2 DECADES NOW, I
THINK WAVE 6 IS IN THE FIELD
BEING COLLECTED.
IT ASKS MEASURES OF SEXUAL
ORIENTATION IN MULTIPLE WAVES
AND IT ALSO ASKED A VARIETY OF
HEALTH BEHAVIORS AND PREGNANCY
OUTCOMES.
SO THE SAMPLE HERE IS, SINGLETON
LIVE BIRTHS, WE USE THE
PREGNANCY ROSTER INFORMATION
FROM WAVES 4 AND 5 ASK WHAT WE
DID IS BECAUSE YOU HAVE ALL
THESE WAVES OF SURVEY DATA
COLLECTION AND YOU HAVE THE DATE
OF THE BIRTH, CAN YOU SORT OF
PLOP BABIES INTO AN INDIVIDUAL'S
LIFE COURSE AND LOOK AT THE
RELATIONSHIP BETWEEN THEIR
BEHAVIORS BEFORE AND POTENTIALLY
AFTER.
OUR OUTCOME VARIABLES THAT I
WILL SHOW YOU ARE PRENATAL
BIRTH, AND THE MATERNAL HEGHT
CONDITION I WILL SHOW IS
MATERNAL HYPERTENSION, THE
INDEPENDENT VARIABLE HERE IS
SEXUAL IDENT IITY PRIOR TO
BIRTH, SO AGAIN BECAUSE WE HAVE
TO USE THE TIME ORDERING ISSUE,
WE ARE ABLE TO USE THE SEXUAL
ORIENTATION REPORTED CLOSEST AT
THE TIME OF BIRTH, WE WE'VE DONE
A BUNCH OF SENSITIVITY ANALYSIS
LOOKING THERE, AND CLOSEST AS
OPPOSE TO PRIOR, AND TO THE
RESULTS ARE LARGELY ROBUST TO
ALL OF THESE DIFFERENT
SPECIFICATIONS.
AND IMPORTANTLY IN 2019, THEY
RELEASED THE SUPPLEMENTAL
CONTEXTURAL FILE THAT ADDED
THESE 4 LGB SPECIFIC POLICIES,
TO THE DATA SET AT WAVES 3 AND
4.
SO ALL OF OUR BIGGERS HAPPEN
AFTER WAVE 3 OF DATA COLLECTION
SO WE'RE NOT INCLUDING TEEN
PREGNANCIES IN IN DATA SET BUT
EVERYTHING THAT HAPPENED, ALL
THE WEBS THAT HAPPENED AFTER
THAT HAVE 3.
AGAIN BECAUSE OF THIS
LONGITUDINAL DATA STRUCTURE
WE'RE ABLE TO CONTROL FOR A
VARIETY OF PRECONCEPTION AND
PERRY NATAL CO VARIANTS IN OUR
MODELS AND A NUMBER OF CONTROLS.
SO THE REEL KEEPSAKES SULTS I
WILL SHOW YOU ARE FROM RANDOM
EFFECT MODELS TO EFFECT CLUSTERS
TO A SINGLE PERSON AND THEY
ACOULD YOU WANT FOR COMPLEX
SAMPLING FRAME.
SO THE FIRST SET OF RESULTS WAS
PUBLISHED LAST YEAR, AND THESE
WERE LOOKING AT STATE LEVEL
REGULATIONS, POLICIES AND BIRTH
OUTCOMES SO WHAT YOU'RE SEEING
HERE IS 2 MODELS SHOWING IN
STATES WHERE THERE WAS 0
PROTECTION, WE SAW HIGHER RISK
OF PRETERM BIRTH AMONG LESBIAN
WOMEN COMPARED TO BOTH
HETEROSEXUAL AND FIGURE 1 AND
BISEXUAL IN FIGURE 4 THERE AND
WE SEE ALMOST NO EFFECT OF THE
POLICIES AMONG HETEROSEXUAL OR
BISEXUAL WOMEN.
IMPORTANTLY IF YOU LOOK DOWN AT
THE STATE'S WHERE THERE ARE 3 OR
MORE PROTECTIONS IN PLACE, WE
SAW THAT THERE'S ACTUALLY
PROTECTIVE EFFECTS, SO THAT
LESBIAN WOMEN WERE ACTUALLY LESS
LIKELY TO HAVE A PRETERM BIRTH
IN THOSE HIGHLY PROTECTIVE
ENVIRONMENTS.
AND WE SEE THE SAME EFFECT HERE
FOR PREDICTED BIRTH WEIGHT.
SO IN STATES WHERE THERE'S 0
PRACTICES TEKS, WE SEE LESBIAN
HAVE LOWER RATE INFANTS AND AS
THEY GO UP, THEY ACTUALLY LOOK
SIGNIFICANTLY BETTER THAN
HETEROSEXUAL WOMEN.
THIS NEXT SET OF RESULTS USING
POLICY INDICATORS WERE PUBLISHED
JUST IN JANUARY IS OF THIS YEAR
AND THEY'RE LOOKING AT THE
PREDICTED PROBABILITY OF
MATERNAL HYPERTENSION AND THIS
TIME WE ALSO STRATIFIED BY RACE
ETHNICITY HERE AND WHAT WE FOUND
IS THAT, FOR ALL WHITE WOMEN,
REGARDLESS OF THEIR SEXUAL
ORIENTATION, PROTECTIVE
POLICIES, LGB POLICIES WERE
ASSOCIATE WIDE THE DECREASED
RISK OF MATERNAL HYPERTENSION,
BUT THAT AMONG PLAQUE WOMEN, THE
BENEFITS OF THIS POLICY WERE
REALLY CONCENTRATED AMONG QUEER
WOMEN OF COLOR.
AND FINALLY THE LAST BIT OF
EVIDENCE I WILL SHOW YOU COMES
FROM A SET OF RESULTS THAT ARE
CURRENT LOAMACYY UNDER REVIEW
RIGHT NOW BUT THIS IS LOOKINGA
THE PRENATAL CARE IN THE FIRST
TRIMESTER AND SO WHAT YOU CAN
SEE IS THAT IN STATES AGAIN WITH
YOUR PROTECTION, WE SEE NO
DIFFERENCE BUT SLIGHTLY LOWER
POINT ESTIMATES FOR SEXUAL
MINORITY WOMEN RECEIVING
PRENATAL CARE IN THE FIRST
TRIMESTER AND AS THESE POLICIES
INCREASED AND THEY ACTUALLY LOOK
BETTER IN TERMS OF ACCESSING
PRENATAL CARE THAN THEIR
HETEROSEXUAL PEERS.
SO I THINK THERE ARE A FEW
IMPORTANT TAKE AWAYS FROM THIS,
THE FIRST IS THAT THESE FINDINGS
CONTRIBUTE TO EVIDENCE THAT
MACROFORMS OF STIGMA AND
DISCRIMINATION NEGATIVELY IMPACT
HEALTH OUTCOME AND THIS IS
REALLY IMPORTANT IN PART BECAUSE
PREGINANCE SESUCH A UNIQUE STATE
IN TERMS OF ITS IMPLICATIONS FOR
INTERGENERATIONAL HEALTH THAT
LISAA ALLUDED TO EARLIER, BUT
ALSO THE LONG-TERM HEALTH OF THE
PREGNANT PERSON.
WE KNOW THAT THERE IS JUST THE
BEGINNING OF LITERATURE AROUND
HOW PRETERM BIRTH AND LOW BIRTH
WEIGHT IN INFANTS IMPACT WOMEN'S
FUTURE CARDIO VASCULARY HEALTH
AND THAT'S SOMETHING I HOPE I
CAN CONTINUE TO STUDY.
THE SECOND REALLY IMPORTANT
THING TO TAKE AWAY IS THAT THESE
RESURVEYSS MODIFY POLICIES FOR
SEXUAL WOMEN AND NOT ONLY CAN
THEY REDUCE THESE RISKS BUT THEY
CAN RESULT IN POTENTIAL BETTER
OUTCOMES THAN HETEROSEXUAL WOMEN
SO WE HAVE THE OPPORTUNITY TO
FLIP THIS SCRIPT AND LOOK AT,
WHAT QUEER WOMEN A STIGMATIZED
GROUP ARE DOING IN THESE STATES
WHERE THEY'RE PROTECTED THAT,A
LOW THEM TO THRIVE IN A WAY THAT
THEY'RE ACTUALLY HAVING BETTER
OUTCOMES THAN THEIR HETEROSEXUAL
COUNTERPARTS.
AND FINALLY, IT'S IMPORTANT TO
REALLY KEEP IN MIND THAT, WE'RE
GETTING ALL THESE REALLY
COMPELLING SETS OF RESULTS ABOUT
HOW POLICIES IMPACT INDIVIDUAL
HEALTH FOR SGM POPULATIONS AT
THE SAME TIME AS WE'RE SEEING
THIS INCREASING NUMBER OF
POLITICAL ATTACKS ON LGBTQ
PERSONS AND REPRODUCTIVE REETS
AND AS MORGAN ALLUDED TO
EARLIER, WE HAVE IN OTHER PLACES
MADE THE ARGUMENT THAT THE
ATTACK ON FAMILY PLANNING AND
ACCESS TO,A BORGZ ARE HEIGHTLY
RELATED TO THOSE IN LGBTQ
POPULATION AND THEY MAY BE PART
OF A LARGER WHAT WE CALL
STRUCTURAL HETEROPATRIARCHAL
SYSTEM THAT ENFORCES A WHITE
MALE SEXIST RACIST POLITICAL
AGENDA.
SO LIMITATIONS AND FUTURE
DIRECTIONS SO IN ADD HEALTH
THERE ARE NO GENDER IDENTITY AT
THIS TIME.
IT WAS ONLY MEASURED AT WAVE 5
FOR THE FIRST TIME WHICH IS
GREAT BUT AT WAVE 5 WE FOUND
THERE WERE NO PREGNANCY REPORTED
TO INDIVIDUALS WHO IDENTIFIED AS
MEN AND WE ONLY HAD 17
PREGNANCIES RELATED TO PEOPLE
WHO IDENTIFIED AS OTHER OR
MISSING GENDER IDENTITY AND WE
DIDN'T WANT TO INCLUDE THIS
GROUP AND MAKE STATISTICAL
CLAIMS ABOUT THEM GIVEN THAT
THIS SAMPLE SIZE IS SO SMALL AND
THAT OTHER ARE REALLY MEANINGFUL
CATEGORIES FOR US TO MAKE GOOD
ASSERTIONS.
BASED UPON THIS WORK AND THE
WORK THAT MYSELF AND OTHER
COLLEAGUES HAVE DONE, THERE'S NO
REASON FOR SGM MEASURES TO BE
LEFT OFF ANY SURVEY, ESPECIALLY
REROUGH ATOM DUCTIVE HEALTH
SURVEYS AND IT'S BEEN REALLY
DIFFICULT IN THIS FIELD TO GET
THESE GOOD MEASURES, OF SEXUAL
ORIENTATION OR GENDER IDENTITY
ON REPRODUCTIVE HEALTH SURVEYS
BECAUSE OFTEN TIMES PEOPLE IN
THE FIELD OF OBSTETRICAL AND
GUIN COALING THEY DON'T THINK OF
THEIR PATIENTS AS BEING SEXUAL
MINORITY UNLESS THEY'RE WORKING
SORT OF WITH SAME SEX COUPLES
WHO ARE TRYING TO GET PREGNANT.
I AM HAPPY TO SAY THAT MY CLIEG
BRITDNY CHARLTON AND I WE PUT IN
AN APPLICATION FOR PRAMS TO
INCLUDE SGN MEASURES AND THEY
WERE INCLUDED AS AN OPTIONAL
MEASURE FOR STATES TO ADD IN THE
NEW ROUND OF PRAMS DATA SO
HOPEFULLY ALL STATES WILL KNOW
ELECT TO INCLEEZ THESE SGM
MEASURES OR EVEN HALF WE WOULD
BE VERY, VERY HAPPY AND FINALLY,
YOU THINKING AGAIN ABOUT THESE
INTERSENSIONAL APPROACHES, HOW
DO WE MEASURE THEM WITH
STRUCKURAL RACISM AND MOVING
FORWARD I THINK IT WILL BE
SOMETHING REALLY, REALLY
IMPORTANT AND SOMETHING I'M
TRYING TO THINK ABOUT AND LEARN
FROM OTHERS AND WITH THAT I WILL
END.
THANK YOU SO MUCH FOR THE
SUPPORT, OF NICHD AND MY
COLLEAGUES AND ADD HEALTH.
>>THANK YOU SO MUCH DR. REF
RETINAL LOCATION, GREAT TALK AND
NOW WE HAVE A NUMBER OF
QUESTIONS FROM THE VIDEOCAST
AUDIENCE AS WELL AS
DR. MUSTANSKI, DO YOU WANT TO
ASK YOUR QUESTION?
IS DR. MUSTANSKI STILL ON?
MAYBE NOT.
OKAY, I WILL ASK HIS QUESTION.
SO HIS QUESTION IS FOR
DR. DIAMOND, HAS THE QUESTION OF
MATURITY, RISK TAKING, BEEN
STUDIED SPECIFICALLY IN SGM
POPULATIONS, GIVEN THE SOAKERS
SGM IDENTIFIES AND EARLY
ADVERSITY THERE COULD BE SOME
CONFOUNDING RELATIONSHIPS THAT
WOULD BE RESOLVE INDEED IN SGM
YOUTH.
>>IT HASN'T BEEN STUDIED, THIS
IS 1 OF THOSE THINGS WHERE
THEY'RE SILOED AND A LOT OF WORK
ON EARLY ADVERSITY AND
EVOLUTIONARY DEVELOPMENTAL
PARADIGMS IS NOT REALLY EVEN
FOCUSED ON SGM POPULATIONS AT
ALL.
IS
--AND SO THAT'S A BIG
MISUNDERSTANDING.
WE DO KNOW THERE'S HUGE
DIVERSITY AT WHICH THE TIME
YOUTH SELF-IDENTIFY AS SEXUALLY
GENDER DIVERSE AND IN GENERAL
THE AGES HAVE BEEN GETTING
YOUNGER AND I THINK THAT YOU CAN
JUST BLAME THE INTERNET.
YOU KNOW?
I THINK TO SOME DEGREE IT IS AN
AMAZING TRANSFORMATION IN OUR
WORLD THAT NOW EVERY ADOLESCENT
LIKE ON THE PLANET CAN LOOK AT
THE SEXUAL AND GENDER EXPRESSION
OF FAR FLUNG INDIVIDUALS INSTAIN
TAINIOUSLY CHEAPLY AND PRIVATELY
AND THAT HAS RADICALLY CHANGED
THE CLIMATE FOR
SELF-IDENTIFICATION AND 1 THING
I THINK WE NEED TO TAKE INTO
ACCOUNT WHEN WE DO THESE BIG
NATIONAL STUDIES AND THAT WE
NEED TO TREAT THE TIMING OF
SMART PHONE USE AND SOCIAL
MEDIA, WE NEED TO TREAT THAT AS
A HISTORICAL MARKER BECAUSE, WE
ALREADY DIDN'T KNOW VERY MUCH
ABOUT WHY SOME KIDS COME OUT
EARLY AND OTHERS KIDS DON'T AND
THEN WE HAD THIS HUGE
TRANSFORMATIVE TECHNOLOGICAL
EEIVET THAT IS REALLY A BRAIN
ISHT VENTION IN TERMS OF SEXUAL
AND GENDER IDENTITY DEVELOPMENT
AND WE NEED TO MAKE SURE THAT
MEN WITH HIGHER WE'RE COMPARING
SAMPLES AFTER THAT TIME TO
SAMPLES BEFORE, THAT IS A
HISTORICAL CHANGE TO INTEGRATE
INTO THE MODELS.
>>GREAT.
OKAY SO THERE'S A MESSAGE FOR
DR. PH ILBIN, CAN YOU SPEAK TO
THE NEEDS AND BARRIERS FOR LGBTQ
+ INCLUSIVE POLICIES OR WHERE
MORE INTERVENTION SHOULD BE
FOCUSED FOR EXAMPLE, PARENT
ACCEPTANCE, COMMUNITY NORMS,
SCHOOL STAFF, PROFESSIONAL
DEVELOPMENT, ET CETERA.
>>YEAH, THE SHORT ANSWER IS ALL
OF IT AND ANYTHINGEE CAN GET AND
I DON'T MEAN THAT TO BE GLIB BUT
I LEGITIMATELY MEAN WE HAVE TO
COME AT THIS FROM ALL SIDES.
IT'S SO OBVIOUS HE ON MUCH THE
VERY EXISTENCE PARTICULARLY OF
TRANSPEOPLE AND UNDER ATTACK IN
THE MAJORITY OF THE STATES IN
THE U.S., I THINK THERE IS A
DIFFERENCE BETWEEN CHIPPING AWAY
AT RIGHTS AND ACTUALLY TRYING TO
FUNDAMENTAL ERASE A GROUP OF
PEOPLE AND THAT IS WHAT IS
HAPPENING RIGHT NOW I THINK WE
HAVE TO KEEP PUSHING AT THE
POLICY LEVEL, THAT GOING TO BE
REALLY HARD, I DON'T HOLD OUT A
LOT OF HOPE THAT SOUTH DAKOTA OR
LOUISIANA OR NARRATIVE REVIEW
FLOOR IS GOING --OR FLORIDA IS
GOING TO DO ANYTHING ANYTIME
SOON SO WE NEED TO THINK ABOUT
WHERE WE CAN ENGAGE, I THINK
ABOUT OKAY IF WE CAN'T GET THE
STATE TO CHANGE THEN MAYBE MIAMI
FT. LAUDERDALE AND TAMPA CAN
FIND WAY TOTS CREATE FOLKS--THIS
SEES THAT WILL BUFFER WHAT'S
HAPPENING AND/OR MAYBE THE COOLS
CAN CREATE CLIMATES TO DO IT AND
I THINK TO WORK WITH PARENTS AND
HOPEFULLY MAYBE FROM THE
CLINICIANS TO START FINDING WAYS
TO SUPPORT STUDENTS AND MAKING
SURE PARENTS AND FOR SOME OF
THEM THAT HAVE THE MEANS I THINK
THIS FARE TALKING ABOUT IF THAT
MEANS THEY ARE MOVING OUT OF
STATE TO GET THE CHILDCARE THEY
NEED, THEN THAT'S WHAT HAPPENS,
IT'S NOT IDEAL BUT I THINK IT IS
SOMETHING THAT WE REALLY HAVE TO
COME AUGHT FROM ALL LEVELS AND
THAT'S WHY JUST TO MAKE A PLUG,
IT'S SO IMPORTANT THAT WE HAVE
THE DATA TO PROVE THIS AND LIKE,
I KNOW I KEEP HARPING ON FLORIDA
BUT THEY JUST PULLED OUT OF THE
IRBS, SO WE WON'T BE ABLE TO
TRACK PEOPLE, AND SOW NOW WE
NEED TO MAKE SURE THROUGH THE
GRANTS THAT WE HAVE THE DATA TO
SHOW OVERTIME HOW THESE POLICIES
IMPACT THE "LIKE" US ON
FACEBOOKS OF MINORITIZED
INDIVIDUALS.
SO I WOULD SAY ANY AND ALL
EFFORTS WE HAVE TO MUSTER.
>>YEAH, SO THERE'S A MESSAGE IS
FOR DR. DIAMOND FROM THE
VIDEOCAST AUDIENCE, I HAVE
FASCINATING PRESENTATION, WHEN
THINKING OF EEIVETS ON
MATURATION AS A RESPONSE TO
ADVERSITY, IT MAKES ME THINK OF
SUCH EMOTIONAL MATURATION,
THINGS LIKE SOCIAL AWARENESS,
SELF-REGULATION, EMPAPGHTY,
OFTEN TALK ABOUT AS POSITIVE
ASPECT BUT MAY ALSO BE
MANIFESTING OUT OF IDENTITY
CONCEALMENT AS ASHES DATA
PROTECTIONATION TO ADVERSITY CAN
YOU SPEAK TO THE INTERSECTION OF
THESE PROTECTIVE FACTORS AND
POSITIVEAZ LESSENT DEVELOPMENT
AND MENTAL WELL BEING?
>>I REALLY APPRECIATE THAT
QUESTION, I THINK THE SINGLE
BIGGEST MOST IMPORTANT
PROTECTIVE FACTOR AND THAT
LUCKILY ALL OF US CAN SORT OF
PULL THAT LEVER IN OUR OWN LIVES
AND INNS TUITION SYSTEM WHAT I
CALL SOCIAL SAFETY WHICH IS
UNCONDITIONAL SOCIAL CONNECTION
AND PROTECTION FROM THOSE AROUND
YOU AND I THINK FOR YOUTH, THAT
IS DEVELOPMENTALLY CRITICAL.
OUR SOCIAL BRAINS WERE DESIGNED
TO DEVELOP IN A SOCIALLY SAFE
ENVIRONMENT BECAUSE HUMANS ARE
SOCIAL, WE NEED OTHER PEOPLE
PROTECTING US, AND SO, A LOT OF
THE HEALTH OUTCOMES THAT WE HAVE
HISTORICALLY TRIBUTED TO STRESS
ARE EQUALLY ATTRIBUTABLE TO THE
ABSENCE OF NUTTURING
UNCONDITIONALLY PROTECTED SOCIAL
TIES.
AND THAT GOES, THAT'S
MULTILEVEL.
INSTITUTIONAL DISCRIMINATION,
WHAT IS THE SOCIETY FOR IF NOT
PROTECTION?
AND YET THAT PROTECTION IS
UNEQUALLY DISTRIBUTED.
SO, 1 OF THE THINGS THAT WE CAN
DO TO SORT OF FOSTER RESILIENCE,
BECAUSE THE BRAIN KNOWS HOW TO
HEAL, THE BRAIN KNOWS HOW TO
ADAPT, BUT WHAT IT NEEDS TO DO
THAT IS SAFETY IN THE IMMEDIATE
ENVIRONMENT.
I THINK SHIPPING THE
CONVERSATION AROUND PARENTAL
ACCEPTANCE, TO SAFETY, TO HEY,
MOM AND DAD, WHEN YOU LOOK AT
YOUR CHILD AS IF THEY'RE
DISGUSTING, YOU MAY NOT THINK
YOU'RE HITTING THAT HIELD BUT
THAT IS COMMUNICATING A LACK OF
SAFETY AND THAT IS GOING TO
PREVENT THE DEVELOPMENT OF
RESILIENCE.
IN THE SCHOOL SYSTEM, IS THERE A
PLACE WHERE--IS THERE A TEACHER,
IS THERE A COUNSELOR WHERE THE
KID FEELS THAT NO MATTER WHAT
HAPPENS, THAT DOOR IS OPEN TO
ME.
IN THE HEALTHCARE SYSTEM, I
THINK INSTITUTIONS THAT ARE
NORMALLY SUPPOSED TO PROVIDE
CARE, HEALTHCARE SYSTEMS,
RELIGIOUS INSTITUTIONS, SCHOOL,
WHEN THEY FAIL TO COMIEWPICATE
UNCONDITIONAL SAFETY, THAT'S
ACTUALLY AN ADDITIONAL FORM OF
TRAUMA AND IT'S CALLED SANCTUARY
TRAM.
THE REQUESTED IF YOU HAVE A
SYSTEM WHOSE ONLY PURPOSE IS TO
PROTECT YOU AND THEY DON'T, IT'S
A DOUBLE HIT TO THE SYSTEM AND
SO FINDING WAYS TO UP KIDS,
FEELINGS OF SOCIAL SAFETY AND
CONNECTION, AT SCHOOLS, AT HOME,
IN THE COMMUNITY, FINDING WAYS
TO FILL IN THOSE GAPS AT
MULTIPLE LEVELS, THOSE SORTS OF
PROTECTIVE EFFECTS, ALLOW THE
BRAINS EMPATHY CONNECTION TO
THEM TO THEN COME ONLINE AND
DRIVE THEM.
>>GREAT, THANK YOU.
DR. LENARES, YOU HAD A QUESTION
FOR DR. DIAMOND.
>>SURE.
THANKS DR. DIAMOND AND THANKS
FOR THE WHOLE PANEL FOR
INTERESTING PRESENTATIONS.
THE QUESTION I HAD FOR
DR. DIAMOND WAS WHAT MIGHT BE
KEY LIFE STAGES OR TIME POINTS
FOR INTERVENTION TO REDUCE THE
EFFECTS OF THE STRESS OR TRAUMA
AS YOU DISCUSSED ON THIS
POPULATION AND PERHAPS IMPROVE
WELL BEING?
>>I THINK THE PERIOD AROUND THE
PIEWBITTAL TRANSITION IS A HUGE
1 AND IT'S AN OBVIOUS 1, RIGHT?
EVERYONE KNOWS THAT HIGH SCHOOL
AND BLAH, BLAH, BLAH BUT THAT IS
ESPECIALLY FOR THE SOCIAL PARTS
OF THE BRAIN, THAT IS WHEN YOU
ARE SENSITIVITY TO SHAME AND
REJECTION DIALS UP TREMENDOUSLY
WHICH IS WHY WE'RE SEEING ALL OF
THESE ALARMS DAILY BASIS THEA
ABOUT THE MENTAL HEALTH EFFECTS
OF SOCIAL MEDIA USE.
SO DURING A PERIOD OF BRAIN
DEVELOPMENT, WHERE THE BRAIN IS
VERY SOCIALLY SENSITIVE, IF YOU
ARE COMING INTO AN AWARENESS OF
BEING DIFFERENT AND BEING IN A
SHAMED AND STIGMATIZED GAT GORY
AT THAT TIME IT CAN BE A WORST
CASE SCENARIO BECAUSE YOUR BRAIN
IS MORE SENSITIVE TO THAT AND
THE ANTIDOTE IS CONNECTION,
CONNECTION, CONNECTION, IN REAL,
NONAPOPTOTIC THE ON MEDIA, LIKE
REAL PEOPLE IN THE SCHOOLS, I
FEEL LIKE EVERY SINGLE
ELEMENTARY AND HIGH SCHOOL NEEDS
A TRAUMA INFORMED MENTAL HEALTH
PROFESSIONAL WHO KNOWINGS HOW TO
RECOGNIZE THE SIGNS OF COMPREKS
TRAUMA WHO IS MY DOOR'S ALWAYS
OPEN, THERE'S NO TIME OF DAY YOU
CAN'T FIND ME, THAT'S THE BEST
WAY TO FORESTALL SOME OF THE
VULNERABILITY TO HAPPENS AROUND
THE PIEWBITTAL TRANSITION.
>>GREAT.
THANK YOU.
SO I HAVE A QUESTION TO THE
WHOLE PANEL, I GUESS, IF YOU ARE
TO PICK SOME SPECIFIC SOCIAL
DETERMINANTS OF HEALTH, TO
ADDRESS, IN ORDER TO REDUCE
HEALTH DISPARITIES AMONG SEXUAL
AND GENDER MINORITIES WHAT WOULD
THOSE BE AS PRIORITIES?
AND YEAH, I WOULD LIKE EACH OF
THE PANEL MEMBERS TO ANSWER
THAT.
>>I DON'T KNOW HOW TO ANSWER
THAT.
AND IN PART BECAUSE I FEEL LIKE
IN SOME WAYS WE'RE PLAYING KIND
OF WHACK-A-MOLE WITH POLICIES
AND LIKE I ALLUDED TO IN MY TALK
AND MORGAN DID, TOO, THAT THE
ATTACKS ON TRANSPEOPLE ARE ALSO
YOU KNOW THEY'RE INHERENTLY
RELATED TO THE ATTACKS ON CISLGB
PEOPLE AND THE ATTACKS ON
WOMEN'S REPRODUCTIVE RIGHT, THIS
IS ALL KIND OF PART OF THE SAME
AGENDA AND YOU KNOW YOU BOP 1
AND ANOTHER 1 REARS ITS HEAD AND
SO, YOU KNOW TRY TO THINK OF
WHERE DO WEIGH START IN TERMS OF
PICKING 1 POLICY IS REALLY I
HAVE A HARD TIME CPS ABOUT
POSSIBLY WHAT THIS WOULD BE WITH
THIS WHOLE IRPT CONNECTED
SYSTEM, AS DOING HARM SO HA IS A
NONANSWER TO YOUR QUESTION.
>> LI FERS THINKING ABOUT, YOU
KNOW THE MAIN SOCIAL
DETERMINANTS LIKE THE STRUCTURAL
1S LIKE, FOR EXAMPLE,
SOCIOECONOMIC STATUS, RACE
RACISM, DISCRIMINATION, I DON'T
KNOW ALONG THOSE LINES AND YOU
KNOW DIFFERENT POLICIES OR
INTERVENTIONS OR EVEN SOCIAL
DETERMINANTS EVEN THE PROXIMAL
1.
>>I THINK TO BETHANY'S POINT
TOO BECAUSE IT IS SO INNER
CONNECTED IT'S ALSO A QUESTION
TOO OF ARE WE TALKING ABOUT
SURVIVING OR THRIVING?
AND I THINK YES, OBVIOUSLY WE
NEED HOUSING POLICY AND WE NEED
NONDISCROSS EXAMINE NATION AND
EMPLOYMENT AND BUT THAT FEELS, -
IT IS SO BASIC AND THAT IS JUST
ABOUT GETTING BY, THAT'S NOT
ACTUALLY ABOUT LIVING THE LIVES
THAT EVERYBODY DESERVES AND SO,
TRYING TO THINK ABOUT, AND I
WOULD SAY ALSO ABOUT TRYING TO
THINK ABOUT IT IN A WAY
TAKEN--THEY POLICIES, THEY ARE
SYMBOLIC MARKERS OF BELONGING,
LIKE HOW CAN WE SHOW PEOPLE THAT
THEY ARE ALLOWED TO EXIST.
THAT THEY ARE ON IA FUNDAMENTAL
LEVEL THAT CAN YOU GROW UP
KNOWING WHOEVER YOU ARE IS FINE
AND THOSE ARE NOT NECESSARILY
TIED TO A SPECIFIC DETERMINANT
BUT IN SOME WAYS ARE SO
FUNDAMENTAL, I MEAN I THINK TO
DR. DIAMOND'S POINT OF BEING YOU
GROW UP FEELING LIKE YOU HAVE
THAT SECURITY AND I WOULD SAY,
TOO, ALSO MAKING SURE WE DO IT
IN A WAY THAT DOESN'T EXACERBATE
DISPARITIES.
WE WANT TO SUPPORT EVERYBODY BUT
WHAT'S GOING TO HAPPEN IS IT'S
GOING--I MEAN IS IT ALREADY
VERY, VERY DIFFERENT TO BE A
TRANSPERSON OF COLOR IN
CALIFORNIA AND NEW YORK THAN IT
IS IN ALABAMA.
SO MAKING SURE WE ALSO THINK
CAREFULLY ABOUT WHERE TO WORK,
SO THAT WE DON'T DO IT WHERE IT
IS EASIER, NOT THAT IT IS EASY
BUT EASIER, SO AT LEAST START
WITH THE FUNDAMENTALS,A ROUND DO
YOU HAVE A PLACE TO LIVE, DO YOU
HAVE A JOB, DO HAVE YOU FOOD
WHILE MAKING SURE WE ARE
THINKING ABOUT MARRIAGE OR
ADOPTION OR SORT OF LARGER
SOCIAL ISSUES.
>>TO SOME DEGREE, WE CAN GO
BACK TO MASLOW'S HIERARCHY OF
NEEDS AND SELF-PROTECTION IS A
BASIC FUNDAMENTAL RIGHT FOR
HUMANS AND SELF-PROTECTION
INCLUDES SOCIAL JUDGMENT BECAUSE
THE BRAIN IS SOY SENSITIVE TO
THREAT.
SO 1 WAY I SORT OF TRY TO THINK
ABOUT THIS AND YOU KNOW I THINK
ECONOMIC POSITION FOR EACH WOB,
POVERTY SETHE FASTEST WAY TO
ERODE ALL YOUR SOURCES OF
SAFETY.
SAFETY ON THE STREET, SAFETY IN
YOUR HOME.
POVERTY WILL DO IT PRETTY FAST,
BUT I THINK IN TERMS OF LOOKING
AT POLICY APPROACHES, AND
BECAUSE DIFFERENT STATES ARE SO
DIFFERENT, I THINK 1 WAY TO,A
PROACH IT IS TO JUST KEEP IN
MIND THIS LENS OF SAFETY AND
PROTECTION, SAFETY IS A
FUNDAMENTAL HUMAN NEED AND
PROTECTION IS A FUNDAMENTAL
HUMAN THRIVE SO WHEN YOU LOOK AT
THE SOCIAL SAFETY NET, LOOK,
WHERE ARE PEOPLE FEELING
UNPROTECTED.
YOU KNOW?
INABILITY TO ACCESS HEGHT CARE,
INABILITY TO TO HAVE A DOOR YOU
CAN CLOSE AND PROTECT YOURSELF
FROM HARM.
WHERE ARE THE GAPS IN PROTECTION
BECAUSE THE BRAIN WILL CHOOSE
SAFETY EVERY TIME.
SO LOOK AT THE HOLES IN THE
FABRIC THAT WILL LEAVE CHILDREN
AND ADULTS VULNERABLE, FEELING
LEFT BEHIND.
THE WAY I THINK OF THIS IS
THERE'S THIS VAN MORI GUESSON
SONG, SOMETIMES I FEEL LIKE A
MOTHERLESS CHILD.
LIKE THAT FEELING OF SAFETY IS
NO 1'S COMING FOR ME, NO 1 WILL
RESCUE ME, IF I FALL DOWN A
WELL, NO 1 AM COME AFTER ME,
THAT IS THE SORT OF FEELING WE
SHOULD LIKE WEAR IN THESE SOCIAL
POLICY FRAMEWORK ARE PEOPLE
FEELING NO 1 IS INCLUDING ME, I
AM JUST, YOU KNOW, I'M JUST ON
THE GROUND, HOW CAN WE MAKE SURE
THAT EVERYONE WITH THEIR
DIFFERENT INTERSECTIONAL
FORMINGS OF MARGINALIZATION
FEELS THAT SOMEONE IS COMING TO
THEM, IF THERE'S SOME WAY THAT
THEY ARE CONNECTED TO THE WORLD.
>>THANK YOU DR. DIAMOND, YOU
WROTE UP A VERY IMPORTANT POINT
DURING YOUR PRESENTATION ABOUT
HOW CHILDREN, CHILDREN WHO ARE
SEXUAL MINORITIES EXPERIENCE
MORE EMOTIONAL PHYSICAL ABUSE
AND HAVE CAREGIVERS WITH MORE
SUBSTANCE ABUSE AND SO ON.
SO WHAT WOULD YOU SUGGEST IN
TERMS OF HOW DO YOU PROVIDE
SAFETY FOR CHILDREN LIKE, WHO
GROW UP IN HOUSEHOLDS LIKE THAT?
>>I THINK A LOT OF--IN LARGER
CITIES AND I WISH I COULD SPEAK
MORE BROADLY, A LOT OF LARGER
CITIES HAVE FANTASTIC YOUTH
PROGRAMS LIKE WE HAVE 1 MERE IN
SALT LAKE CITY, AND 1 OF THE
THINGS THAT IS REALLY BENEFICIAL
IS THAT THEY PROVIDE
ENVIRONMENTS WHERE SEXUAL AND
GENDER MINORITY YOUTH CAN PLAY,
WHERE THEY CAN DRESS UP, THEY
CAN DO THEIR NAILS, THER CAN GO
TO A PROMULGATE, PLAY IS A
BEHAVIOR THAT HUMANS ONLY BEN
GAUGE IN WHEN THEY FEEL SAFE.
PLAY STOPS AS SOON AS YOU'RE IN
DANGER SO PROVIDING AND PLAY IS
NORMAL FOR THE HUMAN BRAIN,
THAT'S HOW WE LEARN SOCIAL
RULES, THAT'S HOW WE CONNECT, WE
PLAY, WE JOKE, WE TEASE, WE HUG
AND PROVIDING YOUTH SPACES AND 1
THING THAT HAPPENS IS WHENEVER
YOU SET UP THESE SPACES FOR
QUEER YOUTH, HETEROSEXUAL KIDS
COME ALONG TOO BECAUSE THEY FEEL
GOOD, BECAUSE EVEN THE
HETEROSEXUAL KIDS ARE LIKE
REJECTION DOESN'T HAPPEN THERE,
THAT'S LIKE DEFINED AS AN
ANTIGE
ANTIREJECTION ZONE SO PROVIDING
PLACES WITH SAFE AND TRUSTED
ADULTS WHICH IN BIG CITIES CAN
BE HARD, WHERE KIDS CAN BE KIDS
SO THAT EVEN IF THEIR HOME
ENVIRONMENT IS REALLY
PROBLEMATIC THEY HAVE A PLACE
AND WOB OF THE HOACHFUL THINGS
ABOUT THIS RESEARCH IS TO
SUGGEST IF IF YOU LACK SAFETY IN
1 DOMAIN, HAVING A LOT OF IT, IN
ANOTHER, WILL WORK, YOU KNOW
BECAUSE OUR BRAINS ARE LOOKING,
LOOKING FOR THE SAFE PERSON SO
WE IF CAN CREATE THAT AND
SUPPORT THAT AND SAY OUR DOORS
ARE OPEN FROM 7 AMTO MIDNIGHT
AND SOMEONE'S ALWAYS HERE,
SOMEONE'S ALWAYS HERE AND WE
KNOW THAT IN THE SUICIDE
PREVENTION REALM, JUST CHOOT
LINES, ABILITY TO FIND SOMEONE
AT ANY POINT IN TIME WHENEVER
YOU FEEL SAFE, YOU DON'T HAVE TO
ACCESS THAT SERVICE, YOU DON'T
HAVE TO GO TO THE GAY AND
LESBIAN YOUTH CENTER TO KNOW
THAT IT'S THERE AND KNOWING THAT
IT'S THERE IS ACTUALLY JUST AS
PROTECTIVE FOR SOME KIDS.
AND THAT'S GREAT, BUT I THINK
YOU KNOW THIS PLAY APPLY TO
YOUTH BUT I'M TALKING ABOUT
YOUNGER KIDS, WHEN THEIR
BRAINMENT IS HAPPENING AND YOU
KNOW I'M THINKING, YOU COULD
THINK OF SCHOOLS FOR EXAMPLE, OR
KINDERGARTEN AS A PLACE FOR
INTERVENTION, BUT I'M JUST
WONDERING LIKE WHAT'S THE STATE
OF SCIENCE ON THAT RIGHT NOW ARE
THESE GOOD VIERPTS.
>>ONE OF THE MOST OPTIMISTIC
STUDIES I FOUND, 1 THAT SHOWS
THAT EACH REALLY TINY, KINDS OF
LIKE LGBTQ INCLUSION, IN
ELEMENTARY SCHOOL AND 1 TEACH
WHO ARE WORE RAINBOW SOCKS EVERY
DAY THAT HAS DEMONSTRATABLE
EFFECTS EVERY DAY, KID ARE
LOOKING FOR THAT, JUST HAVING IN
A SCHOOL, A PERSON THAT
EVERYBODY KNOWS IS THE SAFE
PERSON, AND HAVING ACTUAL REAL
RELATIONSHIPS, NOT JUST SYMBOLIC
BUT REAL RELATIONSHIPS, AND
MAKING SURE THAT THE STAFF ARE
TRAINED UP AND THAT THE SCHOOL
SYSTEM KNOWS, HEY, WE MAY NOT
THINK THIS IS RELEVANT BECAUSE
THESE KIDS ARE 6 AND 7 YEARS OLD
BUT YOU KNOW WHAT?
THOSE 6 AND 7 YEAR-OLD KIDS
SEEING LGBT INCLUSION, THEY
REMEMBER.
THERE'S 1 STUDY WHERE A KID CAME
OUT AT 13 AND HE ACTUALLY TOLD
THE PEOPLE HE CAME OUT TO AT
SCHOOL, I KNEW IT WOULD BE OKAY
BECAUSE I REMEMBER A COUPLE
YEARS AGO MY TIECHER HAD A
RAINBOW PIN.
SO, EFFORTS TO SIGNAL INCLUSION
CONSISTENTLY AND EVEN FOR
YOUNGER KIDS HAVE REALLY
PROFOUND CENTER FOR EXCELLENCE
ON AGING TO WHY IT WAS GOING ON
WITH FLORIDA IS SO TRAG
ECTOMYOSIN BECAUSE IT'S
LITERALLY GOING IN THE OPPOSITE
DIRECTION.
>>YEAH, SO, I GUESS DR. LI
NARES IS HAS I QUESTION, YOU
GUESS WE ARE PICKING ON FLOWER
FLOOR A LOT TODAY DOCTOR, ARE
YOU STILL ON?
DID EMPLOY.
>>SORTING SIGNALS SORRY, I GOT
MUTED ISSUES IT'S MY QUESTION,
IT'S 1 FROM THE VIDEOCAST.
>>OH, OKAY, SORRY, I THOUGHT IT
WAS FROM YOU.
>>OKAY, SO HOW CAN WE IN THE
FIELD OF PUBLIC HEALTH PRACTICE
[INDISCERNIBLE] QUEER
EXCLUSIONARY DATA WITHOUT
CONTRIBUTING TO QUEER
TRANSERASURE AND SIMULTANEOUSLY
WITHOUT MAKING ASSUMPTIONS ABOUT
QUEER TRANSFOLK THAT WE DON'T
YET HAVE THE EVIDENCE TO STAY
FROM DATA THIS IS ESPECIALLY
WITH WRITING ABOUT PREGNANCY
WHEN DATA ONLY INCLUDES WOMEN
BUT WE KNOW NOT ALL PEOPLE WHO
BIRTH ARE WOMEN.
ANYBODY WOULD LIKE TO ANSWER
THAT?
>>YEAH, I'M NOT SURE WHAT THE
QUESTION WAS IN THERE BUT YEAH,
ABSOLUTELY, WE DON'T HAVE GOOD
MEASURES OF SEXUAL ORIENTATION
OR GENDER IDENTITY IN PREGNANCY
DATA ESPECIALLY.
WITH ADD HEALTH AND THE NATIONAL
SURVEY OF FAMILY GROWTH, LIKE I
SAID YOU HAVE TO BE--YOU HAVE TO
SELECT THE FEMALE FORM OR
WOMAN'S SURVEY SO WE ASSUME THAT
WOMENS WHO ARE SELECTING THAT
SURVEY ARE IDENTIFYING AS WOMEN
BUT THAT'S AN ASSUMPTION THAT
WE'RE MAKING AND THEY HAVE TO
HAVE GIVEN BIRTH TO BE IN THESE
SAMPLES SO THERE IS SOME LEVEL
OF CONFIDENCE THAT THESE ARE
CISWOMEN.
IN THE SAMPLES THAT I'VE USED,
HOWEVER, IF YOU'RE JUST LOOKING
AT MEDICAL RECORDS FOR EXAMPLE,
AND WHERE THEY'RE NOT SELECTING
FOR A FEMALE SURVEY OR SOMETHING
LIKE THAT, IT'S POSSIBLE YOU GET
A DIVERSITY OF GENDER IDENTITIES
IN THAT DATA, AND MAKING THE
ASSUMPTION THAT ALL THE PEOPLE
IN THAT DATA ARE HETEROSEXUAL
CISWOMEN IS REALLY PROBLEMATIC
EMPLOY THE ONLY THING I THINK OF
THAT HAS TRIED TO LOOK AT SOME
OF THESE USING A PROBABILITY
DACED BATTA SET IS 1 THAT CAME
OUT OF CALIFORNIA, THEY USED
BIRTH DERSIEVEICATE DATA BECAUSE
CALIFORNIA ALLOWS TO YOU
IDENTIFY THAT YOUR GENDER ON THE
BIRTH CERTIFICATE AND SO THEY
WERE ABLE TO LOOK AT BIRTHING
FATHERS AND BIRTHING MOTHERS AND
AND THE GENDER OF THE PARTNER ON
THE BIRTH DERSIEVEICATE.
AND THIS IS LOOKING AT COUPLE
LEVEL DATA, THEY FOUND THAT
BIRTHING MOTHERS THAT WERE
MARRIED TO OTHER WOMEN HAD
HIGHER RISK FOR MATERNAL
MORBIDITIES AND ADVERSE BIRTH
OUTCOMES BUT THEY FOUND THAT
BIRTHING FATHERS, THERE WAS
EITHER NO DIFFERENCES OR A
DECREASED RISK, SO THEY DIDN'T
SEE IN THE TRANSPOPPULATION OF
PREGNANT PEOPLE THAT ELEVATED
RISK BUT YOU KNOW WE NEED PEOPLE
TO INCLUDE THESE MEASURES ON
REPRODUCTIVE HEALTH SURVEYS LIKE
I SAID FOR THE LONGEST TIME, I
THINK THAT REPRODUCTIVE HEALTH
AND LGBT HEALTH HAVE BEEN SILOED
FROM EACH OTHER AND LGBTQSPAY
RESEARCH HAS NOT THOUGHT ABOUT
PREGNANT PEOPLE AND PREPRO
HEALTH PEOPLE HAVE NOT THOUGHT
ABOUT LGBTQPEOPLE AND SO TRYING
TO BRIDGE THESE FIELDS ITTH IS
REALLY IMPORTANT FOR GETTING
BETTER DATA AND BETTER
ASSUMPTIONS.
>>DO YOU THINK THIS HAS TO DO
WITH HOW YOU COLLECT THE DATA
BASICALLY LIKE YOU FRAME THE
QUESTIONS?
>>I MEAN THE QUESTIONS AREN'T
EVENOT SURVEYS MOST OF THE TIME.
SO IT'S NOT EVEN A POSSIBLE.
BUT THEY'RE STARTING TO INCLUDE,
LIKE THE PRAMS, THE PREGNANCY
RISK AND MONITORING STUDY IS NOW
HAVING GENDER IDENTITY AND
SEXUAL ORIENT AS AN OPTION, THE
MEASURES ARE INCLUDED PRETTY
BRIEF, AND YOU KNOW THEY DON'T
GET IN A LOT OF THE NUANCE OF
GENDER IDENTITIES AND SEXUAL
ORIENTATION THAT WE'VE SEEN ARE
IMPORTANT FOR COLLECTING GOOD
DATA.
SO ARE THERE SOME MEASURES THAT
ARE WELL VALIDATED THAT YOU GUYS
IN THE FIELD WOULD RECOMMEND?
>>YEAH, I MEAN THERE ARE
DEFINITELY WELL VALIDATED GENDER
MEASURES, I MEAN OBVIOUSLY IT'S
CONSTANTLY CHANGING BUT WE DO
HAVE EMPLOY ANDS SO IT'S NOT
THAT WE DON'T HAVE THEM, IT'S
SIMPLY THAT EITHER THEY'RE NOT
PUT IN, DUE TO POLITICAL WILL OR
PEEL ARE AFRAID TO LOOK LONG
NUDEINALLY, I THINK THE YRBS IS
GREAT FOR THIS, THE WAY THEY
ADDED IT WE CANNOT TELL, WE CAN
TELL IF SOMEONE'S TRANSBUOY
DON'T KNOW BECAUSE WE ASK THE
SEX, NOT SEX AT BIRTH SO THAT'S
THE PROBLEM, NOW WE ADDED A
QUESTION WE CAN'T USE IN AN
ACCURATE WAY.
SO I THINK WE HAVE TO BE VERY,
VERY CAREFUL ABOUT WHICH
QUESTIONS WE ADD AND HOW WE DO
IT.
I WOULD ALSO LIKE TO PUT IN A
PLUG FOR MIXED METHODS RESEARCH
HERE BECAUSE I THINK THAT'S
WHERE WE WILL FIGURE THIS OUT IN
THE BEGINNING TO YOUR POINT
ABOUT DEVELOPING THESE MEASURES.
AND SOME OF THESE MORE DETAILED
NUANCED EXPERIENCES THAT PEOPLE
FOR EXAMPLE, PREGNANT PEOPLE ARE
HAVING, IS WE'RE GOING TO FIGURE
THAT OUT QUAL FATIVELY AND THAT
CAN HELP INFORM SOME OF THESE
QUESTIONS IN THE SURVEYS MOVING
FORWARD.
>>GREAT.
THANK YOU SO MUCH, THIS WAS A
GREAT PANEL AND WE KIND OF WENT
OVERTIME BECAUSE I JUST REALIZED
IN THE AGENDA THERE WAS A MIX UP
IN THE TIME SO WE HAD MORE TIME
TO ASK QUESTIONS, AND ANSWER
THEM.
SO WE'RE GOING ON BREAK FOR 15
MINUTES AND THEN WE ARE GOING TO
HAVE DR. KAREN PARKER WHO IS THE
DIRECTOR OF THE SEXUAL AND
GENDER MINORITY RESEARCH OFFICE
WHO IS GOING TO BASICALLY
SUMMARIZE THE THEMES FROM TODAY,
AND DISCUSS WITH THE SPEAKERS,
YOU KNOW SOME OF THEIR IDEAS FOR
FUTURE RESEARCH AND DIRECTIONS.
SO, I GUESS THANK YOU SO MUCH
EVERYONE AND THANKS TO ALL THE
SPEAKERS THAT CAME TODAY AND
GAVE THEIR TALKS AND YEAH, SO
LET'S GO ON BREAK FOR 15 MINUTES
AND COME BACK TO WRAP UP THE
DAY.
THANK YOU.
>>GOOD AFTERNOON, IT IS MY
PLEASURE TO INTRODUCE DR. KAREN
PARKER THE DIRECTOR OF THE
SEXUAL AND GENDER MINORITY
RESEARCH OFFICE WHO'S GOING TO
MODERATE OUR SESSION TODAY THAT
INTEGRATES ACROSS THE SESSIONS
THAT WE'VE HEARD TODAY AND
DISCUSS SOME FUTURE RESEARCH
DIRECTIONS WITH THE SPEAKERS.
DR. KAREN PARKER PLEASE GO
AHEAD.
>>GREAT.
THANK YOU SO MUCH, RADA, I AM SO
HAPPY TO BE HERE TODAY AND I
WOULD LIKE TO TAKE A MEMORY
CLONE TONIGHT THANK THE NATIONAL
INSTITUTE OF MENTAL HEALTH, AS A
REMINDER WE'RE ONLY HALFWAY
THROUGH, WE WILL BE TOGETHER
AGAIN TOMORROW TO CONTINUE THESE
DISCUSSIONS BUT MY TASK FOR
TODAY IS REALLY TO THINK ABOUT
EVERYTHING I HEARD TODAY, PULL
OUT IN KEY THEMES, AND THEN, WE
WILL ASK ALL OF THE FOLKS WHO
PARTICIPATED TODAY TO TURN ON
THEIR VIDEO, I WOULD LOVE TO
HAVE A CONVERSATION SORT OF
AMONGST THOSE FOLKS.
SO IF YOU HAVE QUESTIONS FOR
YOUR FELLOW PANELLIVES, THIS
WILL BE A TIME WE CAN DO THAT WE
WILL TAKE Q, ANDA FROM PER TIS
PANTS WHO ARE WATCHING VIA
VIDEOCAST IF WEB CONNECTEDS
REMAIN AND OF COURSE I HAVE A
FEE QUESTIONS OF MY OWN I WOULD
LIKE TO POSE IF TIME ALLOWS.
SO FIRST I WOULD LIKE TO TALK
ABOUT SOME OF THE MAIN THING I
THAT I HEARD TODAY, I WILL TALK,
I CLUMP THESE INTO 3 CATEGORIES,
SO THE FIRST IS COLLECTION, SO
OF COURSE, WE'RE TALKING ABOUT
DATA COLLECTION S&P VERY NEAR
AND DEAR TO THE HEARTS OF
EVERYONE HERE AT THE SEX AND
GENDER MINORITY OFFICE HERE AT
THE NIH, THE OTHER IS CLIMATE
IMPORTANCE, WHEN YOU THINK ABOUT
THOSE AND RESEARCH.
AND THEN THE LAST IS CONDITION,
SO THINKING ABOUT KEY RESEARCH
AREAS THAT WERE HIGHLIGHTED
TODAY AND THE KINDS OF THINGS
THAT WE HEARD THAT I SORT OF
LIFTED OUT AS BEING PARTICULARLY
SORT OF CRITICAL IN THESE
DISCUSSIONS.
SO FIRST I WILL TALK ABOUT DATA
COLLECTION AND YOU KNOW THINKING
ABOUT DATA COLLECTION, I THINK
IN SOME WAYS FEELS LIKE IT'S
VERY SIMPLE, WE SHOULD JUST
START TO DO DATA COLLECTION
ACROSS THE BOARD.
YOU KNOW FREQUENTLY, WHEREVER
THERE'S OPPORTUNITY AND WHERE
ARE WE COLLECT DEMOGRAPHICS AND
I BELIEVE THAT IS TRUE, AND WE
ARE WORKING SORT OF AT THE
NATIONAL LEVEL TO THINK ABOUT
WAYS WE CAN GET SOGI DATA
INTEGRATED INTO THE FEDERAL DATA
FOR COLLECTIONS, FOR EXAMPLE,
ALL FEDERAL SURVEYS, WE KNOW
IT'S IMPORTANT.
WE HAVE BEEN WORKING AT NIH FOR
EXAMPLE, IN FUNDING THE NATIONAL
ACADEMIES OF REPORT THAT WAS
MENTIONED.
I'M REALLY THINKING DEEPLY ABOUT
HOW CAN WE MAKE SURE THAT WE ARE
LOOKING TO THE EVIDENCE TO GUIDE
THE WAYS THAT WE ASK THESE
QUESTIONS AND HOW CAN WE THINK
ABOUT WHEN IT IS APPROPRIATE TO
ASK WHAT KINDS OF QUESTIONS, SO
FOR EXAMPLE, A QUESTION WE MIGHT
ASK ON A NATIONAL SURVEY MIGHT
BE VERY DIFFERENT THAN A
QUESTION WE WOULD ASK IN A
RESEARCH PROJECT THAT IS FOCUSED
SPECIFICALLY ON SEXUAL AND
GENDER MINORITY COMMUNITIES.
WE KNOW THAT THERE ARE ALSO
CHALLENGES RELATED TO
ADMINISTRATIVE DATA COLLECTION,
WE HEARD ABOUT THAT, FROM JOHN
BLOSNICH TODAY THINKING ABOUT
DATA COLLECTION THAT IS TIED TO
A DELIVERABLE OR SERVICE, THINK
ABOUT WHAT THAT MEANS FOR
BARRIER ANALYSIS ISSUES RIGHT?
IF PEOPLE ARE AFRAID TO ANSWER A
QUESTION ON A FORM, THEY FEEL
THEY MAY BE DENIED A SERVICE,
THEN HOW DO WE REALLY UNDERSTAND
POTENTIAL DISCRIMINATION
HAPPENING AT THAT LEVEL OR OTHER
CHALLENGES RELATED TO SERVICE
DELIVERY.
OF COURSE, THERE ARE CONCERNS
ABOUT THE COST OF VISIBILITY DHS
IS A PHRASE THAT JOHN USED AND
THEN WITH WE THINK ABOUT OTHER
KINDS OF DATA COLLECTION, WE
HEARD FROM SUSAN COCHRAN ABOUT
THE NATIONAL VIOLENT DEATH
REPORTING SYSTEM AND SOME OF THE
PROMISING FUTURE THAT MACHINE
LEARNING MIGHT HOLD FOR THINKING
ABOUT IDENTIFYING SEXUAL AND
GENDER MINORITY POPULATIONS.
WE KNOW THAT CLINICAL DATA IS
INCREDIBLE LOAMACYY IMPORTANT
AND I THINK THAT THE LACK OF
DATA RELATED TO THE COVID-19
PANDEMIC IS A REALLY GREAT
EXAMPLE OF WHY WE NEED GOOD
CONSISTENT DATA COLLECTION
WITHIN CLINICAL SPACES AND THEN
OF COURSE, BRIAN MUSTANSKI,
BROUGHT UP THE NEED FOR DATA
WITHIN THE STEM WORKFORCE AND
THAT'S SOMETHING WE'RE
INTERESTED IN AS WE THINK ABOUT,
YOU KNOW BEING ABLE TO GROW, THE
FIELD OF SGM HEALTH RESEARCH,
WHO'S ASKING THE QUESTIONS,
WHO'S CONDUCTING THE RESEARCH,
HOW CAN WE MAKE SURE THAT
SCIENCE IS A WELCOMING AND
AFERMING PLACE FOR ALL SO THAT
WE AREN'T LOOSING PEOPLE YOU
KNOW STARTING OUT IN VERY EARLY
AGES BUT REALLY THINK BEING
MAKING SURE WE'RE NOT LOSING
PEOPLE THROUGH THAT SCIENTIFIC
PATHWAY, FROM UNDERGRAD TO
GRADUATE STOOL TO POST DOC AND
TO FUNDED NIH RESEARCHER.
OF COURSE, WITH WE TALK ABOUT
DATA WE ALSO HAVE TO THINK
THINGS LIKE SUBPOPULATION DATA,
SO, VICKI MAYS TALKED ABOUT
SMALL GROUP DATA AND THE
IMPORTANCE OF THINKING ABOUT
DATA IN WAYS THAT INCORPORATE
MIXED METHODS, THINKING ABOUT
NARRATIVES, QUALITATIVE DATA
USING FOCUS GROUPS AND THEN OF
COURSE, WE WANT TO THINK ABOUT
SORT OF WHAT DOES DATA LOOK LOOK
ACROSS THE LIFE SPAN AND WE WERE
REMINDED THAT THERE ARE SORT OF
COHORT ISSUES RELATED TO HOW
WELL PEOPLE ARE DOING OR
CHALLENGES THAT PEOPLE ARE
FACING, AND SO UNDERSTANDING
THAT WE NEED TO CONTINUE TO
COLLECT ACROSS THE LIFE SPAN AND
EACH TIME FOR EXAMPLE IN A
LONGITUDINAL STUDY FOR
DEMOGRAPHICS DAILY BASIS THEA
MAKE SURE WE'RE COLLECTING IT AT
EACH WAVE, BETHANY EFFORT ALSO
TALKED ABOUT THAT AND SOME OF
THOSE CHALLENGES WITH
LONGITUDINAL DATA SO BEING
REALLY MINDFUL ABOUT HOW AND
WHEN WE COLLECT THE DATA IS
REALLY CRITICAL, IN EMERGING ITS
OF CONTEXT AND CLIMATES, 1 OF
THE THINGS THAT WE HEARD LOUD
AND CLEAR, EARLY THIS AFTERNOON,
IS THE IMPORTANCE OF THINKING
ABOUT FRAMEWORK OF
INTERSECTIONALITY AND REALLY
MAKING SURE THAT WE'RE GOING
BACK TO ITS ROOTS, WITH KIMBERLY
CRENSHAW AND THINKING ABOUT
POWER, PRIVILEGE, OPPRESSION,
AND I THINK YOU KNOW VICKI MAYS
DID A REALLY GREAT JOB OF LAYING
OUT SOME OF THESE ISSUES THAT
NEED TO BE THOUGHT OF,
CLASSIFICATION VERSUS, IDENTITY
AND INTERSECTIONALITY AND HOW
IT'S NOT JUST SPECIFIC TO
INTERREPRESENTATIONAL
INTERSECTIONALITY BUT POLITICAL
AND STRUCTURAL.
AND OF COURSE EVERYTHING WE DO
SOME OF THE COMPLEXITIES AROUND
FLUIDITY AND WHAT THOSE MEAN IN
THE RESEARCH CONTEXT.
WE HEARD ABOUT THE IMPORTANCE OF
LANGUAGE AND EVEN IN THE WAY WE
TALK ABOUT THINGS LIKE
EDUCATIONAL ATTAINMENT AND HOW
THAT CAN MEAN DIFFERENT THINGS
TO DIFFERENT PEOPLE AND IN
DIFFERENT CONTEXTS AND THAT
THERE'S A DEEP NEED TO ELECTRIC
AT SOCIAL VULNERABILITIES AND
RISK.
DR. MANDY PRATT-CHAPMAN TALKED
ABOUT THE WEALTH GAP, POWER,
VULNERABILITY I WOULD ADD IN
THERE THE IMPORTANCE OF
GEOGRAPHY AND THEN WE HEARD A
LOT ABOUT SORT OF POLICY, SO
THINKING ABOUT STRUCTURAL
POLICIES, NOT JUST FEDERAL
LEGISLATION FOR EXAMPLE, WHICH
IS INCREDIBLE LOAMACYY
IMPORTANT, BUT ALSO THINGS LIKE
SCHOOL POLICIES, AND
INSTITUTIONAL POLICIES AND HOW
THOSE CAN IMPACT THINGS LIKE
BELONGING AND INCLUSION.
WE KNOW THAT POLICIES, YOU KNOW
NEED TO BE LOOKED AT IN A
MULTILEVEL, MULTISECTORRAL WAY,
AND WE NEED TO LOOK AT POLICIES,
ALONGSIDE OTHER POLICIES,
ALONGSIDE OTHER POLICIES.
AND SO IT'S NOT THAT JUST 1
POLICY WILL LEAD US TO
UNDERSTAND 1 THING IN A PERFECT
WAY.
IN TOMORROWS OF SOCIAL AND
STRUCTURAL DEPERMANENTS WE HEARD
ABOUT STRUCTURES OF DOMINATION
AND THERE ARE A VARIETY OF
THOSE, TRANSPHOBIA HETEROSEXISM,
RACISM, CLASSISM, SEXISM, + +,
AND SO, WE NEED TO MAKE SURE
THAT AS WE'RE THINK BEING
RESEARCH WE'RE CONSIDERING ALL
OF THESE ISSUES NOT JUST FOR
EXAMPLE, WITHIN THE HEALTHCARE
SETTING BUT ALSO WITHIN RESEARCH
SETTINGS AND HOW IS THAT
IMPACTING NOT JUST SORT OF WHAT
WE FIND BUT WHO PARTICIPATES.
GREGORY PHILLIPS TALKED ABOUT
PANDEMICS, AND THE STIGMA
DISCRIMINATION, DATA MESSAGING,
ALL THE CHALLENGES WE HAVE FOUND
ACROSS SEVERAL DIFFERENT
PANDEMICS AND AS I MENTIONED
BEFORE THE COVID-19 PANDEMIC
REALLY SHOWN LIGHT ON THE NEED
FOR VERY MINDFUL DATA COLLECTION
AND THEN OF COURSE, MPOX WAS
ALSO HIGHLIGHTED AS A REAL
CHALLENGE JUST IN RECENT MONTHS
AND ALL OF THE SORT OF ISSUES
RELATED TO STIGMA AND
DISCRIMINATION AND HOW THESE
PLAY INTO OUR RESPONSE.
BOTH MANDY PRATT-CHAPMAN AND
DAPH NA STROUMSASHELLS, TALKED
ABOUT CLINICAL CARE AND WE NEED
TO THINK ABOUT EDUCATION,
KNOWLEDGE OF PROVIDERS THINK OF
RESEARCHERS AND HOW CANY WE MAKE
SURE THAT THE WAY WE ARE
IMPARTING THAT KNOWLEDGE IS DONE
IN AN EVIDENCE-BASED WAY, OF
COURSE, I'M THINKING ABOUT HOW
NIH CAN PLAY A BIGGER ROLE, I
WOULD SAY IN FUNDING THE
RESEARCH, TO MAKE SURE THAT THE
EDUCATION IS HAPPENING IN WAYS
THAT ARE HELPFUL FOR NOT JUST
ENGAGING PEOPLE TO DO SGM HEALTH
RESEARCH BUT TO MAKE SURE THAT
FOLKS ARE DOING IT IN A WAY THAT
BENEFITS COMMUNITY, AND THEN OF
COURSE WE HEARD ABOUT COMMUNITY
DRIIVE AND LED CARE AND RESEARCH
AND THAT THAT SORT OF HAS
BUBBLED UP IN RECENT YEARS AT
NIH AT THE MORE IMPORTANT FACTOR
AND OF COURSE, WE KNOW THAT
THAT'S REALLY IMPORTANT AND
SOMETHING WE SHOULD CONTINUE TO
DO AND THINK ABOUT AS WE MOVE
FORWARD, THE ENTIRE SGM RESEARCH
AGENDA.
AND AS WE THINK ABOUT KEY
CONDITIONS AND AREAS OF RESEARCH
THAT WERE HIGHLIGHTED, WE HEARD
ABOUT CARDIOVASCULAR DISEASE AND
THINGS LIKE FOOD INSECURITY AND
SLEEP DISPARITIES AND HOW THOSE
THINGS INTERACT, MANDY
PRATT-CHAPMAN TALKED ABOUT
CANCER AND THINGS LIKE STRESS,
ISSUES RELATED TO MEDIA,
MARKETING, TOBACCO USE,
SCREENING GUIDELINES AND THEN OF
COURSE SOCIAL SUPPORT WHICH WAS
BROUGHT BACK TO TOWARDS THE END
OF THE DAY.
>>DR. SCHULER TALKS ABOUT
MENTAL HEALTH AND SOME OF THE
HISTORY OF THE STRUCTURAL ISSUES
RELATED TO WAYS IN WHICH FOR
EXAMPLE, SEXUAL ORIENTATION AND
GENDER IDENTITY HAVE BEEN
CHARACTERIZED WITHIN MENTAL
HEALTH COMMUNITIES.
DR. SCHULER TALKED ABOUT
CONVERGENT THERAPIES AND STATE
VARIABILITY AND MENTAL HEALTH
DISTRESS AND WE KNOW THAT
LOOKING AT STRUCTURAL ISSUES AND
POLICIES, ARE KEY TO SORT OF
UNDERSTANDING SOME OF THESE
MENTAL HEALTH OUTCOMES.
IN TERMS OF GENDER AFFIRMING
KAY, DR. STROUSMA, DID A GREAT
JOB OF LAYING OUT AN ECOLOGICAL
MODEL AND IMPORTANT IN
UNDERSTAND ISING THE MULTILAYERS
OF GENDER AIF I WERING CARE IN
OUR OFFICE WE ARE TALKING A LOT
ABOUT GENDER ARK FIRMING CARE
AND ALSO THINKING ABOUT IT QUITE
BROADLY.
WE WILL BE HOLDING A WORKSHOP AT
THE END OF THIS MONTH ON GENDER
AFFIRMING CARE FOR TRANSGENDER
AND GENDER DIVERSE POPULATIONS
AND WE'RE REALLY DEFINING CARE
AS BROADLY AS POSSIBLE SO
THINKING NOT JUST ABOUT SPECIFIC
MEDICAL CARE BUT ALSO ABOUT FOR
EXAMPLE, SOCIAL TRANSITION.
AND OF COURSE LISA DIAMOND
TOWARD THE END OF THE DAY
BROUGHT US INTO A DISCUSSION
ABOUT TRAUMA AND CHILDHOOD
ADVERSITIES AND AGAIN, BROUGHT
US BACK TO THE DEVELOPMENTAL
FRAMEWORK, THINKING ABOUT
WINDOWS OF PLAOF THE I GUESSITY,
AND THE SOCIAL BRAIN AND THE
HEALTH SMLICATION OF DIFFERENT
TYPES OF CHILDHOOD ADVERSITIES,
THIS SYSTEMIC INFLAMMATION AND
PATHWAYS WERE DISCUSSED AND ALSO
SORT OF A TAKE HOME MESSAGE THAT
I THINK WE HEARD OVER AND OVER
AGAIN, IS ABOUT THE NEED FOR
SAFETY AND PROTECTION OF ALL
PEOPLE AND SO I THINK IT'S
IMPORTANT TO THINK OF THOSE
CONCEPTS AS WE THINK ABOUT
ROLLING OUT FOR EXAMPLE, NEW
RESEARCH AGENDAS.
SO AT THE VERY END OF THE DAY,
BETHANY EVERETT TALKED ABOUT
REPRODUCTIVE HEGHT WHICH IS A
SPACE ARE THERE'S VERY LITTLE
RESEARCH IN TERPS OF SGM
POPULATIONS, AND WE TALK A LOT
THERE ABOUT LONGITUDINAL HEALTH
DATA AND THE NEED FOR INCREASING
DATA COLLECTION WITHIN
REPRODUCTIVE HEALTH SPACES, AND
THEN OF COURSE, SOME OF THE
REALLY INTERESTING WORK THAT WAS
HIGHLIGHTED, WAS THIS WORK
RELATED TO POLICY AT THE STATE
LEVEL THAT IMPACT VERY DISCREET
WORTH OUTCOMES.
SO I THINK EVERYBODY WOULD
AGREE, WE HEARD SO MUCH TODAY
AND THERE'S SO MUCH MORE TO HEAR
ABOUT TOMORROW, BUT REALLY I
THINK WHAT ALL OF THIS SAYS TO
ME, IS, AS OUR RESEARCH
PORTFOLIO AS GROWN, THERE ARE IS
STILL SO MUCH WORK TO BE DONE
AND SO MANY OPPORTUNITIES WITHIN
SGM HEALTH RESEARCH.
I WOULD LIKE TO SORT OF TAKE US
BACK TO WHERE WE STARTED BEFORE
I OPEN UP THE DISCUSSION, BRIAN
MUSTANSKI, TALKED AT THE
BEGINNING ABOUT WHERE WE ARE AND
WHERE WE NEED TO HEAD.
SO AS WE START TO THINK ABOUT
KEY RESEARCH OPPORTUNITIES AND
SGM HEALTH, --I WOULD LIKE TO
UNDERSCORE THIS NOTION OF REALLY
MOVING BEYOND DESCRIBING
DISPARITIES, RIGHT?
SO THAT WE NEED TO MOVE BEYOND
DESCRIBING DISPARITIES, WE NEED
TO BETTER UNDERSTAND MECHANISMS,
WE NEED TO DEVELOP INTERVENTIONS
AND THEN WE NEED TO DO
IMPLEMENTATION SCIENCE SO THAT
ALL OF THE EVIDENCE CAN ACTUALLY
GET INTO THE COMMUNITIES AND
IMPROVE PEOPLE'S LIVES.
SO I'M GOING TO END THERE AND
I'M GOING TO INVITE ALL OF THE
PANELISTS FROM TODAY WHO ARE
STILL WITH US TO TURN YOUR
VIDEOS ON AND THEN I WILL OPEN
IT UP FOR DISCUSSION AND WE WILL
BEGIN TO TAKE Q&A FROM FOLKS WHO
ARE WATCHING.
SO FOLKS IF YOU HAVE YOUR VIDEO
ON, IF YOU WANT TO ASK EACH
OTHER A QUESTION, OR PUT A HAND
IN THE CHAT, EITHER WAY WILL
WORK.
IF WE FIND THERE ARE NO
QUESTIONS AMONGST THE GROUP, I'M
HAPPY TO MOVE TO VIDEOCAST
QUESTIONS OR--AND JOHN, I SEE
YOU HAVE A QUESTION.
>>I WILL DART FOR THAT OPEN
DOOR.
THANK YOU.
I WONDERED, I HAD TO MEET
BRIEFLY WITH A STUDENT DURING
THE LAST GROUP OF SEGS ON THE
STRUCTURAL STUDIES AND SORT OF
THE PERSPECTIVES, AND I DON'T
KNOW IF MORGAN OR BETHANY ALL OF
WANT TO DISCUSS IS, 1 THING I
WRESTLE WITH AND I DON'T DO
THESE STUDIES BUT WE HAVE THE
STRUCTURAL POLICY STUFF AND WE
HAVE INDIVIDUAL LEVEL DATA BUT,
YOU KNOW THERE'S THIS
MESOSECTION OF THE FAMILY
SYSTEM, AND HOW THESE MIGHT--HOW
THESE POLICIES IMPACT FAMILIES,
HOW FAMILIES SORT OF EITHER
BUFFER OR MAY MAG FIELD
FUNCTIONSIFY OR AMPLIFY THESE
INDIVIDUAL PERSON, ARE THERE
LIKE STUDIES ABOUT HOW WE CAN
DATA AND DATA AND DATA, I DON'T
KNOW IF AN [INDISCERNIBLE] WILL
TAKE CARE OF ALL THESE THINGS
BUT HOW DO WE MAKE MORE SENSE OF
ALL THESE SYSTEMS THAT ARE
EVOLVED AND THESE COOL POLICY
AND STRUCTURAL STUDIES.
>>I MEAN TO BE HONEST I'LL HAVE
TO THINK, I DON'T KNOW IF
THERE'S A DATA SET THAT WOULD
ALLOWS US TO DO FROM A PURELY
QUANTITATIVE PERSPECTIVE.
IT'S REALLY HARD TO GET DATA
THAT WILL LET YOU KNOW WHAT
STATES A PERSON IS IN, SO CAN
YOU LINK THE POLICY AND ALSO
HAVE THE INDIVIDUAL OR FAMILY
LEVEL DATA AND IT HAS SEXUAL
IDENTITY, IT JUST BECOMES THIS
DIAGRAM WHERE YOU GET TO DOWN TO
0 IN THE MIDDLE UNFORTUNATELY.
I KNOW 1 THING WE TALKED ABOUT
IN THE PANEL WAS HAVING TO RELY
ON MIXED METHODS BECAUSE THAT'S
SORT OF AGAIN, IT'S NOT PERPECT
BECAUSE YOU CAN'T CONTROL
EVERYTHING IN A SINGLE MODEL BUT
TRYING TO FIGURE OUT THAT
PATHWAY TO YOUR POINT BECAUSE
THERE IS SO MUCH THAT GOES ON
BETWEEN THE STATE LEVEL AND THE
INDIVIDUAL OUTCOMES AND OFTEN
TIMES WHY CAN'T EVEN GET AT THE
LOCAL POLICY, RIGHT IN WE DON'T
HAVE ENOUGH PEOPLE IN A DATA SET
IN A REGION TO LACK AT A COUNTY
LEVEL.
SO IT'S SORT OF A FRUSTRATING
CIRCLE BECAUSE WE DON'T HAVE THE
DATA WE NEED AND THEN WE GO TO
STUDY SECTION BUT WE GET
CRITICIZED FOR NOT HAVING THE
DATA BUT IT'S A CYCLE BUT
BECAUSE WE CAN'T DO IT BECAUSE
OF THE WAY THE WORK IS THERE.
BETHANY DO HAVE YOU THOUGHTS ON
OTHER WAYS IN GET AROUND IT.
>>WELL MYSELF AND 2 OTHERS ARE
SOCIOLOGIST AND WE'RE WORKING ON
A MENU SCRIPT THAT LOOKS AT
STRUCTURAL STIGMA AND FAMILY
PROCESSES.
SO IN THE FIELD OF LIKE FAMILY
SETTINGS SO THINGS LIKE
MARRIAGE, DIVORCE, CHILDREN, AND
BRINGING THE STRUCTURAL STIGMA
PIECE TO THAT WHICH IS WHAT I'M
CHARGED WITH, IS THE FIELD IS
KIND OF SMALL IN PART BECAUSE SO
MANY OF THE SPECIFIC POLICIES
DIRECTLY IMPACT FAMILY
PROCESSES, RIGHT?
LIKE MARRIAGE, IS A HUGE THING
AND THE FAMILY LITERATURE, BUT I
MEAN THE POLICY, IMPLICATIONS
FOR LIKE BANNING MARRIAGE ARE SO
ON THEIR FACE THAT A LOT OF
PEOPLE HAVEN'T REALLY DUG INTO
WHAT THE SOCIAL CLIMATE LIKE
MEAN FOR LIKE MARRIAGE VERSUS CO
HABITATION VERSES OTHER THINGS,
SO I THINK IT'S RIPE FOR STUDY.
YEAH.
I'LL STOP THERE.
AT LEAST I HAVE SOMETHING TO
ADD.
>>1 OF THE THINGS I THOUGHT
ABOUT RECENTLY IS LOOKING FOR
KRES CREPANCYS BETWEEN LOCAL
SYSTEMS AND LARGER SYSTEMS.
WE ALL HEAR ANECDOTES ABOUT A
SUPPORTIVE FAMILY WITHIN A
HOSTILE CLIMATE OR 1 SCHOOL
WITHIN A LARGER HOSTILE THING
AND I THINK BECAUSE THEY'RE
NESTED AND SOME EFFECTS OR MORE
PROXIMAL, SOME ARE DISTAL AND
SOME ARE TRANSMIT THROOD HEARING
ABOUT THEM, WE DON'T EVEN KNOW
OFTEN WHAT ARE THE MECHANISMS
FOR WHICH POLICY TRICKLES DOWN
BUT I THINK OUR BEST CHANCE TO
BE ABLE TO FIGURE THAT OUT AND
TO LOOK FOR CASES OF LIKE UPON
OVERT DISCREPANCY WHERE YOU HAVE
KNOWA OASIS WITHIN A HOSTILE
ENVIRONMENT OR A HOSTILE
ENVIRONMENT WITH AN SUPPORTIVE
CLIMATE AND I THINK THOSE ARE
EXAMPLES WHERE WE CAN FIND OF
USE THEM AS LITTLE TESTING
GROUNDS AND SAY WELL, WHAT IS
HAPPENING, WHAT IS GETTING
TRANSMITTED, VERY PROXIMALLY.
WHAT'S GETTING TRANSMITTED SORT
OF 1 DEGREE OUT AND THEN 1
DEGREE OUT FROM THAT SO THAT
RIGHT, YOU'RE 1 BIG HIERARCHICAL
MODEL.
I THINK BECAUSE THESE THINGS ARE
NESTED, BY LOOKING FOR CASES
WHERE THEY CLASS, WE MIGHT BE
ABLE TO AT LEAST BEABLE TO IDENT
WHAT THE DRIVERS MIGHT BE
EMPLOY.
>>THANKS AND THAT LEADS ME TO
THINK ABOUT SOME OF THE WORK
THAT BRIAN WAS TALKING ABOUT
THIS MORNING ABOUT LOOKING AT
SOME OF THE PROTECTIVE FACTORS.
BRIAN DO YOU HAVE ANY THOUGHTS
ABOUT JOHNS QUESTION.
>>YEAH, I MEAN, I THINK 1
CONSIDERATION IS THAT THERE'S A
LOT OF VARIABILITY EVEN WITHIN
SMALLER GEOGRAPHIC UNITS AND
STATES SO CITIES WITHIN A STATE
OR EVEN A CITY LIKE CHICAGO,
WHEN WE LOOK AT HOW THE YOUNG
GAY AND BISEXUAL MEN IN OUR
STUDY REPORT HOW MUCH ACCEPTANCE
THEY PRESENCE IN THEIR
NEIGHBORHOOD VERSUS REJECTION,
WE SEE VARIABILITY WITH
NEIGHBORHOODS ACROSS CHICAGO IN
EMERGING ITS OF PERCEIVED SOCIAL
ACCEPTANCE OR EXPERIENCES WITH
DISCRIMINATION OR VICTIMIZATION,
SO I DON'T THINK WE ALWAYS HAD
TO GO TO THE SORT OF STATE BY
STATE LEVEL TO LOCK AT THESE
INTERACTIONS, SO, YOU KNOW IN A
COHORT STUDY, THAT IS LARGE
ENOUGH, YOU COULD LOOK AT
GEOGRAPHIC VARIABILITY, GET DATA
ON ACCEPTANCE AND LOOK AT THOSE
KINDS OF THINGS SO YOU KNOW,
THAT'S THE WAY WE'VE PRIMARILY
DONE IT IS LOOKING AT DIADIC
EFFECTS, FAMILY RELATIONSHIPS IN
OUR COHORT STUDIES AND THEN
TRYING SOMETIMES TO LACK AT
GEOGRAPHIC VARIABILITY AND
STIGMA WITHIN A SINGLE REGION.
>>GREAT, THANKS AND WE DO HAVE
ALSO WITH US SOME OF THE
PRESENTERS FROM TOMORROW DISP WE
ALSO HAVE SOME OF THE PLANNING
COMMITTEE MEMBERS FROM NIH, IF
ANY OF YOU FOLKS WOULD LIKE TO
JUMP IN, PLEASE FEEL FREE, FEEL
FREE TO PUT YOUR VIDEO ON BUT
ABSOLUTELY YOU CAN BE A PART OF
THIS DISCUSSION.
BETHANY.
>>YEAH.
>>THIS IS A QUESTION PRIMARILY
FOR BRIAN, I THINK, AS SOMEONE
WHO WAS TRAINED AS A SOCIAL
DEMOGRAPHER AND I TRIED TO MOVE
BEYOND JUST DOCUMENTING
DISPARITIES TO TRY LOOKINGA THE
MECHANISMS, THE IDEA OF JUMPING
TO INTERVENTION WORK IS SO
ABSOLUTELY DAUNTING MAYBE I'M
NOT ALONE IN THAT FEELING THAT
HOW WOULD DESIGNING THE STUDY,
FINDING THE RIGHT TEAM, PUT IT
ALTOGETHER AND SEEMS REALLY
OVERWHELMING AND IT'S A
LIMITATION OF MY OWN WORK, MY
OWN APPROACH BUT IT'S SOMETHING
THAT BOTHERS ME ON I PERSONAL
LEVEL THAT AT WHAT POINT AM I
TRYING TO TRANSLATE THE FINDINGS
AND I'M JUST WONDERING IF YOU
HAVE ANY ADVICE FOR MAKING THAT
LEAP OR HOW TO WORK WITH
TRANSLATIONAL AND INTERVENTION
TEACHES.
>>I CAN EMPATHIZE WITH THAT
HERE, THE HAVE BEEN THE SCARIEST
PROJECTS I'VE EVER DONE, IT'S
STRESSFUL TO THINK ABOUT
INTERVENING IN PEOPLE'S LIVES
AND IT IS IT DOES FEEL SAFER IN
SOME WAYS WE DON'T KNOW ENOUGH,
WE DON'T KNOW ENOUGH, WE NEED TO
LEARN MORE ABOUT THESE PROCESSES
AND MECHANISMS BEFORE WE START
INTERVENING.
YOU KNOW AT THE SAME TIME, I
THINK, YOU KNOW UNLESS WE HAVE
REASONS TO THINK THAT THE
INTERVENTION IS SUPPOSED TO HAVE
HARMS ASSOCIATE WIDE IT, THERE
CAN BE BE A LOT THAT'S LEARNED
THROUGH INTERVENTIONS, WHETHER
THEY WORK OR NOT, ULTIMATELY,
AND SO, YOU KNOW, I WILL SAY
LIKE WITH MY FIRST INTERVENTION
STUDY, WHICH WAS DEVELOPING THIS
ONLINE SEX EDUCATION
INTERVENTION FOR YOUNG GAY AND
BISEXUAL MEN, A LOT OF IT I
LEARNED FROM WORKING WITH PEOPLE
IN THE COMMUNITY, LIKE FOLK WHO
IS ARE DOING HIV TESTING AND
COUNSELING AND WHAT THEIR
EXPERIENCES WERE WITH DOING
THESE COUNSELING SESSIONS, WHAT
THEY FELT LIKE THEY COULD COVER,
WHAT THEY WISH THEY COULD COVER
BUT NEVER HAD TIME TO GET TO AND
I FEEL LIKE THAT INSPIRED THE
CONTENT OF WHAT WENT INTO THAT
INTERVENTION AND ALSO TALKING TO
DIVERSE YOUNG GAY AND BISEXUAL
MEN WHO SAY I DON'T WANT TO SIT
IN A LECTURE THAT'S LIKE HIV 101
AND HIV IS A VIRUS AND HERE'S
HOW IT'S TRANSMITTED I WANT TO
KNOW ABOUT DATING I WANT TO KNOW
ABOUT HOOK UP ACTIVITIES AND
PROJECTS APS, WHAT DO I DO IF
THE PERSON IS OLDER OR HAS POWER
OVER MERE ME THAT'S WHEY WANT TO
LEARN ABOUT AND EMBED YOUR HIV
EDUCATION IN NACONTEXT SO I'VE
ALWAYS TAKEN INSPIRATION FROM
THE PEOPLE WHO ARE DOING OFTEN
THE WORK WITHOUT NECESSARILY
HAVING THE SCIENTIFIC BACKGROUND
OR SITTING IN A UNIVERSITY TO
SUBJECT TO THAT KIND OF RCT OR
RESEARCH, I THINK THAT'S GOOD
MENTORSHIP OF PEOPLE WHO HAVE
GONE INTERVENTION WORK AND
WILLING TO SORT OF SIT WITH YOU
AND ANSWER THE CHALLENGING ALONG
THE WAY.
AND ALSO NAVIGATE THE
INCREASINGLY COMPLICATED
REGULATORY ENVIRONMENT FOR
INTERVENTION RESEARCH, IT DOES
TAKE MENTORSHIP TO HELP YOU
NAVIGATE THAT BUT I GUESS ARE I
FEEL LIKE THE REWARDS ARE THERE,
SEEING THE BENEFITS OF AN
INTERVENTION AND THE OTHER THING
I WILL SAY ABOUT IT IS, MY BASIC
OBSERVATIONAL RESEARCH WHICH I
CONTINUE TO DO CHANGED SO MUCH
AFTER I DID MY FIRST
INTERVENTION BECAUSE THE THINGS
I THOUGHT THAT INTERVENTIONISTS
WANTED TO KNOW OR NEEDED TO KNOW
TO DO INTERVENTIONS, WHEN I
STARTED DOING MY FIRST
INTERVENTION, I REALIZED WHOA
MOST OF MY BASIC STUDIES ARE NOT
HELPING AT ALL IN TERMS WHAT I
NEED TO KNOW TO DEVELOP AN
INTERVENTION, SO I THINK MY
BASIC RESEARCH BY HAVING LED AN
ISHT VENTION OR THE THINGS YOU
NEED TO KNOW TO DO AN
INTERVENTION SO I THINK IT'S A
BENEFIT TO YOU EVEN IF YOU
PRIMARILY DO BASIC RESEARCH TO
PAIR UP WITH AN INTERVENTION OR
SEE HOW INTERVENTIONS ARE
DEVELOPED BECAUSE I THINK IT
WILL IMPROVE YOUR BASIC RESEARCH
IN MANY WAYS.
>>THANK YOU.
>>SO I'M GOING TO HEAD TO A
VIDEOCAST QUESTION.
SO SOMEBODY FROM THE VIDEOCAST
AUDIENCE COMMENTS THAT ALL THE
STUDIES PRESENTED TODAY WERE
U.S. FOCUSED STUDIES, I SUSPECT
THAT'S BECAUSE NIMHD FUNDS ONLY
U.S. FOCUSED STUDIES, BUT
THEY'RE ASKING COULD
INTERNATIONAL STUDIES HELP US
ELUC DATE, WHAT UNIQUELY AND
THINKING ABOUT DIFFERENCES IN
INSURANCE COVERAGE.
SO ANYONE HAVE ANY COMMENTS
ABOUT SORT OF THE U.S. FOCUSED
VERSUS MORE GLOBAL FOCUSED WORK?
MANDY?
>>YEAH, I DON'T KNOW THAT THIS
IS GOING TO BE SATISFACTORY AS
AN ANSWER BECAUSE MY STUDY WAS
SMALL BUT THE QUALITATIVE STUDY
I DESCRIBED REGARDING RADIATION
ONCOLOGISTS AND INTERSECTION
PATIENTS WAS INTERNATIONALLY
ABOUT EQUALLY DISTRIBUTED
BETWEEN AUSTRALIA AND THE U.S.
AND THAT WAS REALLY BASED ON
CONVENIENCE OF THE CO
INVESTIGATORS ABILITY TO GET
COLLEAGUES TO AT A YES IT A
RAPID STUDY, BUT THERE WERE
DEFINITELY DIFFERENCES, LOOKER I
SAID BUILT INTO THE GRIEW BY
QUESTIONS OR AROUND POTENTIAL
BILLING ISSUES THAT SAT VERY
DIFFERENTLY WITH THE AUSTRAILIAN
PROVIDER GROUPA SO THAT MOST OF
THE RESPONSES WE GOT WERE OH,
THAT WOULDN'T BE AN ISSUE HERE
BECAUSE BECAUSE WE HAVE MEDICAD
FOR EVERYBODY BUT THERE'S A DUAL
PAYMENT SYSTEM THAT MAKE ITS
MORE COMPLICATED, SO IF THERE'S
NOTHING THERE, THERE THEN
THRESHOLD NOTHING AT ALL SO
THERE I THINK THERE'S FINANCIAL
IMPLICATIONS DEPEBDING ON WHAT
THE ISSUE IS, BUT MY SMALL STUDY
WAS ACTUALLY INTERNATIONAL,
YEAH.
SO.
>>JOHN?
>>I WILL QUICKLY SAY LIKE
INTERNATIONAL STUDIES ARE
PROBABLY SOME OF THE ONLY 1S WE
IN TERMS OF MORTALITY ROUTT
COMES BECAUSE THEY HAVE SINGLE
PAYOR SYSTEMS THEY HAVE LINKAGES
THAT WE DON'T HAVE IN THE UNITED
STATES.
DOCTORS COCHRAN AND MAYS HAVE
USED DATA FROM SWEDEN, DENMARK
SO IN TERMS OF MORTALITY
STUDIES, YOU KNOW I KIND OF YOU
KNOW, BEMOANED ALL THE
LIMITATIONS IN THE U.S. BUT
WE'VE BEEN ABLE TO GET SOME
SIGNALS BY LOOKING TO
INTERNATIONAL LITERATURE ON
THAT.
>>MORGAN?
>>YEAH, I WOULD SAY TOO AND I
REALIZE THIS IS NOT HYGLY
DIFFERENT BUT I'M DOING SIMILAR
WORK IN CANADA LOOKING AT
SUBSTANCE USE IN SGN IN YOUNG
PEOPLE.
I THINK 1 OF THE MAIN CHALLENGES
FOR POLICY WORK AND TRYING TO DO
THE BAUDER HLM FACTOR ANALYSIS
IS, YOU JUST NEED A CERTAIN
NUMBER OF STATES OR COUNTRY
COMPARISONS AND SO IT BECOMES
CHALLENGING TO DO, THOUGH WE
HAVE BEEN TALKING TO COLLEAGUES
ACROSS EUROPE, THEN THE DATA
INTEGRATION BECOMES CHALLENGING
BECAUSE YOU DON'T HAVE SURVEYS
THAT ARE EUROPE WIDE, COUNTRY
WIDE, WE HAVE DONE THIS FOR
CANNABIS USE IN SOUTH AMERICA
AND WE HAVE SEEN THINGS THAT ARE
QUITE DIFFERENT BUT BASE LINE
SOCIAL ACCEPTANCE LOOKS
DIFFERENT SO THE WAY IN WHICH WE
ASK QUESTIONS SHIFTS IN A WAY
THAT'S PRETTY FUNDAMENTAL BUT I
THINK IT KEEPS AND I REALIZE I
SAID THIS LIKE 18 TIMES ALREADY
BUT IT COMES BACK TO DATA
AVAILABILITY AND WE ARE LIMITED
BY THE QUESTION SAYS WE ASK ASK
QUAWBTITATIVELY BASED ON WHAT'S
THERE BUT IT'S A GOOD POINT?
, MANDY?
>>I WANT TO GIVE RAIA A CHANCE
TO RESPONSE--CORINNA, IF YOU
COULD QUICKLY INTRODUCE
YOURSELF.
>>IESM KARI NA WALTERS ERS ANDM
CARINA WALTERS LOCATED IN
OKLAHOMA, AND FIRST OF ALL I
WANT TO SAY THANK TO YOU THE
PANELISTS TODAY, INCREDIBLE
PRESENTATIONS, I AM JUST FULL OF
INFORMATION RIGHT NOW AND
QUESTIONS BUT 1 THINK THIS I
WANT TO TAP INTO, BASED ON
WHAT'S BEING DISCUSSED RIGHT
NOW, IS THAT PEOPLE FORGET ABOUT
POPULATIONS QUITE EXPAWVEN WHEN
WE TALK ABOUT INTERNATIONAL
RESEARCH IN TERMS OF TRAFFICKING
SOVEREIGNTYY IT'S 1 WAY TO THINK
ABOUT OUR COMMUNITIES AND OUR
TRIBAL RELATIONS SO I WOULD LIKE
TO PUT A PLUG IN THERE TO BE
MINDFUL OF THAT AND THINK ABOUT
THAT.
SOME OF THE THINGS THAT CAME UP
FOR ME TODAY, JUST THINK BEING
IT I WOULD LIKE TO HEAR FROM THE
PANELISTS ON THIS AND THEN ALSO,
JUST REPONDING TO THE NOVEL
INTERVENTIONS, AMERICAN INDIAN
COMMUNITIES ARE DOING AMAZING
NOVEL WORK RIGHT NOW, LAND BASED
HEALING INTERVENTIONS ARE THE
APPROACHES WITH OUR 2 SPIRIT
YOUTH YOU SEE GOING ON IN CANADA
RIGHT NOW WHICH HAS BEEN REALLY
FAN OF THETIC GETTING YOUTH BACK
OWN OUT INTO THE ENVIRONMENT AND
NATURE AS 1 OF THE WAYS FOR
HEALTH FROM AN INDIGENOUS
PERSPECTIVE SO THOSE HAVE BEEN
SUCCESSFUL.
JAMES IS DOING THAT WORK AT THE
PROVIDER LEVEL.
BUT IN TERMS OF I HAD A QUESTION
FOR THE PANEL I WAS WORRIED WHEN
SOMETIMES WHEN WE'RE TALKING
ABOUT INTERSECTIONALITIES AND A
COUPLE OTHER THINGS IT SOUNDED
LIKE PEOPLE WERE ALLUDING TO
PEOPLE'S EXPERIENCE BEING
DEFIEBED BY OPPRESSION AND OF
COWER OUR EXPERIENCE IS INFORMED
BY OPPRESSIVE EXPERIENCES LGBT
FOLKS BUT FOR AMERICAN INDIAN
POPULATIONS IN PARTICULAR, AND
I'M SURE THIS IS PROBABLY TRUE
FOR OTHER POPULATIONS WE WOULD
SAY, WE'RE NOT--WE HAVE THOSE
EXPERIENCES BUT THAT IS NOT WHO
DEFINES US OR WHAT CONSTITUTES
OUR IDENTITY.
OUR IDENTITY IS DEFINED BY THE
ANCESTRAL VISIONS OF LOVE AND
LIFE THAT OUR ANCESTORS CARRIED
FOR US AND THE TEACHINGS THAT GO
WITH THAT THAT HAVE BEEN WITH US
FOR ILLUMINATENNIA, THAT IS HOW
OUR IDENTITY IS CONNECTED.
SO HOW DOES BEING AN LGBT OR 2
PIRIT PERSON INTERSECT WITH
NAVIGATING RACIST AND HOMOPHOBE
INCREASE IN BODY ENVIRONMENTS
AND OTHER ENVIRONMENTS WOULD BE
A QUESTION WE VALID OPPOSE TO
THINK BEING IT AND FORMING AN
IESHES DENTITY EXPERIENCE THE
MAIN 1 FOR US, IT WILL BE.
SO IT MADE WE THINK ABOUT THAT
INTERSECTIONALITY.
WE ARE NOT DEFINED BY THE
OPPRESSION, THE OPPRESSION IS
PART OF OUR EXPERIENCE, WE'RE
DEFINED BY THE DREAMS OUR
ANCESTORS CARRIED FOR US, SO
THAT'S 1 THING TO PUT OUT THERE
AND THE THEN THE RECOLLECT THING
I WANT TO ACKNOWLEDGE WE TALK
ABOUT THIS, THE NOTION OF
CISGENDER IS TIED TO YOU KNOW
ASSUMING THAT 1'S IDENTITY IS
TIED TO WHAT THEY WERE ASSIGNED
AT BIRTH BUT THE PROBLEM IS FOR
A LOT OF NATIVE COMMUNITY
MEMBERS SOMETIMES IDENTITY AND
GENDER EXPRESSION DO NOT ALIGN
NOR ARE THEY EXPECTED TO ALIGN.
SO THE ASSUMPTION OF CISGENDER
ISSUES ARE KIND OF CONFUSING IN
SOME WAYS IN NATIVE AMERICAN
COMMUNITIES YOU BECAUSE YOU
MIGHT IDENTIFY AS FEMALE, YOU
WERE ASSIGN BIRTH AT FEMALE BUT
YOUR GENDER EXPRESSION MAY BE
MASCULINE.
SO YOU KNOW, YOU'RE GOING TO
ENCOUNTER HARASSMENT IN
HEALTHCARE SETTINGS AND SO
FORTH, SO WE HAVE TO BE CAREFUL
WITH USING CISGENDER AS A PROXY
FOR JUST A HETERONORMATIVE
STRAIGHTISH VIBE, AND
ASSUMPTIONS OF FELPS NITRIC
OXIDITY VERSUS MASKUE LYNNITY.
I KNOW THE SPEAKERS ARE WAY
NUANCED AND GET ALL THAT BUT I
WANT TO PUT THAT OUT THERE FOR
CONVERSATION.
>>I APPRECIATE THAT.
YOU'RE SORT OF HIGHLIGHTING
AGAIN, THE COMPLEXITIES OF
UNDERSTANDING THIS WORK.
OKAY, MIYA, I SAW YOU NEXT.
>>CAN I JUMP BACK IN REAL
QUICK?
OR NO?
>>GO AHEAD MANDY AND THEN WE
WILL GO TO MIYA AND THEN LISA.
>>I WAS JUST GOING TO SAY, IN
TERMS OF THE COMMENT ABOUT
INTERVENTIONS, I DIDN'T MENTION
IN MY TALK THAT I'VE BEEN
WORKING ON WITH COLLEAGUES
SPONSORED BY THE AMERICAN
SOCIETY OF CLINICAL ONCOLOGY
WHERE WE LOOKED AT FACTORS THAT
WERE ASSOCIATED WITH SEXUAL
ORIENTATION AND GEPPEDDER
IDENTITY DATA COLLECTION AND THE
3 THINGS THAT REALLY BUBBLED UP
WERE LEADERSHIP SUPPORT, EHR
DOCUMENTATION AND KIND OF
UNDERSTANDING OF THE KNOWLEDGE
OF THE IMPORTANCE OF SOGI DATA
TO CLINICAL PRACTICE AND THEN WE
DID A COINCIDENCE ANALYSIS WHICH
IS A CONFIGURURATIONAL
METHODOLOGY THAT'S NOT
REGRESSION BASED AND FOR THOSE
WHO DON'T KNOW REGRESSION WAS
ACTUALLY BASED IN THE UGENICS
MOVEMENT SO I FAVOR
METHODOLOGIES THAT ARE
COMPLIMENTARY WHEN POSSIBLE.
SO CONFIGURATIONAL ANALYSIS IS A
NEWER METHOD WELL, NEWER FOR
HEALTH SERVICES THAT TAKES
CONFIGURURATIONS OF DATA AND TO
SEE WHAT THE DIFFERENCE MAKERS
ARE IN RELATION TO A PARTICULAR
OUTCOME AND SO, THAT DATA VERY
MUCH COMPLEMENTED THE REGRESSION
BASED ANALYSIS, BUT ALSO ASKING
ABOUT PRONOUNS, BUILD UP AS AN
IMPORTANT FACTOR.
SO I WOULD SAY IF YOU ARE
THINKING ABOUT STRUCTURAL
INTERVENTIONS THAT TECHNOLOGY
TRANSFERS THAT DRIVE LEADERSHIP
WERE THE IS, EHR DOCUMENTATION
AND UNDERSTANDING OF THE
KNOWLEDGE OF THE IMPORTANCE OF
THESE DATA IN PRACTICE AT LEAST
IN TERMS OF OUR ASSESS MGHT
WOULD BE DESCENT DRIVERS AND
THEN I JUST WANTED TO GIVE THAT
PLUG FOR ALTERNATIVE
METHODOLOGIES THAT WERE NOT
REGRESSION BASED SO THANKS IF
THAT ARE MINUTE.
>>THANK YOU.
>>THANK YOU EVERYONE FOR THE
AMAZING DIALOGUE TODAY IT'S BEEN
SO MEANINGFUL TO BE PART OF THIS
COLLECTIVE OF SUCH TALENTED
INVESTIGATORS.
SO I HAVE A QUESTION, IT'S A BIT
OF A QUESTION BUT ALSO A
COMMENT.
FIRST, THANK YOU DR. DIAMOND AND
DR. EVERETT FOR SPEAKING ABOUT
BOTH THE NUANCES OF WORKING WITH
LGBTQIA + CHILDREN AND YOUTH AND
ALSO THINKING ABOUT EDUCATIONAL
TOOLS THAT CAN BE USED TO KIND
OF PROVIDE SUPPORTS FOR ADULTS
WHO ARE WORKING IN THAT SPACE.
OR WORKING WITH SUPPORTING YOUNG
PEOPLE IN BOTH SEEING THE BEST
POTENTIAL IN THEMSELVES AND
LOVING THEMSELVES OR WHATEVER
AND AND GOING OUT AND LIVING
WHATEVER THEIR POTENTIAL IS, I'M
A CLINICAL PSYCHOLOGIST BY
TRAINING AND DURING MY POST
DOCTORAL FELLOWSHIP AND WHILE I
WAS DOING MY TRAINING IN
GRADUATE SCHOOL, I HAD THE
OPPORTUNITY TO WORK IN JUVENILE
CORRECTIONS AND IT JUST SO
HAPPENED THAT A NUMBER OF THE
YOUTH I WORKED WITH OR WHO WERE
ON MY CASE LOAD WERE FROM
NEIGHBORHOODS THAT WERE
ADVERSELY IMPACT BY NEIGHBORHOOD
INCIVILITY.
THERE WAS THE LAYERING OF
POVERTY AND MANY OF THEM TOO
WERE ALSO IN LGBTQIA +
POPULATIONS, AND IN WORKING WITH
THE KIDS, OFTEN I FELT LIKE A
LOT OF THE DIALOGUE WAS GOING
WITH THE CHILD OR YIEWPGHT IN
ENGAGEMENT WITH SOME ADULT
WORKING AT THE FACILITY AND SORT
OF ROLE MODELING FOR THEM, HOW
TO NAVIGATE A COMPLEX AND
MODELING FOR THE ADULT THERE,
HOW TO BE ACCEPTING, SOCIALLY
APPROPRIATE CREATING THAT SAIOF
THE SANCTUARY YOU WERE TALKING
ABOUT EARLIER, I DON'T THINK I
USED THE RIGHT NAME YOU USED
DR. DIAMOND BUT I THOUGHT THAT
WAS SO IMPORTANT AND 1 THINK
THIS I WAS STRUCK BY IN DOING
THAT WORK IS WE DON'T DO ENOUGH
TO CREATE THAT SCHOOLS ARE
PLACED OR SOMEWAYSS OF SANCTUARY
FOR CHILDREN WHERE THEY CAN LIVE
THEIR POETIC TEBTIAL, WHATEVER
THAT POTENTIAL IS, AND WHERE WE
SORPT OF LOVE ON THEM AND REALLY
CREATE THAT THEY HAVE A GOOD
SENSE OF WHO THEY ARE, CAN LOVE
THEMSELVES OVER WHATEVER CAN GO
OUT THERE AND BE WHOEVER THEY'RE
INTENDED TO BE EVERYONE WITH
THAT BEING SAID, I WAS
WOBDERRING GIVING THE
OPPORTUNITY THAT WE HAVE HERE,
ABOUT THE PANELISTS AND THE
POSSIBILITY OF CREATING A
NATIONAL NETWORK OF SCHOOL BASED
INTERVENTIONS THAT STARTS TO DO
THAT WORK TO CREATE THE SCHOOLS
OUR SAFE SANCTUARYS, I THINK
THERE'S AN OPPORTUNITY BEYOND
JUST THE MENTAL HEALTH
PROFESSIONAL THAT'S WORKED IN
THE SCHOOL BECAUSE THERE'S A
THING CALLED PASSION FATIGUE AND
IF YOU'RE THE OHM MENTAL HEALTH
PROFESSIONAL AT A SCHOOL THAT
HAS--LIKE THE HIGH SCHOOL I HAVE
WAS HERE IN WASHINGTON D.
KRMPLET AND THERE WERE 800 KIDS
ON A GIVEN DAY AND 1 MENTAL
HEALTH PRSM TRYING TO BE THE
SAFE SANCTUARY FOR ALL 800 OF
THOSE KIDS WHO MAY BE GOING
THROUGH THOSE DIFFICULT THINGS
THAT HAVE TO DO WITH LIVING IN
POVERTY AND ENVIRONMENTS THAT
HAVE CRIME AND VIOLENCE AS PART
OF THEIR SPACES, COULD WE DO A
SCHOOL BASED PROGRAM THAT
PROVIDES THAT KIDS ARE PROVIDED
WITH TRAINING TO HELP THEM
BUILD, COPING SKILLS AND
RESWRELIENCE, AND THE ABILITY TO
NAVIGATE THE STRESS, BUT ALSO DO
SOME TRAINING WITH BOTH THE
TEACHERS, THE MENTAL HEALTH
PROFESSIONALS AND TD LEADERSHIP
TEAM MEMBERS IN THOSE SCHOOLS TO
KIND OF PROVIDE THE NETWORK HAS
THE CAPACITY OVERALL TO BE THE
SUPPORTS THAT THOSE CHILDREN
NEED.
EVERYBODY OF COURSE CAN'T BE A
MENTAL HEALTH PROFESSIONAL, I'M
NOT SAYING THAT AT ALL, BUT TO
GROW EVERYONE UP, INCLUDING
ADULT THIS IS BE THE BEST
POSSIBLE THEY CAN, SO IN THE
MOMENT IF A CHILD COMES TO AND
YOU THEY'RE IN NEED, CAN YOU DO
SOME COACHING WHERE THEY'RE LEFT
FEELING LIKE, I'M INTACT, I
MATTER AND THIS PERSON WILL BE
OF OF SUPPORT TO ME BUT WHOEVER
WOULD LIKE TO START BUT I WOULD
LOVE TO HEAR YOUR THOUGHTS
DR. DIAMOND IN PARTICULAR BUT OF
COURSE EVERYONE ON THE PANEL AND
THANKS FOR THE OPPORTUNITY.
>>THANK YOU SO MUCH FOR SAYING
THAT I AGREE WHOLE HEARTEDLY, WE
USED TO THINK SCHOOLS WERE SAFE
AND NOW MY SISTER IS A SECOND
GRADE TEACHER AND THEY DO ACTIVE
SHOOTER DRILLS SO KIDS START OUT
NOT THINKING OF THE SCHOOL AS A
SANCTUARY, IT'S NOT JUST
ANYMORE.
AND THAT MAY, LIKE WE MAY NOT BE
ABLE TO UNDO THAT.
AND AND SO IT'S TYPICAL TO THINK
ABOUT THIS AND I LOVE WHEN YOU
MENTIONED LETTING KIDS KNOW THEY
MATTER AND I'M LINKING THIS TO
WHAT BRIAN MENTIONED IN TERMS OF
IBT--INTEGRATE CREASED
INNERVENTIONS THAT FOCUS ON
COUPLE RELATIONSHIP.
YOU KNOW 1 OF THE FIRST WHEN I
FIRST MOVED HERE TO SALT LAKE
CITY AND I WAS DOING STUFF WITH
THE PRIDE CENTER HERE AND
WORKSHOPS FOR YOUTH AND OVER
OVER AGAIN YOUTH KEPT SAYING, NO
1 WANTS TO TALK ABOUT DATING,
ARE WE ALLOWED TO TALK ABOUT
DATING.
AND OF COURSE, IT GETS TRICKY
BECAUSE WE HAVE A SOCIETY THAT
DOESN'T WANT YOUTH TO KILL
THEMSELVES BUT DOESN'T
NECESSARILY WANT TO ENQUALITY OF
REVIEWAGE THEM TO DATE AND YET
SOCIAL CONNECTION ATTACHMENT,
FEELING THAT YOU MATTER TO
ANOTHER PERSON IS THE BRAIN'S
WAY OF HEALING, LIKE THAT'S
WAWE'RE GIVEN.
IT'S THE RELATIONSHIPS TO WHERE
YOU FEEL IF I DISAPPEAR THAT
PERSON WILL COME FIND ME AND
THAT'S WHAT I THINK SCHOOLS
COULD DO A BETTER JOB OF
CREATING OPPORTUNITY FOR.
AND 1 OF THE THINGS THAT'S
HAPPENED AS SCHOOLS GET BIG AND
THEY'VE GONE ONLINE, IS THAT
STUDENTS FEEL INVISIBLE, THEY
FEEL LIKE THEY COULD SHOW UP TO
CLASS, THEY COULD NOT SHOW UP TO
CLASS NOBODY CARES.
ONE OF THE THINGS THAT WE KNOW
IS THAT UNCERTAINTY CREATES A
LOT OF STRESS FOR YOUTH AND FOR
MARGINALIZED POPULATIONS, AND SO
1 OF THE THINGS THAT I THINK
THAT TEACHERS CAN DO AND I KNOW
I'VE DONE THIS, I'VE DONE IN
THIS MY OWN UNDERGRADUATE
TEACHINGS AND I FOLLOW UP WITH
STUDENT WHO IS START
DISAPPEARING AND LIKE, WELL, YOU
KNOW IF THEY WANT TO FAIL THE
CLASS, THEY WANT TO FAIL THE
CLASS, NOW I'M LIKE I WANT THEM
TO KNOW THAT I NOTICE THAT THEY
DIDN'T SHOW UP, AND THAT EVEN IF
ALL I DO IS SAY, HEY, I NOTICED
THAT YOU DIDN'T SHOW UP, THAT IS
ACTUALLY AN INTERVENTION, YOU
KNOW, IN OUR SOCIETY NOW WHERE
EVERYONE IS TWITTERING AWAY AND
WE FEEL DISCONNECTED, ACTUAL
REAL PHYSICAL CONNECTIONS WHERE
SAFE ADULTS CAN SAY, I SEE YOU.
I SEE YOU.
I REMEMBER YOU.
YOU KNOW?
MY DOOR IS OPEN LIKE YEAH NOT
EVERYBODY IS A MENTAL HEALTH
PROFESSIONAL BUT WE CAN DO MORE
TO TRAIN ADULTS THAT WORK WITH
YOUTH TO SAY, WHAT THEY'RE
LACKING IS A FEELING THAT THEY
MATTER AND WHAT'S STRESSING THEM
OUT IS UNCERTAINTY.
O DO WHAT YOU CAN TO MAKE YOUR
INTERACTIONS WITH THEM CERTAIN
AND I THINK THAT'S 1 OF THE
THINGS THAT PRONOUNS CAN DO,
THEY REMOVE UNCERTAINTY FOR THE
PERSON IRPT ACTING WITH YOU.
ARE YOU A SAFE PERSON, I'M NOT
GOING TO LET YOU THINK ABOUT IT
I'M GOING TO PUT THEM OUT THERE
SO YOU KNOW.
REMOVING UNCERTAINTY AND
CREATING AND SUPPORTING
RELATIONSHIPS OF MATTERING WHEN
IT'S ROMANTIC RELATIONSHIPS, AN
AUNT, A FRIEND, I THINK ANOTHER
THING THAT TEACHERS IS FIND OUT
FROM PEOPLE THEMSELVES WHO IS IT
IN YOUR LIFE RIGHT NOW THAT YOU
KNOW YOU MATTER TO?
MAYBE IT'S GRANDMA, MAYBE IT'S
SOMEBODY ELSE, WHOEVER THAT
PERSON IS YOU NEED TO GO SPEND
MORE TIME WITH THEM.
YOU NEED TO PUT YOUR BRAIN IN AN
ENVIRONMENT WHERE YOU KNOW THAT
YOU MATTER.
SORT OF ACTIVATE THE BRAIN'S
ATTACHMENT SYSTEM, IF THEY DON'T
HAVE THAT RELATIONSHIP, YOU
SHOULD TRY TO CREATE IT BUT IN
GENERAL SAYING TO KIDS LOOK AT
YOUR LIFE RIGHT NOW, LOOK AT WHO
GIVES YOU THAT FEELING, THAT
FEELING OF TRUST, GO, DO MORE OF
THAT.
>>THANK YOU LISA.
I WOULD ALSO ARGUE THAT YOU
DON'T HAVE FOCUSED ON WORK
WITH--TO WORK WITH KIDS TO SHOW
OUTWARDLY SUPPORTIVE OF PEOPLE,
JUDGE UOF THE WHEN YOU'RE
WALKING AROUND YOUR COMMUNITY
AND ENGAGING WITH SOMEONE WHO
WORKS AT THE LOCAL ICE CREAM
SHOP OR IF YOU HAVE CHILDREN IN
SCHOOL AND YOU ARE GOING TO THE
SCHOOL YOU COULD ALSO BE A SAFE
SPACE.
>>SO WELL SAID KAREN BECAUSE I
TRULY FIRMLY BELIEVE THAT LIKE
UNFORT HATELY EVERYBODY DOESN'T
GET TO GROW UP IN A FAMILY
ENVIRONMENT WELL PEOPLE LOVE ON
YOU WELL AND KNOW HOW TO BE
EFFECTIVE IN TERMS OF MODELING
SOCIAL SUPPORT AND IMBUING IN
YOU THAT YOU MATTER OR WHATEVER,
SO ANY ADULT NO MATTER WHERE
YOU'RE WORKING IF YOU HAVE THE
EMOTIONAL AND MENTAL HEALTH
MATURITY TO KIND OF BE THERE FOR
SOMEBODY, GO AHEAD AND TAKE THE
RISK AND DO THAT.
WELL SAID, KAREN, THANK YOU.
>>SO, I THINK THAT RADA MIGHT
GET UP SET WITH ME FOR DOING
THIS BECAUSE I KNOW WE'RE AT
TIME BUT THERE IS 1 FINAL
QUESTION THAT I--
>>I COULD NEVER BE UPSET WITH
YOU.
>>I FEEL IS REALLY.
>>YOU TOOK ON THE HARDEST JOB.
>>THAT IAN PUT IN THE CHAT THAT
I WOULD LIKE TO POSE AS A LAST
QUESTION IF ANY OF THE.
>>SO, THE QUESTION IS, ABOUT
WAYS TO MAKE RESEARCH FINDINGS
ACCESSIBLE TO POLICY MAKERS IN
ORDER TO SHIFT LOCAL STATE AND
NATIONAL POLICIES THAT IMPACTS
LGBTQIA + HEALTH AND ARE WELL
BEING AND I THINK THIS IS A REAL
CHAL EXPESM 1 THAT WE THINK
ABOUT A LOT IN OUR OFFICE, IS
HOW CAN WE GET THE EVIDENCE THAT
IS GENERATED BY NIH, FUNDING TO
SORT OF OTHER PARTS OF THE
FEDERAL GOVERNMENT THAT ARE
MAKING POLICY DECISIONS, AND
ALSO TO OTHER FOLKS WHO MADE
DECISIONS THAT ARE IMPACTING ALL
OF US.
SO IF ANYONE HAS ANY FINAL
THOUGHTS ABOUT, IT FEELS LIKE A
COMMUNICATIONS PACKAGES,
MARKETING, QUESTION, IF ANYONE
WANTS TO TAKE THAT AS THE FINAL?
I'D LOVE TO HEAR YOUR THOUGHTS?
BETHANY?
>>I CAN GO REAL QUICK, SO HAVE
AN ADJUNCT APPOINTMENT IN THE
FAMILY PLANNING DEPARTMENT HERE
AND THEY HAVE DONE A REALLY,
REALLY WONDERFUL JOB AROUND
CREATING 1 PAGERS AROUND
REPRODUCTIVE HEALTH POLICIES AND
LGBTQ POLICIES WORKING WITH THEM
AND BEING A REAL LIKE TOUCH
POINT FOR POLICY MAKERS, THE
STATE OF UTAH OUR POPULATION
ISN'T THAT BIG, OUR LEGISLATIVE
SESSION IS SHORT.
AND SO IT'S TALLLY FAIRLY EASY
TO GET LINES OF COMMUNICATION
GOING BETWEEN RESEARCH AND
POLICY MAKERS, THE DIFFICULT
PART IS GETTING PEOPLE TO ACT ON
IT BUT THERE--IT HAS BEEN MORE
FEASIBLE THAN I WOULD HAVE EVER
THOUGHT TO ACTUALLY MEET WITH
LEGISLATORS AND PRESENT RESEARCH
TO THEM, AND TO OPEN THOSE LINES
OF COMMUNICATION.
SO, I WOULD ADVOCATE FOR FOLKS
TO LOOK INTO THAT IN THEIR LOCAL
AREA BECAUSE IT MIGHT BE EASIER
THAN YOU THINK.
WILL THEY LISTEN, THAT'S ANOTHER
STORY.
>>OKAY, LAST WORD FROM BRIAN
BEFORE WE WRAP UP.
>>YEAH I WAS GOING TO PUT IN A
PLUG THERE'S REALLY GREAT
REPORTS THAT PUBLICLY AVAILABLE
FROM THE WILLIAM T. GRAHAM
FOUNDATIONOT USE OF RESEARCH
EVIDENCE SORT OF WHAT SITUATION
SET UP ENVIRONMENTS WHERE POLICY
MAKERS USE RESEARCH EVIDENCE IS
1 OF THE THINGS THAT KEEPS
COMING DOWN TO IS RELATIONSHIPS
WHICH IS WHAT I THINK BETHANY
SAID WHICH IS WHEN THEY HAVE A
QUESTION, DO THEY KNOW WHO TO
CALL, WILL THEY KNOW YOU, REACH
OUT TO YOU, ARE YOU SOMEBODY WHO
RESPONDS IN A TIMELY FASHION AND
I APPRECIATE WHAT BETHANY WAS
SAYING ABOUT LOCAL POLICY MAKERS
WHICH INCLUDED ELECTED OFICIALGS
BUT INCLUDE A LOT OF APPOINTED
PEOPLE, YOU KNOW FOLKS WHO ARE
COMMISSIONERS ON YOUR HEALTH AND
YOUR CITY OR STATE OR DEPUTY
COMMISSIONERS OR HIV PORTFOLIO,
THEY HAVE A LOT OF POWER TO MAKE
A LOT OF DECISIONS AND OFTEN A
LOT OF MONEY FLOWS THROUGH THEIR
CONTROL, FEDERAL MONEY GOES TO
HEALTH DEPARTMENTS WHO THEN
DEPLOY IT TO ADDRESS DIFFERENT
INITIATIVES, SO I HAVE FOUND
GETTING TO KNOW MY
LOCAL--CHICAGO DEPARTMENT OF
PUBLIC HEALTH COMMISSIONER,
STATE COMMISSIONER OF HEALTH HAS
BEEN A REALLY FANTASTIC WAY TO
WORK WITH THEM, AND SHARE OUR
FINDINGS AND AND OFTEN TIMES IN
A COLLABORATIVE WAY, THEY WILL
COME TO US WITH QUESTIONS AND
SOMETIMES WE HAD THE DATA TO
ANSWER THEM AND WE CAN DO IT
QUICKLY SO DEFINITELY GETTING TO
KNOW YOUR LOCAL FOLKS AND HEALTH
DEPARTMENTS AND OTHER GOVERNMENT
AGENCIES, NOT ALL POLICY MAKERS
ARE ELETTED AND MANY ARE
APPOINTED AND QUITE INFLUENTIAL.
>>OKAY I SAID BRIAN HAD THE
LAST WORD; AND SO LISA HAS TO GO
QUICKLY.
>>VERY QUICKLY 1 OF THE THINGS
THIS IS A PIPELINE ISSUE, AS
ACADEMIC JOB MARKET CONTINUES TO
CHANGE, MORE AND MORE GRADUATE
STUDENTS AND POST DOCS, ARE
THINKING ABOUT CAREERS IN DATA
SCIENCE OUTSIDE OF ACADEMIA AND
THIS ISSUE OF GETTING THE RIGHT
INFORMATION OUT IS A TRAINING
OPPORTUNITY.
I'M TRYING TO SHIP THE TRAINING
IN MY OWN DEPARTMENT SO WE DO A
BETTER JOB OF PREPARING GRAD
STUDENTS FOR THOSE CAREERS.
THAT I HAVE NEED TO WRITE MORE
QUICKLY, THEY NEED TO WRITE IN A
MORE STRAIGHT FORWARD FASHION.
DISP THOSE ARE TRAINABLE SKILLS
AND THEY'RE MARKETABLE SKILLS
AND I THINK WE REALLY NEED TO
THINK AS A DISCIPLINE, OF A
BETTER JOB OF TRAINING FOLKS NOT
JUST PUBLISHING AND PURELY
ACADEMIC JOURNALS BUT TAKING
THAT RESEARCH AND WRITING IN THE
WAY THAT'S COMMUNICABLE AND THAT
WILL HELP TO PLACE WELL TRAINED
PEOPLE NOT JUST IN ACADEMIA BUT
IN THESE SOCIAL SERVICE AND
GOVERNMENT POSITIONS.
>>SO WITH THAT I WILL JUST END
MY PORTION WITH A HEARTY THANK
YOU.
TO ALL OF THE PANELISTS TO NIMHD
TO THE PLANNING COMMITTEE AND TO
ALL OF THE ATTENDEES FROM TODAY,
JOHN HAD TO JUMP OFF, BUT HE
ENDED BY SAYING, THANKS TO ALL
WHO TOOK THE TIME BECAUSE TIME
IS PRECIOUS.
I WILL STEAL THAT FROM JOHN
TODAY WITH MY THANK YOU.
RADA?
>>THEARVEG
>>--THANK YOU SO MUCH FOR
MODERATING THIS AND THANK TO YOU
ALL THE SPEAKER WHO IS SPOKE
TODAY.
IT'S BEEN VERY, INTERESTING, YOU
KNOW TALKS AND YOU KNOW A LOT OF
THEMES THAT IMPORTANT RESEARCH
DIRECTIONS HAVE BEEN STATED
TODAY AND I'M LOOKING FORWARD TO
TOMORROW'S SPEAKERS AND WHAT
THEY'RE GOING TO ADD TO OUR
DISCUSSIONS AND THE WAY WE CAN
GO FORWARD WITH THE RESEARCH ON
ACM HEALTH.
YEAH, SO, THANK YOU AND LOOKING
FORWARD TO SEE YOU AGAIN
TOMORROW.
AND HAVE YOU PARTICIPATE