>>WELCOME, I'M RADA DAGHER
AND THE CHAIR FOR THE TWO DAYS.
YESTERDAY WE HAD A LIVELY
DISCUSSION TALKING ABOUT THE
DISPARITIES AND WE'LL TALK HOW
IDENTITIES AFFECT THE SGM
POPULATIONS AND DISCUSS
INTERVENTIONS.
I ALSO WOULD LIKE TO SHARE AN
ARTICLE I SAW YESTERDAY I
THOUGHT WOULD BE INTERESTING TO
SHARE TODAY AND GIVE US IDEAS
THE CART IS RESILIENCE AS AN
ADVERSE EVENT AND SAYS MAKE IT'S
AN EXPECTATION THAT HAS BEEN
LEVIED ON EXCLUDED POPULATIONS
AND SO I WOULD INVITE YOU TO
THINK WHAT'S NEEDED FOR THOSE
POPULATIONS WHO ARE RACIAL
ETHNIC MINORITIES AND THINK
ABOUT WHAT ARE SYSTEMIC FACTORS
WE NEED TO INTERVENE ON AND VEER
AWAY FROM THE INDIVIDUAL
RESILIENCE PARADIGM.
I WOULD LIKE TO INTRODUCE MY
COLLEAGUE DR. ERIK RODRIGUEZ WHO
WILL BE SPEAKING AN INTRAMURAL
RESEARCHER AT NHLBI AND WILL BE
MODERATING THE NEXT SESSION.
GO AHEAD.
>>THANK YOU, RADA.
I'M ERIK RODRIGUEZ AN
EPIDEMIOLOGIST AT THE HEART,
LUNG, BLOOD INSTITUTE AND
LOOKING AT INTERSECTIONS BETWEEN
SGM AND OTHER POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES.
THE ROLE OF TODAY'S SESSION IS
TO DESCRIBE THE PATTERNS AND
DRIVERS OF HEALTH DISPARITIES IN
SGM POPULATIONS WITH
INTERSECTING SOCIAL STATUSES.
WE HAVE THREE SPEAKERS INCLUDING
DR. AGUAYO-ROMERO AND
DR. FLANDERS AND SARAH MURRAY
FROM THE SCHOOL OF PUBLIC
HEALTH.
I BELIEVE WE'LL START WITH
DR. AGUAYO-ROMERO IF YOU'RE
READY.
>>GOOD MORNINGS THE TALK TODAY
I'LL BE TALKING ABOUT HOW THIS
IS EXPERIENCED WITH PEOPLE OF
COLOR CAN AND MORE THAN ANYTHING
I'LL PROVIDE AN OVERVIEW OF THE
EXPERIENCE OF THIS POPULATION
AND IT WILL TAKE MORE TIME TO GO
INTO THE POTENTIAL ITERATIONS OF
LOOKING AT RACE AND OTHER
DIFFERENT RACIAL GROUPS AND
GENDER IDENTITY GROUPS POR
PEOPLE BUT I WANTED TO START BY
TALKING ABOUT I DID HAVE
DISPARITIES AND LOOKING AT
THROUGH THE LENS OF
INTERSECTIONALITY AND BRIEFLY
TALKING ABOUT WHEN YOU TALK
ABOUT THIS WE'RE NOT ONLY
TALKING ABOUT PEOPLE THAT AT THE
INDIVIDUAL LEVEL EXPERIENCE
DISCRIMINATION GIVEN MULTIPLE
MARGINALIZED IDENTITIES BUT THIS
IS PRODUCED BY AND IMPACTED BY
DIFFERENT LEVELS.
WHAT IS THE EXPERIENCE OF THE
INDIVIDUAL LEVEL AS A RESULT OF
THE PERSONAL LEVEL AND
STRUCTURAL LEVEL WHEN THERE'S
POLICIES IN PLACE THAT IMPACT
SPECIFIC POPULATIONS AND
CURRENTLY WE'RE SEEING IMPACT OF
THE TRANSGENDER COMMUNITY
DIRECTLY.
WE'RE SEEING MANY EXAMPLES HOW
AT THE STRUCTURAL LEVEL THERE
ARE ATTEMPTS TO IMPACT THE
HEALTH OF PEOPLE WHEN IT COMES
TO TREATMENT OF CARE.
AND IF WE'RE TALKING ABOUT
PEOPLE OF COLOR THEY'RE NOT ONLY
EXPERIENCING GENDERISM OR TRANS
PHOBIA BUT RACISM.
THEY'RE HEALTH IS GOING TO BE
IMPACTED BY THE INTERLOCKING
SYSTEMS.
THAT SAID, THOSE ARE NOT THE
ONLY TWO SYSTEMS IMPACTING
PEOPLE OF COLOR.
AS WELL SOME STUDIES ALWAYS SEEM
IT FIND THE DISPARITIES GO TO
POVERTY AND EMPLOYMENT AND
HAVING LOWER INCOME WHICH ALSO
SHOWED THE CONNECTION TO ANOTHER
SYSTEM OF OPPRESSION AND
CLASSISM.
AND CLASSES AND ITSELF THOUGH
IT'S ALWAYS SEEN AS DEMOGRAPHIC
OR IMPACT ON THE HEALTH AND HOW
PEOPLE EXPERIENCE THIS IN
SETTINGS.
GOING OVER SOME OF THE MENTAL
HEALTH DISPARITIES.
TO BEGIN WITH, SOME STUDIES THAT
ARE GENDER QUEER FOR THIS CASE
THE WAY THEY LOOKED AT CISGENDER
PEOPLE AND QUEER INDIVIDUALS AND
LOOKING AT THOSE THAT DON'T
ADHERE TO THE BINARY SYSTEM OF
GENDER SO THEY INCLUDING
NON-BINARY INDIVIDUALS AND THEY
FOUND THEY EXPERIENCED MORE
ANXIETY, DEPRESSION,
PSYCHOLOGICAL STRESS AND EATING
DISORDERS AND MAY HAVE BEEN
SEXUALLY ABUSED AND SUBJECTED TO
ADVERSE EVENTS AT HIGHER RATES
AND EXPERIENCE HIGHER
SUICIDALITY.
WHEN WE LOOK AT DIFFERENCES
WITHIN GENDER GROUPS WE SEE
THESE DISPARITIES.
THERE'S BEEN SOME ANALYSIS
LOOKING AT PEOPLE OF COLOR AND
MENTAL HEALTH AND IN THE
LITERATURE WE FOUND THERE'S A
SMALL NUMBER OF ARTICLES THAT
ARE SPECIFIC ABOUT TRANSGENDER
PEOPLE OF COLOR.
THIS IS AN AREA THAT DOESN'T
RECEIVE MUCH ATTENTION.
AND IT'S BEEN IDENTIFIED BY A
COUPLE CONTENT ANALYSIS.
THE EXPERIENCE RHEUMATOID
ARTHRITIS, GOUT, ASTHMA AND
DEPRESSION AND AGAIN I MENTIONED
BEFORE THIS IS RELATED TO HAVING
LOWER INCOME.
OVER ALL THE UNDER
REPRESENTATION OF PHYSICAL
HEALTH RESEARCH WHEN IT COMES TO
RACE AND ETHNICITY.
THERE ARE SOME SAMPLES OR
SURVEYS LOOKING AT THE
INTERSECTION AND THE 2015
TRANSGENDER SERVE IS THE LARGEST
SURVEY AND WE SHOULD SEE MORE
REPORTS LATER THIS YEAR BUT THE
CURRENT REPORT -- THEY ALSO
PROVIDE A REPORT LOOKING AT THE
INTERSECTION OF RACE AND GENDER
IDENTITY.
YOU CAN FIND THE ARE REPORT
AVAILABLE ONLINE AND LOOK AT
BLACK TRANSGENDER PEOPLE, LATINO
INDIVIDU
INDIVIDUALS THERE WERE
DISPARITIES FOUND IN THE SURVEY.
PARTICULARLY IN TERMS OF
INDIVIDUALS NOT HAVING INSURANCE
COMPARED TO THE ENTIRE
U.S. POPULATION.
BLACK TRANSGENDER PEOPLE HAD A
HIGHER RATE OF NOT HAVING
INSURANCE, ALMOST DOUBLE OF THE
U.S. POPULATION AND WE SEE
SIMILAR NUMBERS FOR LATINO
TRANSGENDER AND AMERICAN INDIAN
AND ALASKAN NATIVE INDIVIDUALS.
WE SEE GREATER DISPARITIES IN
HIV AND PSYCHOLOGICAL DISTRESS
AND SUICIDAL ATTEMPTS AND MOST
THE LITERATURE SHOWS THE BIGGEST
DISPARITY HAS TO DO WITH HIV AND
THE MOST IMPACTED POPULATION BY
HIV ARE BLACK TRANSGENDER
INDIVIDUALS.
WHEN IT TO PSYCHOLOGICAL
DISTRESS AND SUICIDALITY THE
RATES ARE EIGHT TIMES HIGHER
THAN U.S. FOR ALL RACIAL GROUPS.
EVEN FOR SUICIDAL ATTEMPTS EVEN
FOR THE WHITE TRANSGENDER GROUP.
THERE'S HIGHLY DOCUMENTED
DISPARITIES.
THERE'S BEEN EFFORTS TO LOOK AT
FUNDING AND GIVEN THE NEED FOR
THIS POPULATION AND THERE AN
INITIATIVE BY THE HEALTH
RESOURCES AND SERVICES
ADMINISTRATION OF IMPLEMENTING
AND EVALUATING INTERVENTIONS.
THEY HAD NINE DEMONSTRATION
PROJECTS IN THE U.S.
AND THAT INCLUDED DIFFERENT
ASPECTS OF DIFFERENT ACTIVITIES.
THERE'S BEEN SOME OF THAT
ALREADY HAPPENING.
AN AREA THAT WASN'T AS EXPLORED
IN THE LITERATURE OR IN THE
HEALTH DISPARITIES LITERATURE
AND IT'S GOTTEN MORE ATTENTION
RECENTLY IN LOOKING AT
RESILIENCE.
I LOOKED AT HIV TESTING AMONG
TRANSGENDER WOMEN OF COLOR USING
THE SURVEY FROM 2015 I LOOKED AT
THE INTERSECTION OF BEING A
TRANSGENDER WOMAN AND THE HIV
TESTING PATTERN AND COMPARING
THOSE WHO TEST ED IN THE PAST
YEAR AND NON-TESTER.
WHEN WE THINK ABOUT EXPERIENCING
DISCRIMINATION WE THING THOSE
HIGHLY MARGINALIZED ARE FROM
MULTIPLE SYSTEMS AND THINK
THEY'LL HAVE WORSE HEALTH
OUTCOMES AND THAT WAS THE
OPPOSITE.
IN THIS STUDY A WOMAN OF COLOR
EXPLORED THE GROUPS EXPERIENCING
RACISM AND CLASSISM HAD HIGHER
PROBABILITIES THEIR WOMEN OF
COLOR FROM OTHER CLASSES.
SO IN THIS CASE THEY WERE
EXPECTED TO HAVE A WORSE OUTCOME
AND THEY WERE THE ONES NOT
GETTING TESTED MORE REGULARLY.
THERE ARE NO CLEAR PATHWAYS WHY
THIS IS HAPPENING AND ONE REASON
IS AND THIS WAS ALSO THE PEOPLE
THAT BELONG IN THIS GROUP THERE
WAS A HIGHER PROBABILITY THERE
WERE BLACK TRANSGENDER PEOPLE
THAT BELONG TO THESE GROUPS.
IT COULD BE A MATTER OF
DIFFERENCES HERE FOREBLACK
TRANSGENDER WOMAN GIVEN THEY'RE
AFFECTED BY THIS AND THERE'S AN
AREA THAT NEEDS ATTENTION AND
THERE'S AN INTERSECTION OF RACE
AND ETHNICITY AND SOME OF AREAS
WE NEED TO EXPLORE MORE THE
PATHWAY ANALYSIS LOOKING AT THE
PATHWAY AND WHY THE DISPARITIES
ARE OCCURRING AMONG SGM
POPULATION AND SOME SAY IT'S
HARDER BECAUSE OF THE SAMPLE
SIZE BUT IT'S HARD WHEN YOU ARE
LOOKING AT THE INTERSECTION.
IT GETS HARDER TO FIND SAMPLE
SIZES BIG ENOUGH TO LOOK AT THE
DIFFERENT SETS AMONG DIFFERENT
RACIAL GROUPS AND ALSO IF YOU
WANT TO LOOK AT MORE REGULARITY
AND DIFFERENCES BETWEEN
TRANSGENDER WOMEN AND MEN AND
THERE'S NOT ENOUGH DATA ON THAT.
HAVING LARGE SURVEYS LIKE THE
U.S. TRANSGENDER SURVEY ALLOWS
FOR THE DISAGGREGATED DATA AND
THERE'S RESEARCH FOCUSSING ON
TRANSGENDER WOMEN AND NOT BINARY
PEOPLE AND THERE'S AN UNDER
REPRESENTATION OF PACIFIC ANDERS
AND OTHER INDIVIDUALS AND WE
MENTIONED THE INTERSECTIONALITY
AT THE TRUCK STRUCTURAL LEVEL.
AND LOOK AT OTHER AREAS THAT
NEED MORE ATTENTION INCLUDE
GIVEN DISPARITIES TEND TO BE
ASSOCIATED WITH ISSUES OF INCOME
AND ACCESS TO HEALTH CARE.
THERE NEEDS TO BE A MORE
INTENTIONAL EXPLORATION OF THE
CLASSISM AND SYSTEM OF
OPPRESSION AMONG TRANSGENDER
PEOPLE OF COLOR AND ABLISM.
AS WE TALK ABOUT HEALTH THERE'S
DIFFERENT A NUMBER OF
TRANSGENDER PEOPLE AND PEOPLE OF
COLOR THAT ARE DISABLED AND
THAT'S AN AREA THAT IS ALSO NOT
EXPLORED ENOUGH.
WE DO NEED A MORE AVENUE OF
LOOKING AT THE PATHWAYS AND WE
NEED MORE INFORMATION LOOKING AT
PATHWAYS RELATED TO RESILIENCE
AND RESISTANCE.
ACCORDING TO THAT I'M ALMOST AT
MY TIME ACCORDING TO MY TIMER.
THANK YOU.
>>THANK YOU, DR. AGUAYO-ROMERO.
WE'LL MOVE ON TO DR. FLANDERS.
ARE YOU READY?
>>YES, THANK YOU.
>>OKAY.
THANK YOU FOR HAVING ME HERE
TODAY AND THANK YOU FOR THE
FIRST PRESENTATION THAT WAS
REALLY INTERESTING AND LOTS OF
IMPORTANT INFORMATION.
SO I AM HERE TO TALK A LITTLE
BIT MORE WITH HEALTH DISPARITIES
RESEARCH WITH BISEXUAL WOMEN OF
COLOR AND I'M COMING FROM
HOLYOKE COLLEGE IN MASSACHUSETTS
AND I'LL TALK ON REPRODUCTIVE
HEALTH AND I'M ALSO STARTING OFF
WITH THINKING ABOUT
INTERSECTIONALITY.
THANK YOU TO DR. AGUAYO-ROMERO
IN GIVING AN EXCELLENT
INTRODUCTION TO HOW
INTERSECTIONALITY AS A FRAMEWORK
CAN BE A POWERFUL TOOL FOR
THINKING ABOUT PUBLIC HEALTH AND
SEXUAL AND GENDER MINORITY
HEALTH AND I THINK ABOUT IT AS A
USEFUL WAY TO HELP BOTH SHANE
QUESTI
QUESTIONS AND TO ASK OURSELVES
WHO IS MISSING AND WHO HAS BEEN
INTENTIONALLY ERASED FROM THE
RESEARCH AND FROM THE
CONVERSATION ABOUT HEALTH AND
WELL-BEING.
WHEN I THINK OF
INTERSECTIONALITY AS IT CONNECTS
TO HEALTH DISPARITIES IN
PARTICULAR IT'S NOT JUST
THINKING ABOUT THAT INDIVIDUAL
LEVEL AND THE INDIVIDUAL
EXPERIENCE.
WE ALL HAVE MULTIPLE IDENTITIES
BUT IT'S REALLY THINKING ABOUT
THAT INTERSECTING SOCIAL POWER
AT A STRUCTURAL LEVEL THAT THEN
SHAPES AND INFLUENCES HOW THE
WORLD SEES US AND HOW WE SEE THE
WORLD.
IT ALSO SHAPES OUR EXPERIENCES
OF HEALTH AND WHAT BARRIERS AND
FACILITATORS WE EXPERIENCE IN
RELATION TO HEALTH.
WHEN I THINK OF THE HEALTH OF
LESBIAN AND BISEXUAL WOMEN OF
COLOR AND WHEN I LOOK AT WORK
FROM COLLEAGUES AROUND 2008
WITHIN THE AREA OF MENTAL HEALTH
STARTED TALKING ABOUT THIS IN
VISIBILITY IN ACADEMIC
LITERATURE AND THE IDEA IS WE
EXPERIENCE ERASURE OF PEOPLE WHO
EXIST AT THE INTERSECTIONS OF
SOCIAL OPPRESSION AND WE'LL TALK
ABOUT THAT MORE IN A MOMENT BUT
WITHIN THE HEALTH RESEARCH FIELD
THAT OFTEN TIMES LOOKS LIKE IF A
COMMUNITY OR GROUP OF PEOPLE, IF
A POPULATION IS ERASED FROM
PUBLIC ACKNOWLEDGEMENT, IT ALSO
MEANS THEY'RE BEING ERASED FROM
HEALTH RESEARCH AND THEREFORE
SOLUTIONS.
TO PARAPHRASE KIMBERLY CRENSHAW,
IF YOU CAN'T SEE A PROBLEM YOU
CAN'T SOLVE THE PROBLEM.
THAT THEN LEADS TO FURTHER
PERPETUATION OF THE HEALTH
INEQUITIES WE SEE.
I'LL START TALKING ABOUT THE
DISPARITIES LITERATURE WITH
MENTAL HEALTH AND MOVE ON TO
TALK ABOUT MORE ABOUT SEXUAL AND
REPRODUCTIVE HEALTH AND THE IDEA
OF INTERSECTIONAL AND
VISIBILITY.
THIS IS SOMETHING WRITTEN ABOUT
AN IDEA OF A PROTOTYPICAL PERSON
THIS GOES BACK TO KIMBERLY
CRENSHAW'S WORK IN THE LATE '80s
AND '90s ABOUT DISCRIMINATION
LAW BUT IF YOU HAVE
DISCRIMINATION LAW THAT PROTECTS
WOMEN AND BLACK WOMEN AND THAT
GETS INTERPRETED AND BLACK WOMEN
OF THE INTERSECTION OF RACISM
AND SEXISM DON'T BENEFIT FROM
THE LAW PROTECTIONS.
SIMILARLY WHEN WE'RE THINKING
ABOUT WHAT A PROTOTYPICAL SEXUAL
MINORITY WOMEN LOOKS LIKE OFTEN
WE THINK OF A WHITE WOMAN.
THAT MEANS WHEN YOU LOOK AT
RESEARCH WITH SEXUAL MINORITY
WOMEN AND BISEXUAL LESBIAN WOMEN
IT OFTEN LOOKS LIKE THE ERASURE
THAT LEADS TO THE ERASURE OF
WOMEN OF COLOR WITHIN THE HEALTH
RESEARCH FIELD AND MENTAL HEALTH
RESEARCH IN PARTICULAR HERE.
CONSTANT ANALYSIS OF
QUANTITATIVE RESEARCH PUBLISHED
ON BISEXUAL MENTAL HEALTH WHICH
IS A COMMUNITY OVERLOOKED OR
OVERRACED AND MONOSEXUAL THE GAI
AND LESBIAN PEOPLE WITHIN A
CONTENT ANALYSIS THAT DID REPORT
SEPARATE DATA FOR BISEXUAL
PEOPLE RELATIVE TO GAI AND
LESBIAN PEOPLE ONLY 7% OF THAT
LITERATURE ACTUALLY REPORTED ON
OUTCOMES FROM PARTICIPANTS OF
COLOR.
HAD SEPARATE DATA REPORTED.
IT IS A SMALL AMOUNT OF RESEARCH
INFORMATION OR RESEARCH
ATTENTION WITHIN THIS PARTICULAR
POPULATION.
TO LOOK AT SOME OF THE RESEARCH
THAT DOES EXIST AROUND SOME
EXISTING DISPARITIES THAT HAVE
COME UP, WE IN RELATION TO
MENTAL HEALTH DO FIND WHEN
YOU'RE LOOKING AT WITHIN THE
SAME RACIAL AND ETHNIC GROUPS
THAT SEXUAL MINORITY FOLKS
WITHIN THOSE GROUPS REPORT WORSE
MENTAL HEALTH OUTCOMES RELATIVE
TO THE SEXUAL MINORITY WOMEN
OVERALL AND WE SEE BLACK AND
LATINA SEXUAL WOMEN AND
INCLUSIVE AND LOOKING AT HIGHER
RATES OF DEPRESSION AND WE
LOOKED SPECIFICALLY AT BISEXUAL
BLACK AND LATINA WOMEN AS WELL.
WHAT I WOULD STATE IT'S
IMPORTANT WHEN WE THINK OF
HEALTH DISPARITIES WHEN WE THINK
OF WOMEN OF COLOR IS TO NOT
ALWAYS GROUP THOSE TO SEXUAL
IDENTITY GROUPS TOGETHER.
THERE'S LOTS OF HEALTH
DIFFERENCES BETWEEN LESBIAN AND
BISEXUAL WOMENOV OVER ALL AND SE
OF THOSE DISPARITIES ARE BEING
PERPETUATED WITHIN RACIAL AND
ETHNIC GROUPS WITHIN THE SEXUAL
ORIENTATION CATEGORIES.
WE ALSO FIND LOOKING AT YOUNGER
BLACK AND LATINA SEXUAL MINORITY
PEOPLE THAT IS INCLUSIVE OF
WOMEN THAT THERE ARE GREATER
SUICIDALITY RATES COMPARED TO
HETROSE
HETROSEXUAL PEERS AND THIS PLACE
A SIGNIFICANT ROLE IN THE
HEIGHTENED VULNERABILITY FOR
EXPERIENCING SUICIDALITY.
SO IN THE SECOND POINT EVEN
TRYING TO CONTROL FOR SOME OF
THE INFLUENCE OF RACIAL
DISCRIMINATION WE SEE SEXUAL
MINORITY DISCRIMINATION AS A
SIGNIFICANT DRIVER OF INCREASING
RISK FOR SUICIDALITY AMONG BLACK
AND HISPANIC SEXUAL MINORITY
ADULTS AND PARTICULARLY IN YOUNG
ADULTHOOD.
SOME OF MY MORE RECENT WORK HAS
BEEN LOOKING AT INTERSECTIONS
BETWEEN CIS WOMEN AND NON-BINARY
GROUPS AND IN PARTICULAR WE
FOUND THERE'S SIGNIFICANT
DIFFERENCES BETWEEN CIS WOMEN
AND NON-BINARY WOMEN WHO
IDENTIFY AS BUY SEXUAL AND IN
PARTICULAR THAT SEEMS TO BE
DRIVEN BY DIFFERENCES BETWEEN
CIS WOMEN OF COLOR WHO ARE
BISEXUAL AND NON-BINARY PEOPLE
WHO ARE BISEXUAL AND IDENTIFY AS
A PERSON OF COLOR.
WE'RE FINDING NUANCES FOR HOW WE
MIGHT UNDERSTAND DIFFERENCES OR
DISPARITIES IN MENTAL HEALTH
OUTCOMES ACROSS CIS WOMEN AND
NON-BINARY FOLKS AS IT
INTERSECTS WITH RAGE AND
ETHNICITY.
I'LL MOVE ON TO SEXUAL AND
REPRODUCTIVE HEALTH.
AGAIN IT'S A LIMITED BODY OF
RESEARCH THAT HAS IDENTIFIED
WHAT SOME OF THOSE DISPARITIES
ARE AT THIS LEVEL OF LOOKING
SPECIFICALLY AT RACIALLY
MINORITY PEOPLE WHO ALSO
IDENTIFY AND THERE ARE BARRIERS
TO MAINTAINING SEXUAL AND
REPRODUCTIVE WELLNESS.
SOME INCLUDE THEY'RE DELAYING
ACCESS TO CARE LIKE PAP EXAMS OR
SEEKING CONTRACEPTIVE CARE OR
SOMETHING LIKE THAT.
SOME REASONS FOR DELAYING CARE
ARE RELATED TO COST AND WE SAW
INFORMATION RELATED TO INSURANCE
AND WE SEE SIMILAR PATTERNS
WITHIN LESBIAN AND BISEXUAL
WOMEN OF COLOR WITH REDUCED
ACCESS TO INSURANCE AND PRIMARY
CARE.
AND ANTICIPATE SIGMA AND THAT'S
A BARRIER TO CARE AND DISTRUST
OF HEALTH CARE SYMPTOMS
JUSTIFIED WITH THE LEVEL OF
INSTITUTIONAL RACISM AND
HETEROSEXISM PERPETUATED WITHIN
OUR CURRENT SYSTEMS.
SOME OF THE SPECIFIC DISPARITY
RESEARCH LOOKS AT BARRIERS
RELATED TO PROVIDER INTERACTIONS
AND I'LL TALK A BIT ABOUT
PREVENTATIVE CARE.
IN TERMS OF BARRIERS THAT ARE
RELATED TO INTERACTIONS WITH
PROVIDERS, RESEARCH HAS FOUND
BLACK AND LATINA SEXUAL MINORITY
WOMEN REPORT LESS OFTEN GETTING
CONTRACEPTIVE COUNSELLING
COMPARED TO WHITE HETEROSEXUAL
COUNTERPARTS.
WE KNOW SEXUAL BEHAVIOR IS NOT
PREDICTED BISEXUAL IDENTITY
ORIENTATION.
THAT MEANS SOME FOLKS ARE NOT
GETTING THE COUNSELING AND CARE
THEY NEED.
WE ALSO FIND REPORTS WITH A LACK
OF SHARED CULTURAL UNDERSTANDING
WITH A WHITE HETEROSEXUAL
PROVIDER CAN LEAD TO
MISINFORMATION,
MISCOMMUNICATION,
MISUNDERSTANDING OF WHAT
SOMEONE'S ACTUAL HEALTH CARE MAY
BE AND WHEN WE LOOK AT A STUDY
OF BLACK TRANS WOMEN WHO WERE
ACROSS SEXUAL IDENTITY BUT
INCLUSIVE OF BISEXUAL LESBIAN
WOMEN AS WELL SOMETIMES THE
COMMUNICATION CAN GET TO A LEVEL
OF DECREASED PARTICIPATION OF
WOMEN COMING IN FOR CARE WHICH
CAN REDUCE ACCESS TO OTHER
SEXUAL AND REPRODUCTIVE HEALTH
RESOURCES.
LOOKING AT PREVENTIVE CARE WE
FIND FOR HPV VACCINATION IS
IMPORTANT BECAUSE IT REDUCES OR
CAN PREVENT THE HPV STRAINS MOST
LINKED TO CERVICAL CANCER AND
THEN WE FIND THAT BLACK LESBIAN
WOMEN ARE THE LEAST LIKELY TO
RECEIVE HPV VACCINATION COMPARED
TO WHITE HETEROSEXUAL PEERS AND
MEANS BLACK WOMEN ARE BEING AT A
HIGHER LEVEL OF VULNERABILITY
FOR THE POTENTIAL FOR CERVICAL
CANCER LATER UPON -- ON.
WE ALSO GO BACK TO THE DELAY OF
ACCESSING CARE WHEN WE LOOK
SPECIFICALLY AT ACCESSING CARE
AROUND BREAST CANCER, BLACK
SEXUAL MINORITY WOMEN ARE LIKELY
TO DELAY ACCESSING THE CARE
COMPARED TO WHITE STRAIGHT WOMEN
AND THAT TOO IS TIED IN WITH
EXPERIENCING DISTRUST OF THE
HEALTH CARE SYSTEM.
MANY KNOW HER AS THE MOTHER OF
PRIDE AND ONE OF THE MOST
SIGNIFICANT FIGURES OF QUEER AND
TRANSACTION ACTIVISM WITHIN OUR
NATION'S HISTORY AND OVER ALL
LESBIAN AND BISEXUAL WOMEN OF
COLOR DESERVE REPRODUCTIVE CARE
AND THAT'S WHAT I HAVE FOR YOU
AND THE REFERENCES ARE INCLUDE
AND I'LL BE MADE AVAILABLE
LATER.
THANK YOU.
>>THE SLIDES WILL BE MADE
AVAILABLE IN TWO WEEKS.
DR. MURRAY, ARE YOU AVAILABLE?
>>YES, HI.
I'M SARAH MURRAY AND I'M
BATTLING LARYNGITIS AND I'LL
TALK ABOUT THE STIGMA OF SOCIAL
DETERMINANT OF MENTAL HEALTH
DISPARITIES EXPERIENCED BISEXUAL
GENDER MINORITIES AND HOW IT
SERVES THE POPULATION IN THE
U.S.
I WON'T SPEND MUCH TIME OVER
THIS BECAUSE I THINK A IT'S
INCREASINGLY WELL ESTABLISHED IN
OUR FIELD AND B SOME OF THE
TALKS YESTERDAY AND JUST NOW
HAVE DONE A FANTASTIC JOB MAKING
THIS CLEAR.
JUST TO REMIND US THAT WE SEE
ELEVATED PROBLEMS OF MENTAL
ILLNESS AND SUICIDE AMONG
BISEXUAL ADULTS OR GENDER
MINORITIES COMPARED TO CISGENDER
FOLKS.
THE 2015 DATA ALSO SHOWN BY
DR. SCHULER YESTERDAY WE'RE
SEE1 IN
3 SEXUAL MINORITY ADULTS
REPORTING MENTAL ILLNESS AND THE
GENDER SURVEY DR. AGUAYO-ROMERO
JUST SHOWED US NEARLY 40% OF
TRANSGENDER ADULTS SHOWING
STRESS COMPARED TO 5% OF THE
GENERAL POPULATION AND 40% ALSO
REPORTED A LIFE TIME SUICIDE
ATTEMPT AND 7% OF PAST YEAR
SUICIDE ATTEMPT.
THESE DISPARITIES ARE
STAGGERING.
HOW DO WE BEGIN TO MAKE SENSE OF
THIS IN MENTAL HEALTH AND
SUICIDE?
WE KNOW STIGMA'S ASSOCIATED WITH
MENTAL HEALTH OUTCOMES AND A
REVIEW IN 2015 IDENTIFIED
STUDIES AMONG TRANSGENDER FOLK
AND MOST THE STUDIES WERE CROSS
SECTIONAL.
WE CONSIDERED STIGMA PROCESSES
FROM THE STRUCTURAL LEVEL TO THE
INDIVIDUAL AND THE WAY THE
PROCESSES AT DIFFERENT LEVELS
DRIVE RISK AND PROBABLY THE MOST
COMMON FRAMEWORK WERE USED TO
TRY TO UNPACK AND CONSIDER THAT
OF MINORITY STRESS WHICH I THINK
MOST PEOPLE WOULD BE FAMILIAR
WITH BUT WE CAN THINK OF THE
PROCESSES AS OCCURRING DISTALLY
AND EXTERNAL AND RANGE FROM CIS
AND HETERONORMATIVE AND STIGMA
REFLECTED UP LAWS AND POLICIES
WE'RE INCREASINGLY SEEING RIGHT
NOW AS WELL AS EXPERIENCES OF
DISCRIMINATION PEOPLE ENCOUNTER
BECAUSE OF THESE THINGS.
THIS INCLUDES MORE DAILY
EXPERIENCES OR WHAT OFTEN GETS
TERMED MICROAGGRESSION.
THOUGH I WANT TO CAUTION THAT
SHOULD NOT BE TAKEN TO MEAN THE
IMPACT OF THESE THINGS ARE SMALL
OR THE MEANING IS LESS
SIGNIFICANT BECAUSE THEY OCCUR
FREQUENTLY.
THE DISTAL PROCESSES SHAPE THE
PROCESSES THAT ARE INTERNAL.
THINGS LIKE THE INTERNALIZATION
OF STIGMA AND ANTICIPATION OF
STIGMA BY MINORITIZED
INDIVIDUALS AND THERE'S A PIECE
BY RICKMAN AND LATNER DESCRIBING
THE CRITICAL PSYCHOLOGICAL
PROCESSES THAT OCCUR IN RESPONSE
TO THESE EXPERIENCES THAT CAN
AFFECT MENTAL HEALTH.
DR. DIAMOND DID A BETTER JOB
THAN I CAN YESTERDAY EXPLAINING
SOME OF THE CONSIDERATIONS.
BUT JUST TO MENTION WE CAN THINK
OF THEM AS FALLING IN MULTIPLE
BUCKETS LIKE COPING AND
EMOTIONAL REGULATION, SOCIAL,
INTERPERSONAL FACTORS AND
COGNITIVE PROCESSES.
FOR INSTANCE HOW IT MATTERS WHEN
YOU'RE ATTENTION IS CONSTANTLY
BEING AVERTED TO MANAGING THE
POWER DYNAMICS AND HIERARCHIES
AND WHAT IT DOES TO ATTENTION.
IF WE THINK OF STIGMA AS LEADING
TO POOR MENTAL HEALTH OUTCOMES
AS IN SUICIDE OR POOR MENTAL
HEALTH THEN LEADING TO SUICIDE
WE TRIED TO UNPACK THE LEFT SIDE
OF THE FIGURE BUT THINK WE KIND
IGNORED THE RIGHT SIDE.
THIS IS WHERE WE CONSIDER THINGS
LIKE IDEATION, BEHAVIORS OR
ACQUIRED CAPABILITY TO ENGAGE IN
SELF-HARM AND ATTEMPTS USING AN
IDEATION TO ACTION FRAME WORK IS
HELPFUL AND THE MOST WIDELY
FRAMEWORK IS THE PSYCHOLOGICAL
THEORY OF SUICIDE HIGHLIGHTING
THE ROLE OF THWARTED
BELONGINGNESS AND RECEIVE
BURDENSOMENESS WHICH CAN BE
UNDERSTOOD TO BE A REACTION TO
THINGS LIKE ECONOMIC
MARGINALIZATION AND FAMILY
CONFLICT AND THEY MAY BE A
RESULT OF THE DISTAL STIGMA AND
THWARTED BELONGINGNESS ARE MORE
PROXIMAL THAN SOME MENTAL
DISORDERS AND DISTRESS AND ONCE
IDEATION EXIST AS A
SENSITIZATION TO LOSS AND PAIN
AND DEATH THAT MAY OCCUR AS A
RESULT OF EXPERIENCING TRAUMA IS
UNDERSTOOD TO CONTRIBUTE
DIRECTLY TO CAPABILITY TO ACT ON
THE IDEATION.
NOTABLY OTHER IDEATION ACTION
THEORIES CAUSED TO CONSIDER
SUBSTANCE USE AND ACCESS TO
NEEDS.
WE'RE STARTING TO SEE SUPPORT
FOR THIS IN STUDIES WITH SEX AND
GENDER MINORITY POPULATIONS AND
THEY LOOKED AT THIS TO
UNDERSTAND SUICIDE EXPERIENCES
EXPERIENCED BY TRANSGENDER FOCUS
AND WHILE DISTAL MINORITY
STRESSORS ACTED THROUGH PROXIMAL
STRESSORS, BELONGINGNESS
MEDIATED THAT AND THOUGH NOT
ENTIRELY CONSISTENT FINDINGS
EXIST WITH SEXUAL MINORITY
FINDINGS BUT OVER ALL THE
STUDIES WERE LIMITED.
AND LOOKING AT SUICIDE THEORIES
HAVE BEEN ENTIRELY BEEN
CROSS-SECTION AND APPLY AN
INTERSECTION LENS WHICH OUR
SPEAKERS HAVE EXPLAINED WHY THAT
IS SO IMPORTANT WHAT DO WE MEAN
BY INTERSECTIONALITY?
AND THIS GOES BACK TO SOJOURNER
TRUTH AND BECAUSE THE WAY BLACK
WOMEN'S WERE EXPERIENCED THE
CONVERGENCE OF THE STRUCTURAL
FORCES OF OPPRESSION ARE UNIQUE
EXPERIENCES THAT ARE NOT THE SUM
OF ITS PARTS AND WE DON'T HAVE
THE FRAMES TO CONSIDER THOSE
EXPERIENCES WITHIN OUR SYSTEMS,
INSTITUTIONS AND RESEARCH WHICH
RESULTS IN ERASUURE AS JUST
EXPLAINED.
AND WHEN WE APPLY THIS LENS TO
YOU SUICIDE SO MUCH OF THE DATA
AND FINDINGS ARE URBAN FOCUSSED.
MUCH MORE LIMITED DATA EXISTED
ON PERSONS RESIDING IN RURAL
CONTEXT AND THE STUDIES IN RURAL
AREAS FOCUS ON YOUTH WHICH IS
IMPORTANT GIVEN THE MENTAL
HEALTH CRISIS WE'RE SEEING AMONG
YOUTH AND IDEATION AND ATTEMPTS
ARE FRIGHTENINGLY HIGH.
THIS FORGETS MOST SUICIDE DEATHS
AMONG SEXUAL MINORITY
INDIVIDUALS AND THE GENERAL
POPULATION ARE AMONG THE MIDDLE
AGED BECAUSE GIVEN AN ATTEMPT,
THERE'S A GREATER LETHALITY
OBSERVED IN THE AGE GROUP.
WE KNOW THIS CHANGES ACROSS THE
LIFE COURT AND NEED TARGETED
INTERVENTION.
WHERE DATA IS NEEDED ON SEXUAL
MINORITY AND MINORITY HEALTH WE
NEED TO LOOK WITHIN CENTER AND
WE NEED TO LOOK AT THE GENERAL
POPULATION AND IS CONSISTENT
WITH GENERAL POPULATION FINDINGS
OF HIGHER UNMET MENTAL HEALTH
NEEDS IN RURAL VERSUS URBAN
AREAS.
WE GO BACK TO THE FRAMEWORK.
AND WE CAN CHECK THE
INTERSECTIONALITY BOX AND THE
SPEAKERS HAVE DESCRIBED WHY
THAT'S NOT IT.
AND WE THINK ABOUT HOW AND WHY
IT MATTERS WE NEED TO THINK WITH
THE WHOLE PROCESS.
IF WE START OVER HERE ON THE
LEFT IN THE DISTAL MINORITY
STRESSORS BOX IT MAY BE THE
POLICY ENVIRONMENT IS VASTLY
DIFFERENT AND MORE RURAL VERSUS
URBAN AREAS WHICH MEANS THE
EXTENT TO WHICH AND HOW
STRUCTURAL STIGMA AGAINST SEXUAL
AND MINORITY PEOPLE MANIFEST IS
DIFFERENT IN IMPORTANT WAYS.
THIS SAY MAP FROM THE MOVEMENT
ADVANCEMENT PROJECT THAT
DOCUMENTS MORE THAN 50 SEXUAL
AND GENDER MINORITY RELATED LAWS
AND SEE THE REGIONAL DIFFERENCES
THAT CORRELATE WITH DEGREE OF
VERALITY.
IN TERMS OF NEGATIVE POLICIES
THAT EXIST OR THE LACK OF
SUPPORTIVE POLICIES.
WE CAN THINK OF OVERLAP AS AN IT
LEADS TO OVER MARGINALIZATION OF
THESE AREAS AND HARDSHIP THAT
MAY IMPACT THESE MINORITIZED
COMMUNITIES AND MAY CONTRIBUTE
TO THINGS LIKE HOPELESSNESS AND
PERCEIVED BURDENSOMENESS AND
LOOK AT SMALL COMMUNITIES WHERE
THERE NOT BE AFFIRMING SPACES OR
ORGANIZATIONS THAT ALLOW SEXUAL
GENDER MINORITY ADULTS TO
CONNECT AND THE POTENTIAL FOR
THWARTED BELONGINGNESS IF THERE
IS THAT CONNECTEDNESS AVAILABLE.
AND SOMETHING OVERLOOKED IN MANY
WAYS IS TO THE ROLE OF REL
RELIGIOSTY AND IN THERE'S OF
SUICIDE IT'S BEEN STUDIED AS A
PROTECTIVE FACTOR AND THERE'S
EVIDENCE TO SUPPORT THIS IN THE
GENERAL POPULATION.
GREATER IMPORTANCE OF RELIGION
WAS FOUND TO BE ASSOCIATED WITH
GREATER IDEATION IN ATTEMPTS AND
IT'S BEEN ASSOCIATED WITH TWICE
THE ODDS OF IDEATION AMONG
GREATER SEXUAL MINORITY PERSONS.
YOU MIGHT IMAGINE IF YOU'RE
RELIGIOUS INSTITUTION IS
ENGAGING IN HARMFUL PRACTICES
AND ENDORSING STIGMATIZING
ATTITUDES THERE MAY NOT BE OTHER
OPTIONS TO ENGAGE IN A RELIGIOUS
SPACE AND FOSTER THOSE THINGS
LIKE IN AN URBAN AREA.
AND WE THINK WITH THE ROLE OF
CRIMINAL HEALTH AND WE
ANTICIPATE ACCESS OF USE WILL BE
MORE CONSTRAINED IN MENTAL
HEALTH SETTINGS AND THE MENTAL
HEALTH PROVIDERS PER CAPITA IS
EXTREMELY LOW IN RURAL AREAS AND
THE CHANCE OF FINDING AFFIRMING
SERVICES COULD BE WORSE.
AND THINKING ABOUT CAPABILITY.
ONE THING WE KNOW IS IMPORTANT
RELATED TO ACCESS IS GUN
OWNERSHIP AND POPULATIONS LIVING
IN RURAL AREAS WE FOUND TO HAVE
LOWER ODDS OF SUBSTANCE USE AND
BINGE DRINKING ALTERNATIVELY.
AT THIS POINT UNFORTUNATELY I
CAN'T SAY GREAT, THERE'S
TERRIBLE GAPS BUT WE COLLECTED
FANTASTIC DATA TO ADDRESS THE
GAPS AND LEARNED IMPORTANT
THINGS BUT I CAN SAY WE'RE
ACTIVELY WORKING ON IT.
WE RECENTLY RECEIVED AN RO1 TO
CONDUCT RESEARCH WITH THIS
POPULATION IN SMALL AND RURAL
AREAS AND TRY TO UNPACK THE
PATHWAYS AND EXPLORE THE
MECHANISMS WITH AN EYE TOWARDS
FINDING SPECIFIC TARGETS FOR
INTERVENTIONS AND THINGS THAT
COULD BE INTERVENED UPON
REMOTELY.
WORKING WITH FOLKS WITH EMORY
UNIVERSITY AND WE'RE SEEKING TO
ENROLL WE HAVE UP TO 2500
INDIVIDUALS HOPEFULLY AND
HOPEFULLY FIVE COHORTS BECAUSE
IT BECAME OBVIOUS IN OUR
DISCUSSIONS WITH OUR TEAM AND
STARTING TO DISCUSS THINGS WITH
MEMBERS WE'RE NOT ADEQUATELY
CONSIDERING THE UNIQUE
EXPERIENCES OF NON-BINARY
INDIVIDUAL AND WE'LL COLLECT
DATA EVERY THREE MONTHS AND WE
HAVE DISCRIMINATION AND DRAMATIC
EXPERIENCES TO THE DISTAL
FACTORS VARY ACROSS SUB GROUPS
OF SEXUAL AND MINORITY PERSONS
AND WHETHER THE EXPOSURE CLASS
ASSOCIATED WITH PREVALENT
DEPRESSION, SUICIDE IDEATION AND
ATTEMPT AT BASELINE.
BUT THEN WE'LL BUILD UPON THAT
TO SEE IF THE CLASSES ARE
ASSOCIATED WITH INCIDENCE
OUTCOMES USING FIXED AND
EXPOSURE CLASSES WITH MEDIATORS
OF THE PATHWAY AND IN ACCORDANCE
WITH WHAT WAS PRESENTED TODAY
AND TRYING TO CONSIDER
HETEROGENEITY AND ASSOCIATIONS
BY SEX AND GENDER MINORITY
SUBGROUP AND HOPEFULLY HAVE THE
POWER TO LOOK MORE AT
INTERSECTING FACTORS OF RACE AND
ETHNICITY GIVEN THE DEARTH OF
RESEARCH ON TRANSGENDER AND
SEXUAL MINORITY PEOPLE OF COLOR
AS HIGHLIGHTED BY TODAY AND
LASTLY BUILDING ON OUR FINDINGS
WE'LL MEASURE PREFERENCES FOR
INTERVENTIONS TAILORED TO RURAL
SEXUAL AND MINORITY PERSONS
EXPERIENCING TRAUMA AND THERE'S
MAJOR GAPS IN UNDERSTANDING
MENTAL HEALTH DISPARITIES FOR
THESE POPULATIONS.
STUDYING MECHANISMS FORMED BY
MINORITY THEORIES IS A PROMISING
APPROACH TO UNPACK AND FIND
TARGETS FOR INTERVENTION.
THERE'S A LACK OF LONGITUDINAL
DATA AND WITH ATTENTION TO
FACTORS THAT MIGHT BE MODIFIABLE
INCLUDING PROTECTIVE FACTORS.
THERE'S REALLY THE LIMITED
HETEROGENEITY OF POPULATION.
AND IT CAN LEAD TO APPROPRIATE
AND FEASIBLE INTERVENTIONS.
THIS IS ONE SMALL STEP BECAUSE
THE GOAL AND THE DREAM IS TO
INTERVENE BOTH ON THE PROCESSES
BUT ALSO ON THE DISTAL FACTORS
THEMSELVES SINCE WE KNOW
STIGMA'S INSIDIOUS AND THE
FUNDAMENTAL CAUSE OF SOME THESE
ISSUES AND MOVING FORWARD IS
IMPORTANT.
>>THANK YOU, DR. MURRAY.
AT THIS POINT I'D LIKE TO INVITE
ALL THE PANELISTS TO TURN ON
THEIR VIDEO AND INVITE QUESTIONS
FROM THE AUDIENCE.
WHILE WE'RE WAITING FOR OUR
FIRST QUESTION I CAN GET US
START
STARTED I'D LIKE TO REFLECT ON
THE INTRODUCTORY COMMENT ABOUT
RESILIENCE.
HOW SHOULD RESILIENCE BE STUDIED
GIVEN THAT RESEARCH UP TO TODAY
CAN BE VIEWED AS FURTHER
BURDENING MINORITIZED
POPULATIONS TO DEAL WITH STIGMA
RACISM AS MENTIONED IN OUR
CURRENT PRESENTATIONS TO DEAL
WITH THE FACTORS ON AN
INDIVIDUAL LEVEL INSTEAD OF
ELIMINATING RACIST AND
DISCRIMINATORY EXPERIENCES AND
STRUCTURES IN THE CONTEXT OF
YOUR WORK.
HOW WOULD YOU VIEW RESILIENCE
AND HOW SHOULD IT BE STUDIED IN
THE FUTURE?
>>I'M HAPPY TO KICK IT OFF AND
HAVE OTHERS JUMP IN.
I THINK OF IT AS A BOTH/AND
SITUATION.
LIKE THERE'S A PERPETUAL POLE
BETWEEN REFORM AND REVOLUTION
AND FEEL LIKE THINKING ABOUT
INDIVIDUAL RESILIENCE IS
THINKING ABOUT THE REFORM
ELEMENT.
IT'S THE DOWN STREAM BANDAGE FOR
THE UPSTREAM LARGER STRUCTURAL
DETERMINATES.
IT'S A NECESSARY COPING
MECHANISM MANY OF US HAVE
DEVELOPED OUT OF NEED.
THAT MEANS WE STILL NEED TO WORK
TOWARDS DISMANTLING THE LARGER
STRUCTURES THAT CAUSE IT TO BE
NECESSARY IN THE FIRST PLACE.
I'LL STOP THERE AND LET OTHERS
JUMP IN.
>>I'LL ADD AND I'LL PARAPHRASE
MY FRIEND TALKED ABOUT
RESILIENCE IS A RESPONSE TO
OPPRESSION AND THERE WAS A PAPER
I JUST LOOKED AT PUBLISHED BY
HER WHERE THEY LOOKED AT
RESILIENCE AND USING THE ANALOGY
OF SCAR TISSUE AND HOW HAVING TO
DEAL WITH THE ECONOMIC -- IT
ONLY HAPPENS ONCE YOU HAVE
EXPERIENCED OPPRESSION.
AND I THINK GIVEN ON THE
INDIVIDUAL LEVEL A LOT OF IT IS
COPING MECHANISM ALSO COMES FROM
LOWERING THE IMPACT OF SOCIAL
SUPPORT GIVEN IN THIS COMMUNITY
THERE'S A BIG ASPECT OF SUPPORT
FROM PEERS AND FAMILY.
>>I ABSOLUTELY AGREE WITH WHAT
BOTH MY COLLEAGUES HAVE SAID AND
SOME THINGS POINTED TO ARE SO
IMPORTANT IN TERMS OF ADDRESSING
AND YOU LOOK THROUGH THE
QUESTIONNAIRE AND IT'S ALL
NEGATIVE AND EXPOSURE AND TRAUMA
AND STIGMA AND THOSE THINGS ARE
IMPORTANT BECAUSE YOU HAVE TO
STOP AND ASK YOURSELF WHERE IS
THE SPACE FOR JOY.
WHERE'S THE SPACE FOR PRIDE?
AND THOSE AREN'T NECESSARY --
THOSE DON'T HAVE TO ALWAYS BE
VIEWED IN A RESILIENCE FRAME.
WE DON'T WANT TO LEAVE OUT THE
SPACE FOR PEOPLE TO BE ABLE --
AND WE SHOULD STUDY THINGS LIKE
FLOURISHING?
WHERE ARE PEOPLE DOING WELL AND
FLOURISHING?
THE CAUSE OF RESILIENCE IS
PROBLEMATIC IN THAT YOU PUT THE
BURDEN ON PEOPLE WHO EXPERIENCE
STIGMA DISCRIMINATION TO DEAL
WITH IT AND IT'S NOT APPROPRIATE
BUT I TRY TO REMIND MYSELF WE
ALSO HAVE TO MAKE SPACE TO SEE
THINGS LIKE JOY AND UNDERSTAND
JOY AND FLOURISHING AND PEOPLE
TALKED ABOUT YESTERDAY HEALTHY
DATING AND THINKING ABOUT SEX AS
A POSITIVE WONDERFUL EXPERIENCE
FOR PEOPLE.
THESE ARE IMPORTANT THINGS.
>>THANK YOU FOR THAT.
AND THERE'S MORE A COMPLETE
THEME OF BREAKING OUT OF BAD
HABITS AND STUDYING RISK FACTORS
AS INCREASED RISK IN RISK
FACTORS PEOPLE ARE ENGAGING OR
EXPOSED TO ON A STRUCTURAL
SOCIETAL LEVEL THAN AN
INDIVIDUAL PERM -- PERSONAL
QUESTION AND THE NEXT QUESTION
COMES FROM THE VIDEOCAST FOR
DR. MURRAY I'LL GROUP TOGETHER.
ONE, WHAT METHODS HAVE YOU FOUND
TO BE HELPFUL IN RECRUITING
RURAL SGM POPULATIONS AND THIS
PERSON IS PREPARING TO LAUNCH A
STUDY WHAT ARE SUGGESTIONS OF
MEASURES TO LOOK AT AND THREE
CAN THEY GET YOUR CONTACT
INFORMATION.
THEY'D LOVE TO CONNECT WITH YOU.
>>CONTACT INFORMATION I'LL
STICK IN THE CHAT WHEN I'M DONE
BECAUSE I CAN'T DO TWO THINGS AT
ONCE AND I LOVE THESE TOPICS.
FULL HONESTY I'M NOT THE EXPERT
IN THE RECRUITMENT.
OUR COLLEAGUES AT EMORY HAVE FAR
MORE EXPERIENCE AND TRAVIS
SANCHEZ AT EMORY UNIVERSITY.
WHAT I WOULD HIGHLIGHT IS
THERE'S BEEN A REAL NEED TO BE
NIMBLE IN THE CONTEXT OF
POST-PANDEMIC LIFE WHERE SO MUCH
HAS MOVED ONLINE AND WHERE
ONLINE RECRUITMENT WAS A MORE
OPEN SPACE BEFORE HAND.
I THINK THERE'S AN OVERWHEL
OVERWHELMINGNESS OF RECRUITMENT
ONLINE AND IT'S PUSHING US BACK
IT OUR ROOTS OF CONNECTION WITH
COMMUNITY ORGANIZATIONS IN
ADDITION TO ONLINE APPROACHES
AND WORKING IN COLLABORATION
WITH COMMUNITIES TO ENABLE
RECRUITMENT AND THE MESSAGE TO
GET OUT THERE AND ALSO SHIFTING
THE PLATFORMS WE USE CONSTANTLY
BECAUSE PLATFORMS THAT USED TO
RECRUIT A DIVERSE POPULATION ARE
INCREASINGLY RECRUITING OLDER
AND WHITER POPULATIONS FOR US.
THAT'S A WHOLE OTHER
CONVERSATION I'D BE HAPPY TO
ENGAGE WITH IN MORE DETAIL BUT I
THINK NIMBLENESS AND CONNECTION
AND REAL CONNECTION HAS BEEN
REALLY IMPORTANT.
>>WHAT MEASURE HAVE YOU FOUND
HELPFUL IN RECRUITING THE SGM
POPULATIONS AND SUGGESTIONS FOR
MEASURES THAT SHOULD BE LOOKED
AT.
>>I SEE THIS.
THIS IS REALLY CHALLENGING IN
TERMS OF THE MOVEMENT OF PEOPLE
BECAUSE WE MIGHT EXPECT PEOPLE
HAVE MOVED IN AND OUT OF
COMMUNITIES OVER TIME AND THIS
IS SOMETHING WE'RE TRYING TO
TRACK BUT IT'S ONE OF MY
CONCERNS IS FIGURING OUT HOW TO
TRACK PEOPLE IN AND OUT OF THE
SPACE.
NOT NECESSARILY THE LOGISTICS OF
RETAINING PEOPLE BUT HOW TO
CHARACTERIZE TIMING AND EXPOSURE
AND WHAT THAT MEANS TO MIGRATE
TO LOST SUPPORT IN ONE WAY AND
MAYBE GAIN MORE GROUP SUPPORT IN
OTHER WAYS AS YOU SAID.
AND RIGHT NOW WE'RE MOSTLY
LOOKING AT IN GROUP SUPPORT
BECAUSE WE EXPECT THAT TO BE
PARTICULARLY IMPACTED IN RURAL
AREAS BUT I RECOGNIZE WHAT
YOU'RE SEEING IN TERMS OF THE
REAL IMPORTANCE OF THAT SHIFT
AND DYNAMIC.
IT'S A CHALLENGE.
>>THANK YOU, DR. MURRAY.
THERE'S ONE COMMENT I'LL GO TO
OUR NEXT QUESTION.
ONE INDIVIDUAL MENTIONED WIN
BARRIER I NOTED TO STUDYING
RESILIENCE, JOY COPING IS THE
FOCUS ON MOST FUNDING ON RISK
EXPOSURE ALL THE NEGATIVE
THINGS.
I'M SURE THAT'S A COMMENT FOR US
AT NIH.
THE NEXT QUESTION IS WHAT IS THE
MOST -- I BELIEVE THIS IS
DIRECTED TO EVERYONE, WHAT IS
THE MOST EFFECTIVE EDUCATIONAL
RESOURCE AVAILABLE TO SEXUAL
MINORITIES TO DEAL WITH STRESS
AGENTS?
>>IT CAN AFFECT PEOPLE
DIFFERENTLY AND THE WAYS IN
WHICH THOSE STRESSORS MANIFEST.
WHAT CAN BE REALLY HELPFUL FOR
SOME FOLKS IS GOING TO BE LESS
HELPFUL FOR OTHERS.
I WILL PUT IN A PLUG FOR WHEN
WE'RE THINKING ABOUT BISEXUAL
MENTAL HEALTH INCLUDING BISEXUAL
FOLKS OF COLOR THAT THERE ARE
ZERO DEVELOPMENTAL HEALTH
INTERVENTIONS THAT ADDRESS
STIGMA SO A LOT OF IT IS -- IT'S
NOT THERE.
IT DOESN'T EXIST.
THAT'S A HARD THING TO DEAL WITH
TOO.
>>I THINK THERE'S LITERATURE
AND BOOKS THAT ADDRESS RACIAL
TRAUMA AND STRESS.
I THINK SOME OF THE TOOLS
PROVIDED THERE CAN BE ALSO
APPLIED TO CERTAIN PIECES OF
BEING A SEXUAL MINORITY BUT
HAVEN'T SEEN THE SAME
INTERSECTION.
>>
>>ARE YOU INCORPORATING
MEASURES OF IN GRUP -- GROUP AND
OUT GROUP AND ARE THERE INGROUP
VERSUS YOUD -- OUTSIDE DYNAMICS
AT PLAY.
>>THIS IS THE QUESTION I TRIED
TO ANSWER BEFORE AND MISSED IT
SPECIFIC TO RURAL COMMUNITIES SO
I'M HAPPY TO ANSWER THE QUESTION
I MISSED.
WE FOUND IMPORTANT DIFFERENCES
IN THE WAYS MEASURES PERFORM OF
STIGMA ACROSS CONTEXTS THAT VARY
NATIONALLY SO WE'VE LOOKED FOR
SUB-SAHARAN AFRICA AND HAVE
STIGMA MEASURES BASED ON DATA
FROM MULTIPLE PLACES AND
MULTIPLE LOCATIONS STUDYING AND
SEEMED TO HAVE CONTENT VALIDITY
AND FACE VALIDITY BUT WHEN WE
LOOKED AT IT THERE WERE
MEASUREMENT ARTIFACTS THAT WERE
IMPORTANT IN INTERPRETING OVER
ALL LEVELS OF STIGMA IN THE
RELATIONSHIPS AND MAKING
COMPARISONS.
THERE'S NOT A LOT OF MEASURES
SPECIFICALLY DEVELOPED FOR RURAL
POPULATIONS BUT WHAT I WOULD
SUGGEST IS SOME OF THESE GREAT
MEASURES MORE RECENTLY COMING
OUT LIKE THE INTERSECTIONAL
STIGMA, DISCRIMINATION INDEX I
WOULD JUST ENCOURAGE PEOPLE AS
THEY USE THESE POPULATIONS LIKE
FOR INSTANCE SOUTH DAKOTA TO
LOOK AT THE MEASUREMENT AND TAKE
THE TIME TO LOOK TO SEE HOW IT'S
PERFORMING AND HOW IT COMPARES
BECAUSE I THINK WE OFTEN ASSUME
WE'RE MAKING COMPARISONS ACROSS
SUB GROUPS OF SEXUAL MINORITY
AND RACIAL ETHNIC GROUPS AND
CONTEXT THAT MAY NOT ALWAYS BE
APPROPRIATE GIVEN ISSUES OF
MEASUREMENT.
I THINK IT'S A GREAT QUESTION.
I'M HAPPY TO TALK MORE ABOUT.
>>THANK YOU FOR KEEPING TRACK
OF THE QUESTIONS.
THE NEXT QUESTION, WHAT ARE
EXAMPLES OF STRUCTURAL
INTERVENTIONS THAT MAY INCREASE
PEER OR FRIEND SUPPORT AMONG
TRANS AND NON BINARY YOUTH OF
COL
COLOR.
S
>>THERE'S BEEN INTERVENTIONS
THAT ARE COMMUNITY LED TO
ADDRESS SOME OF THE ASKS WHEN IT
COMES TO TRANSGENDER WOMEN OF
COLOR AND HIV.
>>ARE OTHERS FAMILIAR WITH
INTERVENTIONS.
>>WHEN YOU THINK OF THE
INTERVENTION ON PEERS -- I THINK
SO MUCH OF THE STRUCTURAL LEVEL
WILL RELATE TO ADVOCACY AND
CHANGES AROUND POLICIES AND
AROUND INSTITUTIONS IN TERMS OF
GIVING INSTITUTIONS THE FRAMES
TO UNDERSTAND THE UNIQUE NEEDS
AND EXPERIENCES OF THESE
POPULATIONS.
THAT GOES BACK TO HOW WE TRAIN
DOCTORS AND THE THINGS WE TALKED
ABOUT YESTERDAY IN TERMS OF WHAT
PEOPLE ENCOUNTER WITHIN THE
HEALTH SYSTEMS AND WHAT THOSE
POLICIES AND PROCEDURES ARE AND
OUR INSTITUTIONS IN TERMS OF
THINGS LIKE YOU KNOW HOW EASY
TOSS HAVE YOUR NAME BADGE THAT
REFLECT YOUR NAME.
THESE THINGS THAT ARE IMPORTANT
STRUCTURAL FACTORS ACROSS
COMMUNITY ARE -- THAT DON'T
NECESSARILY RELATE TO PEER
SUPPORT PER SE BUT IF WE TALK
ABOUT THE STRUCTURAL FACTORS AND
THE WAY THINGS INTERACT WHEN
SPACES BECOME MORE AFFIRMING WE
MIGHT BE ABLE TO EXPECT WE CAN
DO A BETTER JOB OF SHIFTING AND
CHANGING ATTITUDES THAT RELATE
TO THE INTERPERSONAL ASPECTS AND
RELATIONSHIPS AND ONE THING WE
KNOW FROM THE BROADER STIGMA
LITERATURE IS EDUCATION EFFORTS,
PERIOD, LIKE TO REDUCE STIGMA,
SENSITIZING IN TERMS OF BY
GIVING INFORMATION TENDS TO HAVE
LIMITED EFFECTIVENESS DEPENDING
ON THE POPULATION AND ISSUE AND
OFTEN WHAT WE NEED IS
CONTACT-BASED INTERVENTIONS WHEN
DONE IN APPROPRIATE WAYS AND THE
DYNAMIC IN THOSE INTERVENTIONS
MATTER.
FOR PEOPLE TO BE IN GROUP AND
TALKING ABOUT LIVED EXPERIENCE
OF A STIGMATIZED CONDITION.
THAT PROGRAMMING AND
INTERVENTION CAN BE MUCH MORE
POWERFUL THAN JUST INFORMATION
GIVING THOUGH WE TEND TO FALL
BACK ON INFORMATION GIVING AS A
STRATEGY.
>>WITH THAT I'D LIKE TO THANK
EVERYONE AND THE PANELISTS AND
FOR YOUR COMMENTS AND ANSWERS
AND EVERYONE'S QUESTION.
THERE WAS ANOTHER QUESTION WE
DIDN'T GET TO SO MY APOLOGIES.
WE'RE TWO MINUTES OVER AND I'D
LIKE TO PASS IT ON TO OUR NEXT
MODERATOR, MY COLLEAGUE, CYST
BARNHART AT THE SEX SGM OFFICE.
>>I'M A POLICY ANALYST WITH THE
OFFICE HERE.
IT'S MY PLEASURE AND PRIVILEGE
TO SERVE AS MODERATOR FOR THE
SESSION WE'LL CONTINUE TO
EXPLORE INTERSECTIONALITY AND
THE IMPACT ON HEALTH OUTCOMES
AND OUT IT GOES TO IDENTITIES
AND EXPERIENCES AND SOCIAL
CATEGORIES AND STATUSES.
WE HAVE THREE PANELISTS WHO WILL
SHARE THOUGHT PROVOKING CONTENT
ON THE COMMENTS.
DR. JACKSON AND DR. KUSHALNAGAR
AND DR. WALTERS.
THE FIRST SPEAKER WILL BE
DR. JACKSON.
WHEN YOU'RE READY THE VIRTUAL
FLOOR IS YOURS.
>>A PLEASURE TO BE WITH YOU FOR
THE CONTINUATION OF WHAT'S
ALREADY A STIMULATING DISCUSSION
AND I'LL GIVE AN EXAMPLE ON
INTERSECTIONAL EXPERIENCES AND
WHAT THEY HAVE TO DO WITH THE
HEALTH OF BLACK QUEER FOLKS AND
A QUICK REMINDER OF THINGS YOU
ALREADY HEARD ABOUT.
ONE, AS YOU ALL KNOW OUR LIVES
ARE SHAPED BY NUMEROUS
CATEGORIES OF DIFFERENCE AND
OPPRESSION NOT JUST EVEN AMONG
LGBTQ FOLKS AND THEIR LIVES ARE
SHAPED BY THIS AND WITH AN AN
EXCEPTIONS OVER ALL THE MOST
OPPRESSION AND STIGMA YOU FACE
THE WORSE OFF YOU TEND TO FARE
WITH PHYSICAL HEALTH AND DISEASE
RISK FACTORS AND PHYSIOLOGICAL
RESPONSES.
AND ONE OF THE WAYS WE
UNDERSTAND THAT WHICH HAS BEEN
SAID A NUMBER OF TIMES TODAY AND
YESTERDAY IS THROUGH FRAMEWORKS
LIKE MINORITY STRESS THEORY
WHICH AS YOU KNOW SUGGEST THOSE
DISTAL STRESSORS WITH THE
INTERNAL STRESSORS AND NOT COPED
WITH OVER TIME CAN LEAD TO
PROBLEMS WITH HEALTH.
SO THE QUESTION I WANT TO ASK
NOW THAT I'VE REVIEWED THOSE
PIECES YOU ALREADY HEARD ABOUT,
WHAT DOES THIS HAVE TO DO WITH
THE HEALTH DISPARITY SPACE BY
FOLKS BOTH BLACK AND SEXUAL
MINORITIES.
THE LITERATURE ON HEALTH
DISPARITIES AMONG BLACK PEOPLE
IS MIXED WHEN IT COMES TO HOW IT
COMPARES TO WHITE QUEER FOLKSES
WITH SOME STUDIES SHOWING
GREATER RESILIENCE, SOME RISK
AND I WANT TO TALK ABOUT A
COUPLE ALARMING MENTAL HEALTH
DISPARITIES.
SOME HAVE SHOWN AN INCREASED
RISK OF SUICIDE AMONG BLACK
QUEER FOLKS COMPARED TO WHITE
QUEER COUNTERPARTS AND IN
ADDITION AMONG THOSE WHO REPORT
EXPERIENCING SEXUAL MINORITY
STRESS THAT SEEMS TO LAND HARDER
AMONG BLACK LGBTQ FOLKS WHEN
THEY ENDORSE THAT A HIGHER ODDS
OF SUICIDE ATTEMPT COMPARED TO
THEIR WHITE COUNTERPARTS.
A PLACE WHERE THE RESEARCH IS
MORE CONSISTENT IS IN GENERAL
BLACK LGBTQ FOLKS FACE HIGHER
RATES OF PSYCHIATRIC DISORDERS
COMPARED TO BLACK HETEROSEXUALS.
DESPITE THE HEALTH DISPARITIES
WE TEND TO SEE THE MAJORITY OF
SGM RESEARCH FOCUSES ON ONE
ASPECT OF STIGMA AND ISOLATION
FROM OTHERS AND WHEN STUDIES
LOOK AT THEM IN TANDEM THEY ARE
LOOKED AT ADDITIVELY OPPOSED TO
INTERSECTIONALLY OFTEN BECAUSE
WE LACK GOOD MEASURES TO
UNDERSTAND THE TEXTURE AND
EXPERIENCE OF INTERSECTIONALITY
IN EVERYDAY LIFE.
I STARTED USING THE WORD BUT
INTERSECTIONAL ITY GIVES US A
TOOL TO UNDERSTAND HOW FOLKS
UNIQUE RISKS, RESILIENCES AND
OVER ALL EXPERIENCES AND SOCIAL
PROCESSES ARE SHAPED BY MULTIPLE
DOMAINS OF POWER AND SAYS OF
COURSE OUR EXPERIENCE OF
OPPRESSION ARE GREATER THAN THE
SUM OF ITS PARTS AND IF WE WANT
TO UNDERSTAND THAT INTERLOCKING
NATURE OF STIGMA AND OPPRESSION
THEN WE NEED TO STUDY STIGMA AND
OPPRESSION IN A SIMULTANEOUS
INTEGRATED MANNER.
THAT TAKES US BACK TO THE
QUESTION OF THE QUESTION OF
MINORITY STRESS THEORY.
WHEN I START TO HOLD THIS
FRAMEWORK UP TO THE LENS OF
INTERSECTIONALITY QUESTIONS COME
TO MIND.
WHAT ABOUT PEOPLE WHO FACE
MULTIPLE FORMS OF STIGMA?
HOW DOES RACE FIT IN AND HOW
DOES INTERSECTIONAL FORMS OF
DISTAL AND PROXIMAL STRESS LOOK
LIKE AND CAN THAT HELP US BETTER
UNDERSTAND STIGMA AMONG QUEER
PEOPLE OF COLOR?
I WANT TO GIVE YOU ONE RESEARCH
EXAMPLE OF HOW AND MY COLLEAGUES
ATTEMPTED TO ANSWER THIS
QUESTION.
IN THIS STUDY WE AIM TO LOOK AT
MINORITY STRESS THEORY AND THE
PSYCHOLOGICAL MEDIATION
FRAMEWORK.
BUT DO IT IN A WAY THAT
ENCOMPASSES STRESS PROCESS.
PER THAT CONVERSATION WE WERE
ALSO INTERESTED IN POSITIVE
EXPERIENCES OF INTERSECTIONALITY
AND JOY AND WANTED TO LOOK AT
HOW THIS OCCURS OVER TIME.
WE KNOW THERE'S A BODY OF
RESEARCH THAT LOOKS AT DAILY
EXPERIENCES IN STIGMA AND STRESS
AND WE SEE STUDIES ACROSS RACE,
GENDER AND SEXUAL ORIENTATION
THAT HAVE LOOKED AT THAT AND
OVER ALL THEY'VE DEVELOPED A
SMALL BUT GREG BODY OF
LITERATURE SHOWING STIGMA AND
ASPECTS OF HEALTH EBB AND FLOW
TOGETHER AND SOMETIMES THEY HAVE
A TEMPORAL AFFECT SUCH THAT
EXPERIENCING TRANS PHOBIA ON
MONDAY MAY LEAD TO AN INCREASE
IN DEPRESSION OR SUBSTANCE USE
OR RISK TAKING ON TUESDAY.
LET'S TALK ABOUT HOW I LOOKED AT
THAT AND THE STUDIES I HAD TO
CONSIDER.
THIS IS LIKE A REMIXED VERSION
OF THAT MINORITY STRESS MODEL I
HAD UP EARLIER SHOWING DISTAL
AND PROXIMAL STRESSORS ARE
THOUGHT TO LOOK AT OUTCOMES SUCH
AS LIKE LOGICAL DISTRESS.
INCREASINGLY WE UNDERSTAND THOSE
DISTAL STRESSORS CAUSE AN UPTICK
IN INTERNAL STRESS PROCESSES
WHICH SERVES AS A MEDIATOR
BETWEEN STIGMA AND PSYCHOLOGICAL
EXPRESS.
IN ADDITION OTHER WORK HAS TOLD
US IT'S NOT JUST PROXIMAL STRESS
PROCESS GET ELEVATED WHEN PEOPLE
EXPERIENCE HEIGHTENED STIGMA BUT
ENVIRONMENTAL STIGMA CAN
INCREASE GENERAL STRESS
PROCESSES SUCH AS POORER SOCIAL
SUPPORT, EMOTIONAL DYSREGULATION
OR RUMINATION WHICH I'LL TALK
ABOUT TODAY AND THERE'S A SECOND
NON-IDENTIFIED PATHWAY RELATED
TO PSYCHOLOGICAL DISTRESS.
MY CHALLENGE WAS THIS, WHAT
WOULD INTERSECTIONAL VERSIONS OF
DISTAL AND PROXIMAL STRESS LOOK
LIKE IF I WANTED TO TEST THEM IN
THE MODEL AND START WITH THE
QUESTION OF DISTAL STRESS.
I CREATED A VARIABLE CALLED
NEGATIVE INTERSECTIONAL
EXPERIENCES I TODAY FIND AS ANY
DISTAL STIGMA RELATED STRESSOR
SMALL OR BIG THAT ARISES DUE TO
ONE'S UNIQUE SOCIAL POSITION AND
THE RISK IT POSES.
WHAT ARE THE EXPERIENCES OF
STIGMA AND OPPRESSION YOU
EXPERIENCE BECAUSE OF BEING BOTH
BLACK AND QUEER?
LET'S PLOP THAT INTO THE BUCKET
IN THE MODEL.
THE SECOND QUESTION IS WHAT
MIGHT BE AN APPROPRIATE
APPROXIMATE STRESS PROCESS AND I
LOOKED AT THE QUEER FOLKS OF
COLOR DEVELOPMENT AND MORALES
HAS AN IDENTITY DEVELOPMENT IN
WHICH THE THIRD STAGE IS CALLED
CONFLICTS AND ALLEGIANCE.
THAT'S ONE'S INTERNAL SENSE OR
STRUGGLE OR DISSONANCE.
THEY'RE FEELING LIKE THEIR
RACIAL IDENTITY AND SEXUAL
ORIENTATION ARE INCOMPATIBLE.
THIS HAS GOTTEN ATTENTION BUT
UNTIL RECENTLY HASN'T RECEIVED
EMPIRICAL INVESTIGATION AND IT
CAN EXPLAIN THE EARLIER
DISPARITIES I SPOKE ABOUT SUCH
AS WITH SUICIDE.
WHAT WE KNOW IS THE DISPARITIES
ARE BIGGEST IN LATE ADOLESCENCE
AND EARLY ADULTHOOD.
MY COLLEAGUES AND I HAVE
DEVELOPED A MEASURE OF IDENTITY
CONFLICT WHICH IS A SIX-ITEM
SCALE THAT HELPS US UNDERSTAND
THE EXPERIENCE OF DISTRESS ONE
HAS OR CONFLICT ONE FEELS
BETWEEN THEIR RACIAL AND ETHNIC
IDENTITY.
I USED THE IDENTIFY BLACK AND
THEIR SEXUAL ORIENTATION.
AND BLACK WE'RE FOLKS WHEN
COMPARED TO BLACK AND WHITE
STRAIGHT FOLKS HAVE ITEN --
HEIGHTENED LEVELS SHOWING IT'S A
DISTAL-PROXIMAL PHENOMENON AND
THOUGHT TO BE FITTING THE MODEL
AND THEORIZED TO HAVE IMPACT ON
NEGATIVE AFFECT AND CAUSING MORE
ANXIETY, ANGER AND IN ONE MODEL
SHOWN TO HAVE GREATER RATES.
ON A DAY TO DAY BASIS I TEST THE
TWO MODELS.
EVERY DAY I WONDERED ON DAYS
FEATURING A NEGATIVE
INTERSECTIONAL EXPERIENCE DO
RESPONDENTS REPORT GREATER USING
THE MEASURE AND IS THAT
RELATIONSHIP MEDIATED OR
EXPLAINED BY HIGHER RATES OF
IDENTITY CONFLICT IN THE TOP AND
TESTED WHETHER IT'S EXPLAINED BY
HIGHER RATES OF NEGATIVE
RUMINATION.
IN ADDITION, I MEASURED AND
CONTROLLED FOR NON
INTERSECTIONAL NEGATIVE
EXPERIENCES.
REGULAR OLD RACISM THAT DOESN'T
FEEL INTERSECTIONAL OR OTHER
EXPERIENCES LIKE I FLUNKED A
TEST OR FELL ON ICE AND IT WAS
EMBARRASSING.
THEN I THOUGHT ABOUT LOVE AND
ALL THE JOY I HAVE AS A BLACK
GAY PERSON AND THE JOY
EXPERIENCE NOT DESPITE OF THE
BLACKNESS AND QUEERNESS BUT
BECAUSE OF THIS AND I WANTED TO
LOOK AT THESE AS WELL AND
CREATED A MIRROR IMAGE SET OF
MODELS TO TEST WHERE I LOOKED AT
EVER DAY MEASURED POSITIVE
EXPERIENCES AND SAW WHETHER THEY
HAD A RELATIONSHIP TO POSITIVE
AFFECT AND WHETHER THEY WERE
MEDIATED BY THINGS LIKE A
DECREASE IN IDENTITY CONFLICT OR
INCREASE IN WHAT WE CALL
POSITIVE RUMINATION WE CAN BE
THOUGHT OF AS SAVORING AND I
USED A DAILY DIARY AND IT CAN BE
QUALITATIVE, QUANTITATIVE OR
MIXED METHODS.
IT HELPS REDUCE RECALL BIAS OR
RETROSPECTIVE MEMORY BIAS.
PEOPLE ONLY HAVE TO FOCUS ON THE
LAST 24 HOURS NOT THE LAST YEAR
OR ENTIRE LIFE.
IT ALLOWS FOR ME TO LOOK AT WHAT
HAPPENS WITHIN PARTICIPANTS AND
NOT JUST BETWEEN THEM AND EVERY
DAY WE SENT LINKS TO THE
PARTICIPANTS TO FILL OUT THE
DAILY SURVEY AND THEY WERE PAID
PER SURVEY AND FILLED UP TO
SEVEN.
I'M NOT GOING TO GO THROUGH ALL
THE MEASURES FOR THE SAKE OF
TIME BUT I WANTED TO LET YOU
KNOW HOW WE MEASURED THE
INTERSECTIONAL EXPERIENCE.
I'LL JUST READ THE TOP LINE FOR
NEGATIVE EXPERIENCE.
EVERY DAY PARTICIPANTS WERE
ASKED, TAKE A MOMENT AND REFLECT
ON WHETHER YOU EXPERIENCED ANY
NEGATIVE EVENTS OR SITUATIONS
THAT WERE RELATED TO BEING BOTH
BLACK AND LGBT.
CONSIDER MINOR EXPERIENCES.
CAN YOU THINK OF A NEGATIVE
EVENT FROM TODAY.
THIS WAS A YES/NO QUESTION.
IF YES THEY WERE ASKED TO
DESCRIBE IT AND CATEGORIZE IT
BASED ON CATEGORIES WE CREATED.
THE SAME QUESTION WAS ASKED FOR
POSITIVE INTERSECTIONAL
EXPERIENCES.
HERE ARE THE RESULTS.
ACROSS 849 STUDY DAYS WE FOUND
OVER 10% FEATURED A NEGATIVE
INTERSECTIONAL EVENT.
I'M IN A DANCE CLASS.
IN ORDER TO GET TO IT I HAVE TO
WALK THROUGH THE GYM.
TODAY THE BASKETBALL TEAM WAS
PRACTICING AND WHEN THEY SAW ME
HEADING TO CLASS THEY MADE CRUDE
HOMOPHOBIC COMMENTS AND THEY
WERE BLACK AND I'M SURE I SHOOT
HOOPS AROUND THEM.
AND I WAS AT A BAR AND I FOUND I
WAS BEING IGNORED AND A FOUND IN
VISIBLE AND UNDESIRABLE IN A BAR
OF MOSTLY CISGENDER MALES AND I
THOUGHT I'D FEEL THIS WAY BUT
ALWAYS HOPED IT'D BE DIFFERENT.
ON DAYS FEATURING A NEGATIVE
INTERSECTIONAL EVENT THERE WAS A
RELATED INCREASE IN NEGATIVE
AFFECT.
ON DAYS FEATURING A NEGATIVE
EVENT THESE WERE CORRELATED ALL
HAPPENING AT THE SAME TIME BUT
THAT DOESN'T NECESSARILY MEAN
THERE WAS A MEDIATION HOWEVER,
WHEN WE RAN THE MODEL IT WAS
FOUND TO BE SIGNIFICANT MEANING
THE DAILY EBB AND FLOW BETWEEN
NEGATIVE INTERSECTIONAL EVENTS
AND AFFECT WAS BEING EXPLAINED
IN PART BY A CHANGE IN IDENTITY
CONFLICT.
FOR NEGATIVE RUMINATION IT WAS A
SIGNIFICANT MEDIATION MEANING
NEGATIVE RUMINATION IN GENERAL
NOT JUST ABOUT THIS EVENT WAS
EXPLAINING SOME OF THE DAILY EBB
AND FLOW BETWEEN NEGATIVE
INTERSECTIONAL EVENTS AND
AFFECT.
INTERESTINGLY REGARDING POSITIVE
INTERSECTIONAL EVENTS.
AND ON POSITIVE DAYS I WAS PROUD
TO DISCUSS THE INTERSECTION OF
EXPERIENCES OF BLACK AND LGBT
PEOPLE AND A SPOKE TO MY
GRANDMOTHER ABOUT HER GAY
FRIENDS' EXPERIENCES IN THE
1960s AND 1970s.
ANOTHER SAID I HAVE RECENTLY
STARTED TALKING TO ANOTHER BLACK
GIRL WHO IS BISEXUAL.
WE FOUND SOME INTERESTING
COMPLEX INTERSECTIONAL
EXPERIENCES SUCH AS THIS ONE
THAT SAID AN APPOINTMENT WITH MY
DOCTOR STARTED WITH ME HAVING A
LONG WAIT IN A CRAMPED
RECEPTIONIST ROOM WITH ALL BLACK
PATIENTS.
WHILE WAITING THERE WAS A TV
PROGRAM ABOUT MARRIAGE EQUITY IT
PROMPTED A PATIENT TO MAKE
NEGATIVE COMMENTS.
I OPENED MY MOUTH TO COUNTER HER
COMMENTS BUT SEVERAL PEOPLE BEAT
ME TOO IT AND READ HER UP ONE
SIDE AND DOWN THE OTHER AND THE
DISCUSSION CONTINUED AND I WAS
ABLE TO CONTINUE IN THE
PARTICIPATION ABOUT LOTS OF
DISCUSSION ABOUT MARRIAGE
EQUITY.
THIS WAS BY A BISEXUAL MALE AGE
71.
AND SHOWS DESPITE THE FACT FOR
SOME PEOPLE IT MAY HAVE BEEN
NEGATIVE FOR THIS PERSON IT WAS
POSITIVE AND WE USED THAT
SUBJECTIVE MEASURE OF STRESS.
LET'S LOOK AT THE FINAL RESULTS.
I'M PROUD TO SAY THIS IS THE
ONLY STUDY TO SHOW AMONG BLACK
QUEER FOLKS POSITIVE
INTERSECTIONAL EXPERIENCES ON A
DAY TO DAY BASES ARE RELATED TO
POSITIVE AFFECT.
HOWEVER, THESE WERE NOT RELATED
TO A DECREASE IN IDENTITY
CONFLICT AND THIS MEDIATION
MODEL WAS NOT SIGNIFICANT.
WHEN IT COMES TO POSITIVE
RUMINATION WE FOUND A MEDIATION
EFFECT.
NOT ONLY WAS POSITIVE RUMINATION
RELATED TO NEGATIVE
INTERSECTIONAL EVENTS AND AFFECT
BUT A MODEL MEANING WHEN WE PUT
THIS IN THE MODEL THE MAIN
AFFECT BECAME NON SIGNIFICANT.
IF YOU WANT TO LEARN MORE ABOUT
THE METHOD OF STUDYING
INTERSECTIONAL EXPERIENCES USING
THE MIXED METHOD SAMPLING
APPROACH, YOU CAN LOOK AT THE
STUDY WHERE WE EXPAND THE MODEL
AND INCLUDE QUOTES FROM A STUDY
ON QUEER FOLKS AND SOME
ACKNOWLEDGEMENT ON THOSE WHO
HELPED WITH FUNDING AND SUPPORT
AND A LOOK FORWARD TO CHATTING
WITH YOU ALL ON THE OTHER SIDE
OF THE PRESENTATIONS ABOUT THIS.
THANK YOU FOR YOUR TIME.
>>THANK YOU.
AND IT'S NICE TO SEE THE
RESEARCH IN EFFECT.
NEXT UP WE HAVE DR. KUSHALNAGAR.
WHENEVER YOU'RE READY, TAKE IT
AWAY.
>>HELLO AND GOOD MORNING.
I'MY HAPPY TO TALK ABOUT MY
WORK IN DEAF PEOPLE AND DEAF AND
SEXUAL MINORITIES AND HEAR FROM
GALLAUDET UNIVERSITY.
I WANT TO TALK FOR A MOMENT IN
GENERAL ABOUT THE DEAF
COMMUNITY.
AS YOU MAY KNOW DEAF AND HARD OF
HEARING PEOPLE WHO USE ASL
EXPERIENCE HEALTH DISPARITIES
COMPARED TO OTHER GROUPS.
ESPECIALLY WHO THOSE WHO HAVE
ENGLISH FLUENCY AND ABLE TO
FUNCTION IN SOCIETY.
ISSUES COME UP BETWEEN MEDICAL
PROVIDERS AND PATIENT WHO'S ARE
DEAF, BLIND OR HARD OF HEARING.
THERE'S INCIDENTAL INFORMATION
AVAILABLE ON THE RADIO, FOR
EXAMPLE, ON TELEVISION THAT AT
LEAST IN THE PAST USED TO NOT BE
CAPTIONED.
COMMERCIALS, CLINICAL TRIALS,
VARIOUS DRUGS WITH NO CAPTIONING
ON THE COMMERCIALS.
THESE ARE MISSED OPPORTUNITIES
FOR DEAF PEOPLE TO ACCESS HEALTH
INFORMATION.
IT'S A LITTLE BIT BETTER THESE
DAYS BUT THE ISSUES STILL
PERSIST.
THERE ALSO USED TO BE A LACK OF
QUALIFIED INTERPRETERS FOR
HEALTH EXPERIENCES FOR THE DEAF
COMMUNITY.
THAT'S ALSO IMPROVED BUT CAN
STILL BE AN ISSUE.
AT THIS POINT FOCUSSING ON OUR
CENTER FOR DEAF HEALTH EQUITY WE
TOOK A SAMPLE OF OVER 550 DEAF
AND BLIND INDIVIDUALS USING ASL
AND SOME WERE BIPOC AND 74 WERE
TRANS, NON BINARY OR GENDER
QUEER.
THESE ARE FAIRLY LARGE NUMBERS
FOR THE ASL USER COMMUNITY.
THIS IS THE LARGEST STUDY TO
DATE.
A QUICK SUMMARY OF OUR FINDING.
SIMILAR TO OTHER PRESENTERS THAT
HAVE GONE FORWARD WE SAW A
DISPARITY BETWEEN SGM
COMMUNITIES AND NON-SGM
COMMUNITIES AND IN TERMS OF ONE
DISEASE, ASTHMA, ARTHRITIS, DES
DEPRESSION AND ANXIETY.
WE FOUND DISPARITIES AMONG
TRANSGENDER HEALTH AND
TRANSGENDER ASL AND
NON-TRANSGENDER.
WE ALSO FOUND DISPARITIES
BETWEEN ASL USERS WHO IDENTIFY
AS BINARY VERSUS NON BINARY.
THE STUDY INCLUDED SOME
INDIVIDUALS WHO IDENTIFIED AS
TRANSGENDER, SOME
NON-TRANSGENDER, SOME LGBTQ.
THERE WAS A DIVERSE RANGE OF
PARTICIPANTS.
A LOT OF THESE HAVE TO DO WITH
ACCESS TO INFORMATION AND THE
LACK THEREOF.
THEY MAY NOT HAVE HAD
OPPORTUNITIES TO TALK ABOUT
THEIR IDENTITIES WITH THEIR
PEERS.
THERE MAY BE LESS UNDERSTANDING
OF THEIR IDENTITY WHICH COULD
IMPACT HOW THEY RESPOND WITHIN
THESE STUDIES.
MOVING ON TO THE RELATIONSHIP
BETWEEN PATIENTS AND PHYSICIANS
AS MENTIONED EARLIER THERE'S
OFTEN ISSUES BETWEEN PATIENTS IN
TERMS OF COMMUNICATION WITH DEAF
PATIENTS AND THIS CAN IMPACT THE
RELATIONSHIP WITH THEIR
IDENTITY.
LOOKING AT THE RELATIONSHIP
BETWEEN PATIENTS WHO IDENTIFY AS
LGBTQ AND DEAF, THEY MAY HAVE AN
INTERPRETER IN THE ROOM WHO
SHARES THAT IDENTITY.
BUT IN FACT A SHARED I'D TIE OR
LACK THEREOF BETWEEN THE PATIENT
AND INTERPRETER DID NOT HAVE AN
IMPACT ON THE PATIENT'S
WILLINGNESS TO DISCLOSE THEIR
SEXUAL IDENTITY OR GENDER
IDENTITY TO THEIR PROVIDER.
WE FOUND DEAF PEOPLE WHO
IDENTIFIED AS GAY OR LESBIAN
WERE MORE COMFORTABLE
IDENTIFYING THESE TO THEIR
PROVIDER AND THOSE WHO WERE BUY
SEXUAL OR QUEER DID NOT FEEL
COMFORTABLE DISCLOSING.
THERE ARE SEVERAL FACTORS UNIQUE
TO DEAF INDIVIDUALS WHO
IDENTIFIED AS GM.
IDENTITY, STIGMA,
SELF-ACCEPTANCE AND QUALITY OF
LIFE.
EACH OF WHICH CAN VARY WHETHER
WITHIN THE DEAF COMMUNITY OR THE
LARGER COMMUNITY.
SOME FEEL MORE ACCEPTED IN THE
LGBTQ COMMUNITY THAN IN THE DEAF
COMMUNITY AS WITH A PERSON THAT
IDENTIFIES AS LGBTQ AND THERE'S
STILL EDUCATION TO BE DONE AND
STIGMA ABOUT THE INDIVIDUALS WHO
IDENTIFY AS SGM WHERE AS IN THE
SGM COMMUNITY AS OTHERS HAVE
MENTIONED THEY MAY BE MORE
ACCEPTING OF AN INDIVIDUAL AS
DEAF THAN THE LARGER MAINSTREAM
COMMUNITY.
AND WHICH IS TO SAY IF SOMEONE
GOES INTO A BAR AND ANY BAR THEY
MAY FEEL UNCOMFORTABLE BEING
DEAF IN THAT ENVIRONMENT.
EVEN IF THERE'S DEAF PEOPLE IN
THE BAR THEY MAY FEEL LESS
ACCEPTED THAN GOING INTO AN
ENVIRONMENT WHERE THEY HAVE
OTHER SGM INDIVIDUALS OF THAT
CONTEXT.
IN THE GAY BAR THEY MAY FEEL
MORE ACCEPTED PROBABLY BECAUSE
BOTH GROUPS IDENTIFY AS
MINORITIES.
SO MINORITY MAY BE MORE LIKELY
TO ACCEPT A DIFFERENT MINORITY
IN THAT CONTEXT THAN A
MAINSTREAM BAR.
I HAVE A LARGE BODY OF RESEARCH
I'M TRYING TO DISTILL DOWN FOR
THE PURPOSES OF THIS
PRESENTATION AND HOW TO MAKE
RESEARCH INCLUSIVE OF SGM
INDIVIDUALS WITH SENSORY
DISABILITIES.
DEAF PEOPLE MISS A LOT OF
INCIDENTAL AUDITORY INFORMATION
AND HAVE LACK OF ACCESS.
BECAUSE OF THAT MISSED
INFORMATION GROWING UP THEY MAY
HAVE A SENSE OF PARANOIA OR NOT
REALLY KNOWING WHO AND WHAT IS
GOING ON AROUND THEM.
THEY'VE HAD THE EXPERIENCE
THROUGHOUT THEIR LIVES OF
RESEARCH ON THEM HAVING BEEN
EXPLOITED AND PUBLISHED WITHOUT
THEIR CONSENT.
SO IT'S SO IMPORTANT WITH THE
DEAF POPULATION AND MORE
IMPORTANT FOR THOSE DEAF WHO
IDENTIFY AS SGM TO PROVIDE
COMPREHENSIVE INFORMATION TO
THEM.
THAT TIME INVESTED IN
CONVERSATION IN DEVELOPING TRUST
IN A RELATIONSHIP BETWEEN THAT
STUDY IS CRUCIAL.
COLD FLYERS IN OUR COMMUNITY
HAVE NOT BEEN AS SUCCESSFUL FOR
US AS MORE ONE-ON-ONE CONTACT
AND DIRECT ASL PROVIDED.
THERE'S A RANGE WITHIN THE DEAF
COMMUNITY IN TERM OF ENGLISH
FLUENCY, EDUCATION AND SO FORTH.
MANY DEAF PEOPLE WHO
UNFORTUNATELY ARE UNDER
PRIVILEGED AND LESS FLUENT IN
ENGLISH OR MAY HAVE EXPERIENCED
LESS ACCESS TO INFORMATION,
THOSE ARE THE COMMUNITIES THAT
WE ARE FOCUSSING ON IN TERMS OF
EQUITABLE OUTCOMES AND PROVING
OPPORTUNITIES FOR CONSENT
THROUGH THESE.
SO THEY'RE OFFERING MULTIPLE
TOWNS MAKE AN INFORMED DECISION
AS TO PARTICIPATE OR DECLINE AS
SHOWN HERE.
WE IT IS THEIR RIGHT TO DECIDE
WHETHER TO JOIN OR CONTINUE OR
WITHDRAW FROM A STUDY AT ANY
TIME.
THIS PROCESS HELPS BUILD TRUST
AND HELPS US GET RETURN
PARTICIPANTS IN OUR STUDY.
ANOTHER SUGGESTION IS TO MAKE
YOUR MATERIAL ACCEPTABLE BOTH IN
ASL AND ENGLISH.
HERE WE SEE A VIDEO THIS REDUCES
FRUSTRATION AND HELPS US
MAINTAIN OUR PARTICIPANTS IN OUR
STUDY.
YOU CAN CONTACT GALLAUDET
UNIVERSITY AND WE'D BE HAPPY IT
HELP YOU DEVELOP THOSE
MATERIALS.
ANOTHER ISSUE IS THE DEAF
COMMUNITY VALUES KNOWING WHO ARE
THE INDIVIDUALS THEY'RE SEEING
IN THE PUBLICITY AND THE
MATERIALS THAT WE ARE PUTTING
OUT.
THAT TRUST IS A HUGE FACTOR IN
HELPING PEOPLE FEEL COMFORTABLE
JOINING OUR STUDY.
BEING FAMILIAR WITH THE DEAF
PERSON THEY SEE HELPS THEM IN
THEIR MINDS.
AND I RECOMMEND INVESTING IN ASL
VIDEOS WITH A PAID ASL NARRATOR
PAID FOR THEIR TIME AND IT TAKES
TIME TO EDIT AND LET ME GIVE YOU
AN EXAMPLE WHAT THAT LOOKS LIKE.
WE REALIZED IT WASN'T INCLUSIVE
AND REQUESTED FUND FROM THE
NATIONAL INSTITUTES OF HEALTH
FOR ADDITIONAL FUNDING.
.
EXISTING HEALTH RESEARCH ON DEAF
POPULATIONS OFTEN OMITTED DEAF
LGBTQ.
IT'S MOURN TO KNOW DEAF LGBTQ
NEEDS AND ISSUES MAY BE
DIFFERENT FROM THEIR
HETEROSEXUAL COUNTERPARTS AND
IMPORTANT TO STUDY AND CONSIDER
THE UNIQUE CONCERNS AND NEEDS OF
DISTINCT GROUPS OF THESE
POPULATIONS AND DEAF LESBIANS AN
DEAF GAY MEN, ETCETERA.
OUR PARTICIPANT POOL SO FAR IS
66 MALE PARTICIPANTS WHO
IDENTIFY AS GAY, BUY SEXUAL AND
SEXUAL QUEER OR ANOTHER
IDENTITY.
28 PARTICIPANTS WHO IDENTIFIED
AS TRANSGENDER OR GENDER QUEER
85 FEMALE PARTICIPANTS WHO
IDENTIFY AS LESBIAN, GAY, BUY
SEXUAL, PANSEXUAL OR QUEER OR
OTHER IDENTITIES.
YOU MAY BE THINKING -- I'LL STOP
IT THERE.
>>WHAT YOU JUST VIEWED THERE
THERE WERE A LOT OF VISUALS
INCORPORATED AND INDIVIDUAL AS
NARRATORS AND THIS IS THE FIRST
VIDEO OF THIS TYPE WE'VE
DEVELOPED AND KEEP US IN MIND
WITH YOUR PLAN AND WHEN YOU DO
THE DATA ANALYSIS MAKE SURE YOU
TREAT THE DATA SEPARATELY.
DON'T LUMP EVERYONE INTO A
SINGLE GROUP AND OTHER
PRESENTERS HAVE ALREADY
MENTIONED THIS ASPECT SO I WON'T
REPEAT THEIR COMMENTS.
I DID SHOW MY E-MAIL AT THE END
OF MY PRESENTATION AND PLEASE
FEEL FREE TO CONTACT ME AND
THANK YOU FOR YOUR ATTENTION.
>>THANK YOU FOR THE VIDEO AND
FANTASTIC PRESENTATION AND FOR
THOSE WHO MAY HAVE OTHER SEXUAL
IDENTITIES.
WE NEED MORE RESEARCH AND AS A
FORMER SUPPLEMENTAL AWARDEE I'M
PROUD TO HAVE YOU CONDUCTING THE
WORK.
NEXT I'D LIKE TO MOVE TO
DR. WALTERS.
THE FLOOR IS YOURS.
>>GREAT.
GOOD AFTERNOON OR MORNING.
I'M LOSING TRACK ON EAST
COAST/WEST COAST TIME AND I'M
HERE TO SHARE ABOUT HEALTH
EQUITIES AMONG THE ALASKA NATIVE
POPULATION AND I'LL USE THE TERM
TWO SPIRIT FOR TODAY.
FIRST, I WANT TO INSPIRED BY ALL
THE CONVERSATIONS YESTERDAY AND
TALKING ABOUT THE IMPORTANCE OF
AND TODAY FOCUSSING ON
RESILIENCE AND LOOKING AT ISSUES
OF THRIVANCE WHICH I'LL TALK
ABOUT TODAY WITH OUR
POPULATIONS, I WANT TO SHARE
FIRST A STORY AND THIS IS A
STORY THAT COMES FROM
DR. JENGING AND SHE'S ALSO
CHOCTAW AND I WANT TO SET THE
CONTEXT FOR WHAT A WANT TO TALK
ABOUT IN TALKING ABOUT
DISPARITIES IN THE TWO-SPIRIT
POPULATIONS.
THIS IS A STORY OF APANUKFILA.
A LONG TIME AGO TWO CHILDREN
WERE ORPHANED AND THE OLDER
SISTER HUNTED AND PROVIDED FOOD
AND THEY WERE WELL BUT ONE DAY
THE CLOUDS CAME AND THE WINDS
ROARED AND THERE WAS DEVASTATION
TO THE VILLAGES.
THE BOY WAS SO WORRIED ABOUT HIS
SISTER BECAUSE SHE DIDN'T COME
BACK AND SET OFF TO FIND HER AND
FOUND SOMEONE CALLING IN A TREE
AND CLIMBED UP AND FOUND HIS
SISTER AND SHE SAID GO AWAY, BE
SAFE.
GET AWAY FROM AWAY AND HE BEGGED
HER TO COME DOWN BUT SHE COULD
NOT AND EXPLAINED DURING HER
LAST HUNTING EXPEDITION SHE WAS
VIOLATED BY THE MEN OF ANOTHER
VILLAGE AND SAID GET OUT YOU'RE
NOT SAFE HER.
I MAY TURN INTO A WIND AGAIN AND
HE BEGGED HER TO COME HOME WITH
HIM BECAUSE HE LOVED HER BUT SHE
REFUSED BUT TRANSFERRED TO HIM
HER HUNTING SKILLS.
SHE'S WAS AN INCREDIBLE HUNTER
AND THE YOUNG BOY FREQUENTLY
VISITED HIS SISTER AND WHILE SHE
RAGED OVER THE LAND HE BECAME
KNOWN AS THE BEST HUNTER IN THE
REGION AND SHARED HIS MEAT WITH
EVERYBODY AND AS HIS REPUTATION
SPREAD HE BECAME KNOWN AND HE
VISITED HIS SISTER AND SHE SAID
SHE WAS LONELY AND MET WITH AN
UNCLE OF A PROSPECTIVE WIFE AND
ASKED FOR HER HAND IN MARRIAGE
AND SHE AGREED BUT WHEN THEY
LEFT THE VILLAGE HE SAID
ACTUALLY I HAVE A HITCH.
I'M ASKING ON BEHALF OF MY
SISTER WHO HAPPENS TO BE THE
WHIRLWIND AND SHE SAID I'LL
CHECK IT OUT AND WE'LL SEE IF
I'M A MATCH AND THEY MET AND
AGREED TO MARRY AND THEY GREW A
STRONG PARTNERSHIP AND SHE WAS
ABLE TO TRANSFORM HER PAIN AND
BEGIN TO HEAL.
AS SHE HEALED HER POWER OF
WHIRLWIND TURNED INTO A
RESTORING BALANCE WITH THE EARTH
AND CREATED VEGETATION ON THE
LAND AND HER ROLE TRANSFORMED
THE EARTH SO LIFE CAN BEGIN
AGAIN.
ONE DAY HER BROTHER VISITED AND
SAID TO OTHERS TO PLACE THE BACK
SIDE TO HOME TO MISS THEIR HOMES
AND TO THIS DATA BACK -- DAY
TOBACCO IS TURNED DOWN DURING A
STORM TO THIS DAY.
SHE REMINDS US OF THE
TRANSFORMATIVE POWER OF LOVE AND
HEALING FROM TRAUMA AND WE HAVE
STORIES, WE HAVE INDIGENOUS
STORIES OF THE TRANSFORMATIVE
POWER DESPITE COLONIALISM'S
ATTEMPT AT OUR ERASURE.
WE HAVE A HISTORY OF DEALING
WITH HIGH-LEVELS OF
DISPROPORTIONATELY EXPOSURE TO
TRAUMAS AND THERE'S AN EXAMPLE
OF A BOARDING SCHOOL NATIVE IN
BOARDING SCHOOLS ESPECIALLY TWO
SPIRITS WELL ANY EXPRESSION OF
LOVE IN BOARDING SCHOOL WAS MET
WITH PUNISHMENT AND GENDER NON
CONFORMITY AS WELL AND WHEN BOYS
RAN AWAY FROM BOARDING SCHOOL
AND WERE CAUGHT, THEY WOULD BE
BROUGHT BACK AND FORCED TO WEAR
GIRLS DRESSES AS A FORM OF
HUMILIATION.
THAT'S RECONFIGURING A PRACTICE
OF GENDER AND THERE WERE HETRO
NORMATIVE WESTERN CHRISTIAN
NORMS AND OTHERS HAD THE BURD
END OF THESE EVENTS AND WE
STUDIED THE TWO-SPIRIT
POPULATIONS AND WE FOUND 85% OF
THE WOMEN HAD EXPERIENCED SOME
KIND OF LIFE TIME SEXUAL ASSAULT
AND 75% EXPERIENCED SOME KIND OF
PHYSICAL ASSAULT.
WE'RE TALKING ABOUT HIGH LEVELS
OF TRAUMA WE STILL EXPERIENCE
NOT JUST HISTORICALLY.
THIS IS MANIFESTED IN SOME OF
OUR HEALTH ISSUES THAT ARISE.
WE HAVE HIGH LEVELS OF MENTAL
HEALTH BURDEN AND WE SELECTED
PEOPLE WITHIN THE SAMPLING AND
THE DATA IS AS CLOSE TO
APPROXIMATION AS WE CAN GET FOR
A RANDOM SAMPLE.
OVER A THIRD OF OUR SAMPLE HAD
HIGH LEVELS OF SUICIDALITY WITH
40% OF TRANS AND 39% OF WOMEN
AND 21% OF MEN ATTEMPTED
SUICIDE.
POOR HEALTH, HIV PREVALENCE WAS
HEDGE 1 OF 3 OF MEN WHO HAVE SEX
WITH MEN AND TRANS MEN AND WOMEN
AND 15% OF WOMEN WHO HAVE SEX
WITH WOMEN WERE LIVING WITH HIV.
YOU DON'T HEAR ABOUT THE
NUMBERS.
PEOPLE WERE PRETTY WELL EDUCATED
AND PEOPLE STILL WERE STRUGGLING
WITH POVERTY AND TO NOTE PEOPLE
WHO HAD HAD PARENTS WHO
EXPERIENCED HISTORIC EVENTS SUCH
AS BOARDING SCHOOL AND 80% HAD
SOME KIND OF PTSD.
TO CONTEXTUALIZE WHY THIS LEADS
TO POOR HEALTH AND THEN GET TO
THE RESILIENCE PART.
HISTORICALLY TRAUMATIC EVENTS
ARE DESIGN AND IT'S A LONGER
STORY TO GET INTO BUT THEY'RE
DESIGN TO ERADICATE PEOPLE,
ERADICATE THEIR LIFE WAYS
THROUGH ETHNOCIDE AND
ERADICATING THOUGHT WAYS HOW WE
THINK ABOUT OURSELVES OUR VIEWS
AND INDIGENOUS KNOWLEDGES.
AND THESE ARE CONCEPTUALIZED AS
COLLECTIVE AND THE EXAMPLE IS
THE BOARDING SCHOOL WHERE HETRO
NORMATIVE PRACTICES WERE THE
ONLY TOLERATED PRACTICES AND
CHRISTIANITY REPLACED
TRADITIONAL UNDERSTANDINGS OF
WORLD VIEWS DURING THAT PERIOD.
AND IF YOU'RE WONDERING DID
THESE THINGS HAVE AN IMPACT IN
OUR STUDY WE FOUND THEY DID.
EVEN AFTER CONTROLLING FOR LIFE
TIME PHYSICAL AND SEXUAL ABUSE
AND SERVICE AFTER A GENERATION
OF TRAUMA AND IF THE PERSON
EXPERIENCED HISTORICALLY
TRAUMATIC EVENTS AFTER
CONTROLLING FOR THOSE THINGS WE
FOUND THE EFFECTIVE LIFE TIME
TRAUMA ON TRAUMATIC EVENTS IN
PREVIOUS GENERATIONS STILL
CONTINUED TO HAVE AN EFFECT
TODAY WITH OVER ALL TRAUMA
ACROSS MULTIPLE GENERATIONS
ASSOCIATED WITH GREATER PTSD AND
GREATER ALCOHOL AND SUBSTANCE
ABUSE AND LAND BASED
HISTORICALLY TRAUMATIC EVENTS,
DESECRATION OF BURIAL SITES AND
THOSE ALSO ACCOUNTED FOR SOME
VARIANCE IN MENTAL HEALTH
OUTCOMES.
WE HAVEN'T TALKED THROUGH A
XROOE COMPREHENSIVE IDEA OF HOW
HAS HISTORICALLY DRAMATIC EVENTS
IMPACTED OUR WELL BEING AND
THOUGH OUR RESEARCH HAS SHOWN
HISTORICAL TRAUMA OF NATIVE
AMERICANS ARE ASSOCIATED WITH
CONTEMPORARY MENTAL HEALTH AND
PHYSICAL HEALTH OUTCOMES, I
THINK THAT ALSO HAS IMPLICATIONS
FOR INTERGENERATIONAL TRAUMA IN
LGBTQ COMMUNITIES AND LGBTQ
POPULATIONS STILL EXPERIENCE
SOME HISTORICALLY TRAUMATIC
EVENTS.
I THINK THAT'S AN AREA OF
FURTHER STUDY AND DISCUSSION
DOWN THE LINE BUT THE BOTTOM
LINE, THESE KINDS OF
HISTORICALLY TRAUMATIC EVENTS
PRODUCED DISRUPTIONS IN THREE
MAJOR AREAS HOW WE TALK AND
THINK ABOUT OURSELVES AND
NARRATE OUR STORIES AND DISRUPTS
OUR WAYS OF BEING IN TERMS OF
OUR BODIES AND CULTURES AND TIES
TO LAND AND PLACE AND DISRUPTS
OUR KNOWLEDGE SYSTEMS AND
ABILITY TO CONNECT TO OUR
ORIGINAL STORIES AN ANCIENT
TEACHING TEACH US HOW TO LIVE
WELL.
IN DEVELOPING INTERVENTIONS AT
THE COMMUNITY LEVEL AND THEY
WENT THROUGH THE THREE ELEMENTS
IN HEALTH PROMOTION
INTERVENTIONS RESTORING AND
DRAWING FROM ORIGINAL
CONSTRUCTION AND HOW DO WE DRAW
FROM ANCIENT TEACHINGS AND
RESTORING RELATIONAL WAYS OF
BEING AND HOW RERESTORE OUR
LIVES THROUGH STRATEGIES AND
THEY'RE INCLUDED IN OUR
INTERVENTIONS.
AND SO IN TERMS OF THE LGBTQ
COMMUNITY AND THE TWO-SPIRIT
STUDY WE LOOKED AT QUALITATIVE
NARRATIVE AND EXPANDING OUR
RESEARCH INTO MORE QUALITATIVE
AREA TO GET AT THE MORE
INTERSECTIONAL PIECES AND
RESILIENCY AND AREAS OF STRENGTH
AND WE DEVELOP AND PROMOTE THAT
AND IDENTIFYING WHO IS DOING
WELL AND HOW.
AND THERE WAS A CONCEPT CALLED
THRIVANCE.
IF YOU THINK WEAVING, THERE'S A
WARP AND WEPT.
AND THERE'S REJECTION OF
INTERNALIZATION OF THE MESSAGES
AND ENGAGING IN THE COLONIZATION
PRACTICES ON A DAILY LEVEL.
WE THINK ABOUT THAT WARP AND
WEPT COMING TOGETHER AND THAT
PRODUCE WHAT'S WE CALL
THRIVANCE.
SO TURNING TO OUR QUALITATIVE
INTERVIEWS WITH TWO SPIRIT WOMEN
AND I'M FOCUSSING ON WOMEN
BECAUSE WE DON'T GET A LOT OF
ATTENTION IN THE LITERATURE.
THIS IS PART OF SPEAKING TO THE
INVISIBILITY AND THERE'S BEEN
DATA THAT WE'RE LOOKING FOR.
WE USED THE TRADITIONAL VOICE
CENTER ADD -- CENTERED APPROACH
AND LOOK AT I AND WE STATEMENT
AND THEY STATEMENTS.
WE PULL OUT AND IT CREATES A
FORM OF DATA ANALYSIS TO DIVE IN
THE DATA DEEPER.
I'M GOING SHARE WITH YOU THE
FORMS.
NOT SURPRISINGLY WE WERE ABLE TO
ORGANIZE THE FINDINGS AROUND
THOSE THREE ELEMENTS THAT ARE SO
IMPORTANT FOR THRIVANCE AND
HEALTH AND WELL BEING AND
LOOKING AT INSTRUCTIONS AND WAYS
OF BEING IN THE WORLD AND
TRANSFORMATION AND THE OTHER
ELEMENT IN THE DATA WAS
IMPORTANCE OF CEREMONY AND
SPIRITUALITY.
FIRST TO ACKNOWLEDGE OUR TRAUMA
AND TO SET THE CONTEXT IN WHICH
TO UNDERSTAND HEALTH
EXPERIENCES.
THIS IS AN EXAMPLE AND THESE ARE
ALL PSEUDONYMS AND NO NAMES ARE
USED HERE.
THIS ONE PERSON SAYS BEEN A
WHOLE PHENOMENON OF DISASTER AND
HUGE TRAUMA TOLD THEY WERE LESS
THAN AND WOMEN HAD NO PLACE.
THE MEN WERE FILLED WITH ALCOHOL
AND ANY SPIRITUAL THING WAS
MURDERED AND THE ONLY THING THAT
STAYED WERE SPIRIT.
AND THEY WERE SUPPOSED TO TAKE
CARE OF THE COMMUNITY.
HERE THEY'RE TOLD YOU'RE
NOTHING.
YOU'RE STUPID.
YOU DON'T HAVE RIGHT TO LIVE.
WHAT ARE YOU?
TWO SPIRITS BACK THEN WERE
LOOKING AT A COMMUNITY WHO
ALREADY HATED THE SIGHT OF
INDIANS.
I'M SURE THE HISTORICAL TRAUMA
WAS THERE.
I THINK WE ALL FEEL THE DISTRUST
AND CARE AROUND THE DOMINANCE IN
OUR LIVES.
THE TWO SPIRIT PEOPLE BACK THEN
WERE PROBABLY MEETING
UNDERGROUND OR ELIMINATED UNTIL
THERE WAS A TIME OTHER PEOPLE
COULD RECOGNIZE THEM, TWO
SPIRITS THEMSELVES.
HERE'S A THEME DRAWING FROM SOME
OF THE ORIGINAL INSTRUCTIONS.
AND MY NATIVE PEOPLE ACCEPTED ME
AND LOVED ME.
IT WASN'T JUST THE FAMILY.
IT WAS THE WHOLE TRIBE.
IT DOESN'T MATTER THE SEXUAL
ORIENTATION.
THEY WERE TREATED AS WELL AS
ANYBODY ELSE OTHER TIME SIMPLY
BECAUSE THEY WERE GOOD HEALTHFUL
PRODUCTIVE PEOPLE AND AND I
DON'T KNOW WHY BUT ANOTHER SAYS
BEFORE COLONIZERS CAME AND TAKE
CARE OF THE DEAD AFTER THEY'RE
GONE.
I FEEL THAT'S WHAT I DO,
TEACHING, FEELING.
I ALWAYS FELT COLD IN THAT
DIRECTION.
I HAD FRIENDS DYING IN THE EARLY
'80s AND I WAS THERE BECAUSE
NOBODY ELSE WOULD TOUCH THEM.
THE LOVE COMES NATURALLY.
I'VE GROWN WHO I AM SUPPOSED TO
BE.
I THINK I WAS PUT HERE FOR A
REASON.
MY ANCESTORS PLACED ME HERE FOR
A REASON AN MY GRANDMA KNEW IT.
AND THERE'S GRANDMA'S LOVE AND
THIS IS IMPORTANT AND THIS SHOWS
THE IMPORTANCE OF RELATIONALITY
AND THE ONE OR TWO ELDERS IN A
COMMUNITY THAT HELP TREMENDOUSLY
WITH A PERSON'S WELL BEING.
SHE SAID SOMEBODY GAVE US THEIR
SPIRIT.
WE HAVE THE SPIRIT ALREADY BUT
WE WELCOME INTO THE WORLD
SOMEONE WHO KEEPS REMINDING YOU
BELONG.
THAT THING THAT SAVED ME IS I
WAS ALWAYS GIVEN A LOT OF LOVE.
IT WASN'T ALL HUGS AND SMOOCHES.
MY GRANDMA USED TO GET ME A CUP
OF TEA.
IT GAVE ME PURPOSE.
IT GAVE ME A CHANCE TO TAKE CARE
OF MY GRANDMA.
IT TAUGHT ME ABOUT GIVING.
I WATCH HER GIVE FOOD TO PEOPLE
AND WE NEVER HORDED THINGS THAT
COULD BE USED BY OTHER PEOPLE.
AND I WANT TO END ON THE ONE
PIECE ABOUT THE IMPORTANCE OF
ORIGINAL INSTRUCTIONS TIED TO
CEREMONY AND WELL BEING.
YOU HAVE TO MEET IT HALFWAY TO
HAVE THE POWER TO TRANSFORM.
THIS CAME IN THE LAST FORM I
WANT TO SHARE WITH YOU.
I REMEMBER WHEN I WAS GOING
THROUGH A TOUGH TIME AND WENT
HOME AND SO DISJOINTED AND
ANGRY.
MY GRANDMOTHER GAVE ME A BIG HUG
AND SAID YEP, YOU'VE COME HOME.
I WENT TO THE CABIN AND SAID I
NEED YOUR HELP.
SHE SAID GO FAST, CEREMONIAL
FAST.
I SAID I DON'T WANT TO GO FAST.
I DON'T WA TO AND SHE SAID YOU
HAVE TO AND I WAS MAD GOING UP
THE TRAIL AND THAT WENT ON FOR
DAYS.
EACH TIME I WENT SHE SAID GO
FAST.
I DON'T WANT TO DO IT.
I SAID I DON'T WANT IT HEAR WHAT
THE SPIRIT HAS TO SAY, SHE
LAUGHED.
I WANT TO HEAR IT FROM YOU.
I WANT HUMAN NOT SPIRIT
INTERACTION.
I DIDN'T WANT TO DO ANYTHING OR
SIT DOWN TO DINNER.
I WAS SO PISSED AND ON THE
FOURTH DAY I GOT UP AND
SOMETHING CLICKED INTO PLACE AND
A WENT TO THE CABIN AND SHE SAID
COME HERE.
I'LL MARK THE PLACE FOR YOU.
A CEREMONIAL PLACE OUTSIDE THE
CLASS.
SHE DID.
THERE WAS A TOUGH TIME AND I WAS
UNFORTUNATE.
I'M GLAD I WENT OUT.
I RECEIVED WHAT A NEEDED TO GET
THROUGH.
IT WAS SIMPLE.
I SAY THANKS FOR ANOTHER DAY OF
LIFE AND BREATH.
IT'S THE SIMPLE THINGS THAT GET
ME THROUGH THE TOUGH TIMES,
FAMILY AND FRIENDS AND PEOPLE
WITH LIKE MINDS TO HELP YOU GET
THROUGH THE TOUGH TIMES.
I'LL END THERE AND WANT TO
HIGHLIGHT AS WE TALK ABOUT
MOVING FORWARD WITH OUR RESEARCH
AND COMMUNITIES DEVELOPING
POSITIVE HEALTH PROMOTION
INTERVENTION WE NEED TO THINK
ABOUT THE ORIGINAL INSTRUCTIONS
AND THE IMPORTANCE OF RELATIONAL
WAYS OF BEING AND TRANSFORMING
OUR LIVES FROM OUR POINTS OF
VIEW AND I THINK IT'S IMPORTANT
WE PARTICIPATE AND SHARE AND
BRING OUT THESE STORIES.
THESE STORIES HELP US THINK
THROUGH MORE INTERSECTIONALLY
AND THE INCREDIBLE STRENGTH OUR
COMMUNITIES HAVE DESPITE THE
COLONIALISM AND WHAT WE STILL
NAVIGATE TO THIS DAY.
THANK YOU FOR ALLOWING ME TO SAR
THAT WITH YOU.
>>THANK YOU SO MUCH.
THANK YOU FOR SHARING STORIES
AND PROVIDING THE CONTEXT AROUND
TWO SPIRIT AND THE PEOPLE AND
HOW IT BREEDS DISRUPTION AND
OFFERING STRATEGIES TO RAISE UP
AND THANK YOU AND THANK
EVERYBODY FOR BEING APART OF
THIS PANEL.
WE HAVE SOME TIME FOR Q&A.
WE CAN MOVE INTO THAT SECTION.
IF YOU HAVE ANY QUESTIONS SEND
THROUGH THE NIMHD MAILBOX OR
PANELISTS IF YOU HAVE ANYTHING
PUT IT INTO THE CHAT.
>>AND CAN YOU TALK ABOUT
IMPROVING OUR UNDERSTAND AND
ADDRESS INTERSECTIONAL STIGMA
WHICH IS A DRIVER FOR THESE
POPULATIONS.
>>I THINK WHAT WE'VE BEEN
MOVING INTO AND IT'S FOR
INDIGENOUS PEOPLE PART OF
COLONIALISM AND TRAUMA IS TO
DISRUPT OUR RELATIONSHIP TO LAND
AND PLACE AND ONE THING OUR
COMMUNITIES ARE STARTING TO TALK
ABOUT IS DOING MORE LAND-BASED
HEALING AND ACTIVITIES THAT GET
US OUTSIDE TYPICAL EXPERIENCES
AND SHIFT OUR THINKING AND
PROVIDES AN OPPORTUNITY FOR US
TO MOVE FASTER THROUGH THE
HEALING PROCESS.
ON THE OTHER HAND I ALSO THINK
IT'S CRITICAL TO CONNECT WITH
AND WORK WITHIN OTHER SPACES
WHICH OUR COMMUNITIES ARE
CONNECTED AND FIND OPPORTUNITIES
TO THRIVE AND CHURCH MAY BE A
POSSIBILITY.
MORE LIKELY IT'S COMMUNITY-BASED
CENTERS AND CULTURAL SPACES THAT
WE HAVE IN OUR COMMUNITIES THAT
WE HAVE ACCESS TO.
YEAH.
>>I WOULD SAY THE SAME FOR OUR
COMMUNITIES AS WELL.
IT IS IMPORTANT TO HAVE THAT
RELATIONSHIP COMMUNITY AND TO BE
ABLE TO IDENTIFY COMMUNITY
BEFORE YOU FEEL COMFORTABLE
PARTICIPATING -- HEARING
ACTUALLY EITHER WAY.
>>I DON'T HAVE A LOT TO ADD
EXCEPT SAY I DON'T KNOW OF ANY
LARGE SCALE NATIONAL LEVEL
INTERVENTIONS WORKING TO SUPPORT
LGBTQ FOLKS OF COLOR IN SCHOOLS
OR THROUGH FATHER INSTITUTIONS,
ETCETERA.
BUT I DO KNOW AS SOMEBODY WHO
BEFORE I PURSUED MY CURRENT WORK
AS A RESEARCHER I USED TO WORK
IN A NONPROFIT SECTOR TO REDUCE
PREJUDICE AND CONFLICT AMONG
TEENAGERS AND FROM BEING IN THAT
WORLD SO LONG AND CONTINUING TO
DO CONSULTING WORK WITH
NONPROFITS DOING THAT WORK,
THERE'S A NUMBER OF INTERESTING
AND EXCITING INTERVENTIONS THAT
ARE HAPPENING OUTSIDE OF OUR
WORLD OF RESEARCH AND I THINK
THE OPPORTUNITY IS THERE IN THE
FUTURE FOR MORE PARTNERSHIPS
BETWEEN THESE COMMUNITY
ORGANIZATIONS THAT ARE ON THE
GROUND DOING THIS WORK.
JUST ONE EXAMPLE I USED TO WORK
WITH AN ORGANIZATION OR KNOW OF
AN ORGANIZATION I COLLABORATED
WITH IN ADDITION TO THE GSAs IN
SCHOOL OR THE RACIAL ETHNIC
AFFINITY GROUPS, THEY HAD A
PROGRAM THEY TOOK INTO SCHOOLS
CALLED MERGING IDENTITIES.
THIS IS NO LONGER EXISTING BUT
WAS IN SOME WAYS WORKING ON THE
VERY CONSTRUCT I RAISED OF
IDENTITY CONFLICT MANY LGBTQ
FOLKS WHO ARE PEOPLE OF COLOR
FACE AND HOW DO WE RECONCILE AND
INTEGRATE THESE TWO REALLY
SALIENT AND OFTEN SIGTIGMATIZED
PEOPLE.
AND THE KEY IS TO BRING OUR
SCIENTIFIC MINDS AND RESEARCH
RIGOR TO LEARN WHAT'S WORKING
ALREADY AND BUILD UPON THAT AND
UPSCALE IT TO OTHER ENVIRONMENTS
SO THEY CAN ALSO BENEFIT.
>>VERY TRUE.
I COULDN'T AGREE MORE.
WE HAVE A QUESTION FOR
DR. KUSHALNAGAR.
THANK YOU FOR YOUR TALK ON ADULT
DEAF LGBTQ ADULTS AND ARE THERE
SENSORIES OTHER THAN DEAFNESS
SUCH AS BLINDNESS AND IS THERE
ADVOCACY AND INFORMATION AGAINST
MINORITY STRESS?
>>WONDERFUL QUESTION, I'M SO
HAPPY YOU ASKED.
MY EXPERIENCE AND KNOWLEDGE IS
LIMITED TO PEOPLE WITH SENSORY
DISABILITIES AND IT'S HEAVILY
RELATED TO LINGUISTIC ACCESS.
THOSE GENERALLY BLIND ARE
ENGLISH SPEAKING AND CAN ACCESS
AUDITORY INFORMATION AND NOT
SURE OUR FINDINGS CAN BE
FOCUSSED ON THIS BECAUSE WE LOOK
AT LANGUAGE ACCESS AND FOR THOSE
WHO HAVE AUTISM BUT MAYBE HAVE
SOCIAL ISSUES NOT SURE I CAN
ANSWER THAT.
IT WOULD BE GREAT TO DO MORE
RESEARCH INTO THOSE ISSUES AND
FIND IF THERE ARE ANY
COMMONALITIES AMONG THOSE WHO
HAVE SENSORY DISABILITIES AND
OTHER TYPES OF DISABILITIES.
GREAT QUESTION.
THANK YOU FOR THAT.
>>ANOTHER MESSAGE IN THE CHAT,
DR. WALTER.
THANK YOU.
HOW CAN WE APPLY THIS TO NATIVE,
LGBTQ BIRTHING AND PARENTING
PEOPLE GIVEN HOW FEMINIZING AND
GENDER BIRTH IS.
>>THAT'S A GOOD QUESTION.
GOING BACK TO ORIGINAL
INSTRUCTION AND TEACHINGS WE
HAVE ACROSS MANY TRIBES AND I
SAY ALWAYS GO BACK TO THE
SPECIFIC TRIBE YOU'RE WORKING
WITH OR A PART OF BUT SOMETIMES
IT'S HARD TO GET ACCESS TO THE
BIRTHING PRACTICES AND THERE'S
GREAT WORK ON BIRTHING PRACTICES
ACROSS THE BOARD.
PARENTING PRACTICES IN
PARTICULAR, CROSS A NUMBER OF
TRIBES AND APPROXIMATELY 140
TRIBES THAT ONE PARTICULAR ROLE
TWO SPIRIT FEEL FULFILL IN
COMMUNITY IS PARENTING CHILDREN
AND BEING THE EXPERT PARENT TO
THE COMMUNITY AND HAVING A ROLE
OF NURTURING OTHERS EVEN TO THE
POINT OF SOME TWO SPIRITS WENT
TO THE BATTLEFIELD AND THEY WERE
RESPONSIBLE FOR THE CARE GIVING
OF PEOPLE AS WELL.
THAT NURTURING ROLE OR CARE
GIVING ROLE WAS VERY IMPORTANT
AND AN EXAMPLE WHEN I WAS DOING
OUR TWO SPIRIT HONOR PROJECT
STUDY I ASKED A COLLEAGUE WHO IS
TWO SPIRIT IN OKLAHOMA IN A
TRADITIONAL COMMUNITY AND A SAID
WHAT'S IT LIKE BEING GAY IN THAT
COMMUNITY AND SAID WELL I'M ONLY
GAY IN TULSA BUT I'M HAPPY IN MY
COMMUNITY.
HE'S THE ONE THAT TAKES CARE OF
THE CHILDREN AND DOES THE
BEADWORK OR THE COMMUNITY AND HE
UNDERSTOOD HIS ROLE AS BEING
NURTURING AND LOVING AND VERY
MUCH ACCEPTED.
SO THIS CONCEPT OF GAY IN THE
WESTERN FRAMEWORK WAS WHEN HE
WENT TO TULSA.
I THINK IT'S A GREAT OPPORTUNITY
TO BUILD ON THAT.
IN TERMS OF SPECIFIC BIRTHING
AND PARENTING PRACTICES, IT'S
UNIQUE TO THE TRIBES AND STORIES
AND THE OTTER STORY OF IT
TELLING YOU WHEN THE BIRTH WILL
HAPPEN BECAUSE THE BABY MOVE AND
THERE'S A STORY ABOUT THE
IMPORTANCE OF THE WATER AND
THERE'S STORIES AROUND THAT
THAT'S NOT NECESSARILY TIED TO
GENDER.
A LOT OF OUR NATIVE LANGUAGES IN
CHOCTAW WE DON'T HAVE A HE AND
SHE.
THERE'S BODIES AND IDENTITIES
AND EXPRESSIONS.
IDENTITY AND EXPRESSION DOESN'T
NECESSARILY HAVE TO MATCH.
WHAT YOUR BODY AND GIVE TO THE
WORLD IS PART OF WHAT WE ALL
LOVE.
SO I HOPE THAT HELPS A LITTLE
BIT IN TERMS OF UNDERSTANDING
THE COMPLEXITY.
>>THANK YOU.
I WANT TO BE MINDFUL SO
EVERYBODY GETS A BREAK AND MAYBE
WE CAN SHARE THAT WITH THE
PERSON.
AND IN CLOSING THANK YOU FOR
YOUR UNIQUE TAKES ON THIS
COMPLEX BUT IMPORTANT ASPECT OF
RESEARCH AND LIVELIHOOD AND
GENERAL EXPERIENCES OF SGM
PEOPLE AND PEOPLE WRIT LARGE.
THANK YOU SO MUCH FOR YOUR TIME
AND WE APPRECIATE YOU HAVING YOU
HERE AND HOPEFULLY WE'LL GET TO
SEE YOU LATER FOR BREAKOUT
SESSIONS OR STAY FOR THE OTHER
FOLLOWING SESSIONS BUT IN THE
MEANTIME WE'LL TAKE A BREAK TO
12:15 AND SEE YOU BACK AFTER
THAT.
>>WELCOME BACK.
FIRST WE'LL START BY DR
DRDR
DRDR. BA
DR. BAUERMEISTER AT THE
UNIVERSITY OF PENNSYLVANIA.
>>THANK YOU.
GOOD AFTERNOON.
IT'S A PLEASURE TO JOIN THIS
EXCITING TWO-DAY WORKSHOP.
I'M LEARNING A LOT.
IT'S A PRIVILEGE.
I WANT TO WANT TO LOOK AT THE
OPPORTUNITIES REGARDING
INTERVENTION RESEARCH AND IT WAS
QUITE A DAUNTING TASK AND
CHANCES ARE AFTER 15 MINUTES
I'LL SKIM THE SURFACE BUT IN THE
NEXT 15 MINUTES OR SO WE HAVE
TOGETHER I'M GOING HIGHLIGHT SIX
KEY AREAS RIPE FOR INTERVENTION
AND GROWTH WITH RESEARCH AND
WHAT I TRIED TO DO IS MAP THE
AREAS TO THE INTERVENTION
DEVELOPMENT PROCESS INCLUDING
IDENTIFYING THE PROBLEM OR THE
SOLUTION, DEFINING THE
POPULATION OF INTEREST, FRAMING
THE PREMISE AND ALIGNMENT WITH
EVIDENCE-BASED INTERVENTION
STRATEGIES AND FINALLY THINKING
ABOUT EVALUATION AND DESIGN.
NOW, GIVEN TO THE OPPORTUNITY
FOR THE TALK I WANT TO SHARE
OTHER CONSIDERATIONS UNIQUE TO
SGM RESEARCH I THINK COULD AC
ACCELERATE THE STATE OF THE
SCIENCE.
WHEN I THINK OF THE STATE OF THE
SCIENCE I THINK OF THE
MULTI-LEVEL FACTORS CONTRIBUTING
TO SGM FACT AND HOW TO INTERVENE
EFFECTIVELY.
I'LL MAKE A SHAMELESS PLUG TO
LOOK AT THE FRAMEWORK AS A WAY
TO GUIDE FUTURE SCIENCE FOR SGM
HEALTH.
WE LOOK AT FEDERAL PRIORITIES
SEEKING TO IMPROVE HEALTH OF SGM
PEOPLE AND A WAS GRATEFUL FOR
SOME OF THE CONVERSATION THAT
STARTED YESTERDAY AND HERE'S A
FEDERAL INITIATIVE THAT SETS
TARGETS FOR LGBTQ HEALTH SET IN
FIVE KEY AREAS FOR THIS PROJECT.
THE FIRST IS THINKING ABOUT
BULLYING FOR ADD LESS --
ADOLESCENTS AND ALCOHOL USE AND
MENTAL HEALTH AND HIV AND OTHER
SEXUALLY TRANSMITTED INFECTIONS
AND THE INCLUSION OF DATA AND
THERE'S INDICATORS FOCUSSED ON
CISGENDER AND SPECIFIC
INDICATORS AND OF THE INDICATORS
CURRENT LY TRACKED OF NOTE NONE
OF THE TRANS SPECIFIC INDICATORS
HAVE PROGRESSED.
ALONG SIDE THE TARGETS SET
FORWARD WE CAN THINK OF THE
NATIONAL ACADEMY AND THEIR 2020
REPORT ON THE STATE OF SCIENCE
FOR LGBTQ PEOPLE LOOKING AT
CORRELATES THAT REQUIRE
ATTENTION GIVEN THE RELATIONSHIP
FOR THE HEALTH AND WELL BEING OF
OUR COMMUNITIES INCLUDING HEALTH
CARE, ECONOMIC STABILITY,
EDUCATION, FAMIAL RELATIONSHIPS
AND I WANT TO TAKE A MOMENT TO
THANK THE TEAM AT NIH FOR
PROVIDING THE ANALYSIS OF
NIH-FUNDED STUDIES AS I HELPS
THINK ABOUT THE RESEARCH.
THIS COMES FROM THE 2020
PORTFOLIO ANALYSIS AND THE TOTAL
NUMBER OF SGM PROJECTED
INCREASED BY 66% SINCE GOING
FROM 300 TO OVER 500 PROJECTS
WHICH IS EXCITING TRACTION WE
ARE GAINING IN OUR SCIENTIFIC
AGENDA AND I WANT TO TALK ABOUT
THE PLACES WE CAN GROW MORE.
APPROXIMATELY A THIRD OF THE
STUDIES CATEGORIZED WERE PROOF
OF CONCEPTS OR IDENTIFIED AS
PILOT TRIALS AND ANOTHER THIRD
OF THOSE PROJECTS WERE EITHER
RANDOMIZED TRIALS OR
NON-RANDOMIZED INTERVENTION
STUDIES.
HOWEVER, EXISTING FUNDED
PROJECTS THAT FOCUS ON SGM
POPULATIONS WHETHER THEY BE
DESCRIPTIVE OR INTERVENTIONAL IN
NEARBY WERE NOT ACCURATELY
REPRESENTED ACROSS SGM
CATEGORIES BY AGE GROUPS OR
RACIAL ETHNIC GROUPS OR OTHER
SOCIAL FACTORS.
THESE SOCIAL DETERMINATES OF
HEALTH WERE LOOKED AT TEST AND
SCALE AND BEING EVALUATED BY ALL
SGM PEOPLE NO MATTER WHERE THEY
LIVE.
AND THE EXPLORATION OF
INTERVENTION RESEARCH THROUGH
NIH WILL REQUIRE SEVERAL
CONSIDERATIONS INCLUDING
INCLUSION OF SGM PEOPLE IN
INTERVENTION RESEARCH AND WE
LOOKED AROUND SAMPLE SIZES.
BEFORE WE TALK ABOUT POWER AND
SAMPLE SIZE I WANT TO REMIND US
THERE ARE FOUR KEY QUESTIONS
AROUND HOW AND WITH WHOM WE'RE
DESIGNING DISPARITIES RESEARCH
INTERVENTIONS.
FIRST, WHAT HEALTH DISPARITY
INTERVENTION RESEARCH
OPPORTUNITIES FOR SGM PEOPLE AND
INTERVENTION RESEARCH WITHOUT
THE NEED FOR A CISGENDER OR
HETRO COMPARATOR AND WHAT
OPPORTUNITIES ARE THERE TO
UNDERSTAND DIFFERENTIAL
INTERVENTION TAILORING,
FEASIBILITY, ACCEPTABILITY,
EFFICACY AND EFFECTIVENESS
ACROSS SGM GROUPS INCLUSIVE OF
DIFFERENCES IN VARIABILITY BY
RACE, ETHNICITY, AGE, RACE,
ETCETERA.
WHEN IS IT APPROPRIATE TO MAKE
INTERVENTION COMPARISONS BETWEEN
MAJORITY AND MINORITY GROUPS AND
IN PARTICULAR WHERE MY SGM
INTERVENTION RESEARCH OFFER
INSIGHTS THAT CAN BE TRANSFERRED
AND SCALE TO CISGENDER
HETEROSEXUAL COMMUNITIES AND
BESIDES THINKING OF PARTICIPANTS
IN INTERVENTIONS, WHAT
STAKEHOLDERS NEED TO BE INCLUDED
TO ENSURE EQUITABLE OF
EVIDENCE-BASED INTERVENTIONS.
AND ONE CHALLENGE WE FACE IN
INTERVENTION RESEARCH HAS BEEN
HIGHLIGHTED IN PRIOR TALKS IS
THE IDEA OF SUFFICIENT SAMPLE
SIZE TO DETECT AND DESIGN
MEANINGFUL EFFECTS.
I'D LIKE TO THINK OF SAMPLE SIZE
AND POWER AS IT RELATES TO THE
CHALLENGE.
HOW CAN WE SECURE THE
APPROPRIATE RESEARCHES TO
OVERCOME SAMPLING AND
REPRESENTATIONAL CHALLENGES AND
AT THE END I'LL SPEAK TO IDEAS
REGARDING FUNDING MECHANISMS AND
PARTNERSHIPS THAT MAY HELP SOLVE
SOME CONCERNS.
I WANT TO STOP FOR A SECOND AND
THINK OF THE VALUE OF HARMONIZED
MEASURES AND THE VALUE OUTSIDE
OF INVESTIGATOR INITIATED
PROJECTS.
THERE'S AN OPPORTUNITY TO CREATE
A COST-PROTOCOL DATA BANK, IF
YOU WILL, BY WHICH ALL NIH
STUDIES AND INTERVENTIONS
PROVIDING PRELIMINARY EVIDENCE
BY INCLUDING SGM HARMONIZED
INDICATORS.
THIS APPROACH MAY HELP PROVIDE
FIRST PRELIMINARY DATA FOR SGM
RESEARCHERS TO THINK WHETHER
THERE'S ALREADY SOME SIGNAL THAT
AN INTERVENTION THAT HAS BEEN
BUILT FOR ANOTHER PURPOSE IS
ACCEPTABLE AND FEASIBLE FOR SGM
PEOPLE CIRCUMVENTING THE NEED TO
REINVENT THE INVENTION WHEEL AND
OFFERS OPPORTUNITIES FOR
CROSS-PROTOCOL LEARNING AND IN
RECRUITING SGM PARTICIPANTS, A
PLATFORM COULD HELP MAP OUT SGM
DATA TO ALLOW FOR TIF ANALYSIS.
AND I'LL POINT BACK TO THE
CONSENSUS REPORTS ON HARMONIZED
DATA AROUND VALUES THAT MAY HELP
UNDERSTAND INCLUSIVENESS,
DECISION, AUTONOMY AND PRIVACY.
AND THERE'S HEALTH DISPARITIES
AS EXPLAINED ON THE LEFT SIDE
AND IT REMAINS CRUCIAL WE START
MAPPING THE RESEARCH ON
DETERMINATES OF HEALTH AND WELL
BEING AND WE NEED TO START BEING
MORE CAREFUL HOW TO CREATE A
ROAD MAP ACCESSIBLE TO ALL
VARIABLES CAN BE MARIED TO
INTERVENTIONS AND MECHANISMS.
WHETHER IT'S INDIVIDUALLY OR
ACROSS DIFFERENT LEVELS OF
INTERVENTION.
THIS MAPPING EXERCISE WOULD HELP
AMPLIFY THE CONSTELLATION FROM
INTERVENTION AT A FASTER PACE
AND CREATE A SECURE OR GROWING
EVIDENCE BASED INVENTORY OF WHAT
SOLID AND RIGOROUS LEVEL
INTERVENTION THEORIES AND
STRATEGY LINKED TO IMPROVEMENTS
IN ALL OR IN SOME SGM
POPULATIONS.
AND YOU HAVE THEORIES AND
INTERVENTION THEORIES AND
APPROACHES AND WE HAVE TO THINK
OF KEY INTERVENTION DELIVERY
MODES INCLUDING BIO MEDICAL
INTERVENTIONS, DIGITAL
INTERVENTIONS, ECOLOGICAL
INTERVENTIONS, COMMUNITY
INTERVENTIONS, MULTI-LEVEL
INTERVENTIONS AND SOME TOPICS
HAVE COME UP BUT I'M EXCITED FOR
THE REMAINING OF THE DAY AS SOME
COLLEAGUES WILL BE TALKING ABOUT
THE ISSUES.
THERE'S ALSO AN OPPORTUNITY FOR
METHODOLOGIC INTERVENTION.
WE CAN THINK ABOUT ADAPTIVE
DESIGNS OR INTERVENTIONS THAT
CAN BE DEPLOYED TO THINK ABOUT
HOW TO INCREASE STRATEGY
INTENSITY IF THE INTERIM OUTCOME
TARGETS WE'RE INTERESTED IN
AREN'T BEING MET SIMILAR TO A
SMART DESIGN.
WE CAN THINK OF MULTI-LEVEL
APPROACHES LIKE HYBRID
IMPLEMENTATION TRIALS AS TALKED
ABOUT YESTERDAY TO HELP
UNDERSTAND EFFECTIVENESS OF AN
INTERVENTION AND IMPLEMENTATION
OPPORTUNITIES TO SCALE AND
SUSTAIN THE WORK IN THE REAL
WORLD.
WE CAN THINK OF FAMILY LEVEL
INTERVENTIONS FOR PARENTS AND
YOUTH AND PERHAPS OTHER MEMBERS
AROUND HEALTH IMPROVEMENT.
WE CAN THINK ABOUT BIG DATA AND
INFORMATICS.
HOW CAN WE BEST USE BIO
INFORMATIC TOOLS TO ASSESS
WHETHER CLINICAL SAFETY OR
EFFECTIVENESS IS DIFFERING
ACROSS SGM POPULATIONS AND
HEALTH CARE AND THAT CAN
ACTIVATE QUALITY IMPROVEMENT AND
CONTROL TEAMS TO REVIEW THEIR
PROTOCOLS AND PUT TOGETHER RAPID
IMPROVEMENTS TO EQUITABLY
ADDRESS DELIVERY OF CARE.
FINALLY, WE STARTED TALKING
ABOUT STRUCTURAL LEVEL
INDICATORS AND POLICIES ON
CONSTRAINT ANALYSIS.
IT'S EXCITING TO THINK ABOUT
DIFFERENCE AND DIFFERENCES
DESIGN OR IN LOOKING AT WHAT
STRATEGIES WOULD LEAD TO MORE
POPULATION-LEVEL IMPROVEMENTS.
FINALLY, I RECOGNIZE THIS WILL
REQUIRE VARIOUS MECHANISMS TO
SUPPORT THE WORK THROUGH
TRADITIONAL ARM MECHANISMS AND
MAY ADDRESS SOME OF THE EXISTING
AND MORE STRUCTURAL CHALLENGES
RAISED INCLUDING THE RECRUITMENT
OF DIVERSE POPULATIONS ACROSS
THE U.S. AND GLOBALLY AND
HARMONIZATION OF EFFORTS IN A
SYNERGIZED WAY AND THERE'S A U4
MECHANISM AND THE
ACROSS-INSTITUTE NETWORKS AND WE
HAVE THE HIV PREVENTION TRIALS
NETWORK OR EVEN THE NIMHD WITH
NHLBI INITIATIVE TO ENSURE
COMMUNITY RESEARCH.
I'D BE REMISS TO TALK ABOUT NIH
IN A VACUUM.
I THINK IT'S IMPORTANT FOR ALL
OF TO US THINK ABOUT STRATEGIC
PARTNERSHIPS WITH THE COMMUNITY
SECTOR AND BUSINESS PARTNERS
THROUGH SBIR AND STTR MECHANISMS
TO BRIDGE BETWEEN OUR SILOS AND
HEALTH CARE SECTORS.
I THINK IT WILL ACCELERATE OUR
COLLECTIVE IMPACT.
AS WE THINK ABOUT SITUATING THE
CURRENT OPPORTUNITIES FOR
INTERVENTION RESEARCH I WANT TO
TAKE A MOMENT TO POINT YOU TO
THE PORTFOLIO ANALYSIS AND TALK
ABOUT THE PIPELINE OF WHERE WE
ARE.
THE NIH TOTAL FISCAL YEAR
REVIEWED NEW GRANTS HAD BEEN
SECURED WHICH WOULD SUGGEST OF
THE 500 PROJECTS GEARED TOWARDS
SGM POPULATION IT'S 1% OF ALL
FUNDED RESEARCH LOOKING AT SGM
HEALTH.
GIVEN THESE BACK OF THE ENVELOPE
ESTIMATES AND THE PROPORTION OF
NIH FUNDED PROJECTS FOCUSSED ON
SGM POPULATIONS AS NOTED IN THE
TABLE FROM THE PORTFOLIO
ANALYSIS, WE ALL COLLECTIVELY
HAVE A RESPONSIBILITY TO MOVE
IMPLEMENTATION AND INTERVENTION
SCIENCE FORWARD.
AS SCIENTISTS WE NEED TO
CONTINUE TO SUBMIT INTERVENTION
SCIENCE APPLICATIONS TO BRING
THE PERCENTAGE OF PROJECTS AT
NIH UP.
IF WE DON'T SUBMIT IT CAN'T BE
REVIEWED OR CONSIDERED FOR
FUNDING.
MY HOPE IS AS GREATER NUMBER OF
FOLKS START THINKING ABOUT SGM
HEALTH AS A VIABLE AREA OF
RESEARCH, WE WOULD START
INCREASING THE NUMBER OF
PROJECTS ALLOCATED TO MIRROR THE
HEALTH NEEDS OF OUR COMMUNITIES.
NOW, LONG SIDE MORE APPLICATIONS
IT REMAINS CRUCIAL INTERVENTION
RESEARCH WITH AND FOR SGM PEOPLE
ARE EMBEDDED ACROSS DIFFERENT
INSTITUTES AND CENTERS.
THERE'S STILL MUCH WE DON'T KNOW
REGARDING HOW TO IDENTIFY AND
ADDRESS SGM HEALTH DISPARITIES
AND INEQUITIES.
IN SUM, THE FIELD OF
INTERVENTION RESEARCH IS RIPE
FOR INTERVENTION.
WE HAVE DATA FOR REPRESENTATION
AND AS A WAY OF ACCELERATING THE
STATE OF THE SCIENCE AND TAILOR
THE NEEDS ACROSS THE SGM
CONTINUUM.
WE NEED BETTER THEORETICAL WORK
HOW TO MAP DETERMINATE SCIENCE
WITH INTERVENTION SCIENCE TO
BUILD BETTER INTERVENTIONS AND
BE ABLE TO REPLICATE THEM.
I'M EXCITED FOR ALL THE
INNOVATIONS COMING IN THE LARGER
FIELDS OF STUDY THAT HAVE HUGE
APPALACHIAN -- APPLICATIONS AND
CALL FOR MULTIPLE PARTNERSHIPS
TO GROW TOGETHER AND ADVANCE SGM
HEALTH SOLUTION.
WITH THAT I'LL LEAVE MY CONTACT
INFORMATION HERE AND LOOK
FORWARD TO DISCUSSING THESE AND
OTHER TOPICS DURING OUR Q&A.
THANK YOU.
>>THANK YOU, THAT WAS A GREAT
PRESENTATION.
VERY THOUGHT PROVOKING.
NEXT WE HAVE DR. PACHANKIS TO
TALK ABOUT LGBTQ AFFIRMATIVE
COGNITIVE THERAPY FROM THEORY TO
TRIALS TO IMPLEMENTATION.
>>WE SEE THE PRESENTER NOTES.
AUTO
>>I'LL FOCUS ON MENTAL HEALTH
AND LGBTQ AFFIRMATIVE BEHAVIORAL
THERAPY ONE OF THE FEW
EVIDENCE-BASED THERAPIES FOR
IMPROVING SGM PEOPLE'S MENTAL
HEALTH.
AND I'LL REVIEW THE RESEARCH
SUPPORT AND THEN EFFORTS TO
IMPLEMENT THIS INTERVENTION.
FOR LGBTQ PEOPLE WE KNOW THE
MOST INFLUENCE IS SOCIETAL AND
WE ALSO KNOW THAT THE FIELD HAS
COME A LONG WAY AND RELATIVELY
QUICKLY IN TERMS OF ESTABLISHING
A LINK BETWEEN STRUCTURAL STIGMA
AND STRESS SENSITIVE OUTCOMES
LIKE DES -- DEPRESSION AND
OTHER IMPLICATIONS AND OTHER
FORMS OF STIGMA.
AND EXPOSURE GIVES RISE TO
INCLUDING BULLYING, PARENTAL
NON-ACCEPTANCE AND
DISCRIMINATION REPRESENT THE
MOST IMPORTANT TARGET
INTERVENTION THAT PLACE THE ONUS
FOR CHANGE ON STRUCTURES AND
UPSTREAM CAUSES YET AS LONG AS
THEY EXIST WE KNOW UP STREAM
MINORITY STRESSORS LIKE PARENTAL
NON ACCEPTANCE ARE ASSOCIATED
WITH IDENTITY CONCEALMENT,
INTERNALIZED STIGMA AND
SUPPRESSION AND SHAME AND EVEN
INFLAMMATION WHICH A LARGE BODY
CAN PREDICT MENTAL HEALTH RISK.
BECAUSE THESE MINORITY STRESS
ADAPTATIONS REPRESENT COGNITIVE
EFFECTIVE REACTIONS WITHIN THE
PERSON THEY CAN BE AFFIRMATIVELY
ADDRESSED THROUGH MENTAL HEALTH
SERVICES.
THOUGH THE IDEAL INTERVENTION
TARGET WOULD BE THE UP STREAM
FACTORS THE REACTION TO MINORITY
STRESS REPRESENT AN IMPORTANT
SOURCE OF INTERVENTION AS LONG
AS THE UP STREAM FACTORS EXIST.
OUR TEAM AT YALE AND OTHER
COLLEAGUES AROUND THE U.S. AND
AROUND THE WORLD HAVE BEEN IN
THE PROCESS OF DEVELOPING AND
TESTING THE EFFICACY OF AN
INTERVENTION THAT RESPOND TO
STIGMA AND IMPROVE REACTION TO
MENTAL HEALTH.
WE INTERVIEWED NUMEROUS MENTAL
HEALTH PROVIDERS WHO SPENT THEIR
CAREERS WORKING WITH LGBTQ
PEOPLE.
WE ASKED THEM HOW WE SHOULD
ADAPT STANDARD AND PRACTICE
CALLED CBT TO SUPPORT LGBTQ
INDIVIDUAL'S MENTAL HEALTH AND
MET WITH PEOPLE EXPERIENCING
DEPRESSION, SUBSTANCE ABUSE AND
SUICIDALITY IN THIS POPULATION
AND THEY TALKED ABOUT HOW THEY
HAD SEEN LGBTQ PEOPLE GROW
DESPITE THE PAIN OF STIGMA AND
LEARNING EMPOWERING WAYS TO
STAND UP AGAINST STIGMA AND
LEARNING WAYS OF THINKING AN
BEHAVING AND FINDING SUPPORT AND
A PURPOSE WITHIN THE LGBTQ
COMMUNITY.
WE PACKAGED THE RESEARCH
FINDINGS AND STORIES AND THE
COMMUNITY INTO A CBT TREATMENT
MANUAL FOR LGBTQ PEOPLE AND
THERAPISTS TO LOOK AT HOW IT
MANIFESTS IN THEIR LIVES AND
IMPACTS THEIR MENTAL HEALTH AND
IT'S BEEN PACKAGED INTO A
TREATMENT MANUAL SPECIFICALLY
THAT ADDRESSES MINORITY STRESS
AND THE UNIQUE MENTAL HEALTH
DETERMINATES THAT LGBTQ PEOPLE
FACE.
WE TESTED THIS IN RANDOMIZED
CONTROL TRIALS REPRESENTING
MONTH THE FIRST RCTs OF THE
MENTAL HEALTH IS PSYCHO THERAPY
INTERVENTION FOR LGBTQ PEOPLE.
I DON'T HAVE THE TIME TO GO INTO
THE TREATMENT BUT IT'S GUIDED BY
A PERSONALLY TAILORED MINORITY
STRESS CASE CONCEPTUALIZATION
THAT SPECIFIES TECHNIQUES FOR
ADDRESSING THE WAYS MINORITY
STRESS CAN BE COMPROMISED IN
PEOPLE'S MENTAL HEALTH SUCH AS
RAISING AWARENESS OF THE
EMOTIONAL CONSEQUENCES OF
MINORITY STRESS AND RAISING
AWARENESS OF THE EXISTENCE OF
FORMS OF STRESS AND THE WAYS OF
COPING EMOTIONALLY INCLUDING
BEHAVIORAL TENDENCIES LIKE
DRINKING OR SELF-HARM OR OTHER
WAYS OF EMOTIONALLY NUMBING AND
COPING WITH STRESS AND THE
SOCIAL WITHDRAWAL TENDENCIES
MINORITY STRESS CAN INSTILL.
REWORKING PHOBIC CULTURAL I
IDEOLOGY AND THE VERACITY OF THE
INTERNALIZATION AND BELIEFS OF
ONE'S INFERIORITY OR THAT
THEY'LL BE ALONE FOREVER OR
UNLOVEABLE.
AND FINALLY INTENTIONALLY
BUILDING ON VIEWS OF SOCIAL
SAFETY BY BUILDING SUPPORTIVE
COMMUNITY AND PLACING ONE SELF
WITHIN THE COMMUNITY AND THESE
ARE SKILLS THAT HELP LGBTQ
PEOPLE OVERCOME MANY OF THE
DEEPLY INTERNALIZED WAYS OF
THINKING AND WE FIRST TESTED THE
TREATMENT IN A SMALL WEIGHTLESS
CONTROL TRIAL WITH 63 YOUNG AND
BISEXUAL MEN IN NEW YORK CITY.
THIS SAY RACIALLY, ETHNICALLY
AND SOCIO ECONOMICALLY DIVERSE
SAMPLE AND THE LINES IN BLUE
SHOWED THE AFFECTS FOR TREATMENT
TO THREE MONTHS AFTER TREATMENT
COMPARED TO THE LINES IN GRAY
WHICH SHOWED THE AFFECTS AND
SHOWED REDUCTION IN WAIT LIST
AND DEPRESSION AND ANXIETY AND
PROBLEMATIC ALCOHOL USE AND
SEXUAL RISK BEHAVIOR.
WE THEN DELIVERED THE TREATMENT
TO 60 YOUNG QUEER WOMEN ALSO IN
NEW YORK CITY IN A WAITLIST
CONTROL TRIAL IN WAS DIVERSE IN
TERMS OF GENDER IDENTITY AND
SOCIALLY ECONOMICALLY DIVERSE
AND THE TREATMENT SIMILAR TO THE
FIRST STUDY WITH MEN WAS
ASSOCIATED WITH GREATER
REDUCTION IN DEPRESSION, ANXIETY
AND PROBLEMATIC ALCOHOL USE
PATTERNS.
WE THEN ASKED KWL -- WHETHER IT
MAY BE MORE EFFICACIOUS AND WITH
MEN IN MIAMI AND THE MAJORITY
IDENTIFIED AS LATINO OR BLACK WE
GOT SUPPORTIVE COUNSELLING IN
THE COMMUNITY AND NOT CBT BASED
OR INFORMED BY MINORITY STRESS
THEORY AND COMPARED THE
TREATMENT TO SINGLE SESSION HIV
TESTING AND SAMPLING AND FOUND
CBT WAS ASSOCIATED WITH SMALLER
RISK AND AFFECT SIZES WERE
LARGEST FOR SUBSTANCE USE
PROBLEMS WITH LGBTQ AFFIRMATIVE
CBT WITH MORE IMPACT THAN THE
OTHER CONDITIONS AND BASED ON
THE TRANSDIAGNOSTIC TREATMENT
LOOKING AT THE THEORIES
UNDERLYING THE RISK OF THE FULL
SPECTRUM OF STRESS SENSITIVE
DISORDERS WE CREATED A
COMORBIDITY AFFECT WHICH WAS THE
SUM OF THE PRESENCE OF
DEPRESSION, ANXIETY, HIV AND
SUBSTANCE USE PROBLEM AND FOUND
IT REDUCED COMORBIDITY ACROSS
THE OUTCOMES.
WE THEN USED A TREATMENT AFFECT
HETEROGENEITY ANALYSIS TO LOOK
AT THE MODERATORS OF CBT WE
LOOKED AT THE 12ISTS TO DELIVER
THE TREATMENT ACROSS THE TRIAL
TO NOMINATE ANY AND ALL FACTORS
THEY THOUGHT SOME COULD BENEFIT
FROM OTHER AND THEY SUGGESTED 20
MODERATORS AND IDENTIFY THE TOP
MODERATORS.
WE PRE REGISTERED THIS WITH THE
PRIMARY OUTCOME BEING THE
COMORBIDITY INDEX I SHOWED ON
THE PREVIOUS SLIDE.
AND ONLY ONE MODERATOR EMERGED
NAMELY RACE AND ETHNICITY SUCH
AS LATINO AND BLACK PARTICIPANTS
RECEIVED MORE BENEFIT THAN WHITE
PARTICIPANTS.
WHILE WE HAVEN'T YET EMPIRICALLY
ESTABLISHED REASONS WE KNOW
BLACK AND LATINO PARTICIPANTS
SEEM MORE AMENABLE TO THE FOCUS
OF THE TREATMENT PERHAPS BECAUSE
THEY WERE ABLE TO DRAW ON THE
RACIAL SOCIALIZATION EXPERIENCE
TO INCORPORATE THE LESSONS OF
AFFIRMATIVE LGBTQ OR IT MIGHT
ENCOMPASS THE IDENTITIES WHERE
THEY'RE NOT SEPARATABLE AND
LEARNING WAYS TO COPE WITH LGBTQ
STRESS MAY APPLY TO RACIALLY
HOSTILE SITUATIONS.
WE THEN TESTED WHETHER THE
TREATMENT CAN ALSO LEND ITSELF
TO MORE EFFICIENT REACH BY USING
AN ASYNCHRONOUS FORM WHERE LGBTQ
YOUNG PEOPLE IN THE U.S. CAN
RECEIVE 10 WEEKS OF THE CONTENT
ABOUT MINORITY STRESS AND CBT
SKILLS FOR ADDRESSING IMPACT AND
READ THE MATERIAL ONLINE AND TRY
THE SKILLS IN THEIR LIVES AND
RECEIVE WEEKLY FEEDBACK.
WE COMPARED THE TREATMENT TO
WEEKLY TRACKING FOR MOOD AND
STRESS AMONG 120 SGM YOUTH AND
YOUNG ADULTS AND THE ASENK
WE DID FIND THE TREATMENT WAS
EFFECTIVE AND BENEFITTED MORE
FROM THIS ASYNCHRONOUS CBT
COMPARED TO WEEKLY MONITORING.
MOTIVATED BY THE POSSIBILITY
SUCH INTERVENTIONS WORK
PARTICULARLY WELL IN STIGMA
ENVIRONMENTS WE TESTED WHETHER
THIS DELIVERED AFFIRMATIVE CBT
MAY BE SUITABLE FOR CHINESE
YOUNG MEN IN A PROVINCE IN CHINA
IN A STUDY CO-LED WITH OUR
COLLEGIATE CENTRAL SOUTH
UNIVERSITY IN THE PROVINCE.
THE QUALITATIVE WORK REVEALS
YOUNG LGBTQ PEOPLE RENOUNCE
BEING MARRIED AND OTHER FORMS OF
STRESS.
WE FOUND THE TREATMENT DID EXERT
SIGNIFICANT AND STRONGER EFFECTS
THAN MOOD TRACKING WITH THIS
POPULATION AND CONTEXT FOR
DEPRESSION, ANXIETY AND ALCOHOL
USE.
IN THE FUTURE THEREFORE THE
FIELD MIGHT WISH TO CONTINUE
STUDYING FOR WHOM AND UNDER WHAT
CONDITIONS THIS EFFICIENT
MODALITY MAY BE MOST EFFECTIVE
IN THE TERMS OF COST COMPARED TO
THE MORE COSTLY INDIVIDUALLY
DELIVERED VERSIONS OF THE
TREATMENT TO ENSURE THE BEST
TREATMENT MODALITY AND WE LOOK
AT CBT IN A WAY THAT RESONATES
WITH LOCAL COMMUNITIES AND
SUSTAINABLE IN THE COMMUNITIES.
THE U.S. HAS AN IDEAL NETWORK OF
SETTINGS IN WHICH TO IMPLEMENT
THIS AND REACH THE LGBTQ PEOPLE
WHO MAY NOT OTHERWISE RECEIVE
CARE INCLUDING INDIVIDUALS WITH
LOWER INCOMES AND LGBTQ PEOPLE
OF COLOR.
WE PARTNERED WITH THE
COORDINATING HUB OF THE 300
CENTER TO SURVEY THE DIRECTORS
AND CEOs TO ASSESS THEIR
CAPACITY TO IMPLEMENT LGBTQ
AFFIRMATIVE CBT.
MOST REPORTED ROOM TO IMPROVE
MENTAL HEALTH SERVICES AND THAT
THEIR STAFF CAN RECEIVE TRAINING
AND ALL INDICATED THEY'D GIVE
TRAINING AND WE USED IMPLEM
IMPLEMENTATION TIMING.
WE HAD AN 11-WEEK TRAINING IN
ZBT TO 130 MENTAL HEALTH
PROVIDERS AND LOOKING AT THE
LINES OF BLUE FROM THREE TO
THREE MONTHS AFTER COMPARED TO
THE LINES IN RED ON THE WAIT
LIST WE SAW IMPROVEMENTS IN THE
PROVIDERS' ABILITY TO DELIVER
LGBTQ AFFIRMATIVE AND THE CBT
TREATMENT AND PRESENTED THEM
WITH VIDEOS CREATED BY ACTORS IN
WHICH THEY'RE ROLE PLAYING
CLIENTS THAT ARE LGBTQ AND
THROUGH MASS CODING OF THE TAPES
WE SHOWED THERAPISTS
DEMONSTRATED MORE CONSISTENT AND
FATHERFUL DELIVERY OF LGBTQ
AFFIRMATIVE CBT.
IN CONCLUSION IN THE STANCE FROM
MENTAL HEALTH WAS AT THE
FOREFRONT OF THE COMMUNITY'S
DEMAND AND THE FIELD HAS COME A
LONG WAY IN PROVIDE SCIENTIFIC
EVIDENCE BASE AND THE CBT
TREATMENT IS EFFICACIOUS AND
CAPABILITY OF IMPLEMENTATION
INCLUDING HIGH STIGMA SETTINGS
WORLDWIDE.
I WANT TO ACKNOWLEDGE THE
RESEARCH TEAMS DOING THE WORK.
THANK YOU.
>>THANK YOU.
GREAT PRESENTATION.
NOW I WOULD LIKE TO INTRODUCE
DR. STEVEN WHO WILL TALK ABOUT
OPTIMIZING INTERVENTION TO
ADDRESS STRUCTURE RISK AND
SUBSTANCE USE AMONG SEXUAL AND
GENDER MINORITY POPULATIONS.
>>THANKS TO THE ORGANIZERS.
THE LAST TWO DAYS HAVE BEEN
AMAZING AND I WOULD HAVE
PROBABLY GIVEN A DIFFERENT TALK
IF I HAD KNOWN THE PRESENTERS IN
THE SPACE.
I'LL TRY TO CONNECTITEXTULIZE T
AMOUNT OF INTERVENTION DATA AND
THE OPPORTUNITIES THAT EXIST TO
STUDY SEX AND GENDER DIVERSE
COMMUNITY NEEDS BETTER IN THE
CONTEXT OF HIV PREVENTION
RESEARCH USING THE SYSTEMIC
REVIEWS.
THOUGH WE HEARD SO MUCH AMAZING
STIGMA MITIGATION WORK, I'LL
TALK THROUGH THE STATE OF THE
FIELD IN TERMS OF PUBLISHED
LITERATURE AND PROVIDE SOME DATA
DOMESTICALLY ORIENTED WITH
SUBSTANCE USE TREND AND THE
RELATIONSHIP AND OPPORTUNITIES
FOR INTERVENTIONS BOTH IN THE
CONTEXT OF MENTAL HEALTH AND
SUBSTANCE USE THAT REMAIN
RELEVANT IN 2023.
FIRST I'LL BRIEFLY SAY THE LIVE
DATABASE OF COLLABORATION IS
BETWEEN OURSELVES, WASHINGTON
UNIVERSITY AND NYU AND OTHERS
AND CATEGORIZED ALL INTERVENTION
RESEARCH THAT'S BEEN DONE SINCE
2004 FOCUSSING ON LOW AND MIDDLE
INCOME COUNTRIES.
THERE'S OTHERS FOCUSSED ON
HIGH-INCOME SETTINGS.
THIS IS ANY POPULATION OR STUDY
DESIGN AND CLASSIFY THE
STRATEGIES USING THE PROCTOR
FRAMEWORK AS WELL AS THE CASCADE
TARGET.
IT PROVIDES AN OPPORTUNITY TO
FOCUS ON SEXUAL AND GENDER
MINORITY COMMUNITIES.
SUMMARIZE THIS AND THEY'RE
FOCUSSED ON CAPACITY BUILDING AS
A DELIVERY OF TRAINING AND
EDUCATION.
THE AND WE HEARD THERE'S
VIRTUALLY ZERO VENTIONS FOCUSSED
ON POLICY MAKERS AND IT'S
NOTABLE WE HEARD SO MUCH
DOMESTICALLY AND INTERNATIONALLY
ABOUT THE INTERVENTIONS IN THE
ARENA OF POLICY AND THIS ALLOWS
FOR THESE COMMUNITIES AND WE
HAVE LIMITED RESEARCH ON
CISGENDER GAY MEN AND LITTLE
INTERVENTION WORK IN SETTINGS
FOCUSSED ON TRANSGENDER
COMMUNITIES WHEN IT DIDN'T MAKE
THE TABLE.
MOST THE WORK IS WHERE THEY'RE
NOT CLASSIFYING WHO THEY'RE
INTENDED TO SERVE AND WE HEARD
SO MUCH OVER THE LAST FEW DAYS
AND ALSO AROUND THE IMPORTANCE
OF SPECIFYING AND ADDRESSING
FOLKS WHERE THEIR NEEDS ARE AT
AN INDIVIDUAL NETWORK AND
STRUCTURE LEVEL AND AREN'T DOING
THAT EVEN AS RECENTLY ADD THIS
YEAR.
IN TERMS OF WHAT WE'RE DOING FOR
PARTICULARLY FOR SEXUAL AND
GENDER DIVERSE COMMUNITIES MOST
THE INTERVENTIONS ARE FOCUSSED
ON THE COMMUNITIES THEMSELVES
AND THERE'S A DISCONNECT FROM
WHAT WE HEARD WHERE A LOT OF THE
ISSUES AND IN FACT MANY WOULD
ARGUE THE MAJORITY ARE AT THE
SYSTEM LEVEL OR WITH HEALTH CARE
ORGANIZATIONS AND PROVIDERS AND
THOSE REPRESENT STILL THE
MINORITY OF INTERVENTION TARGETS
IN TERMS OF WHAT IT IS THEY'RE
TRYING TO CHANGE.
AND MAPPING OUT THE MOST RECENT
DATA YOU'LL SEE IN GRAY ARE
AREAS WHERE THERE'S NO STUDIES
AVAILABLE AS RECENTLY AS THE END
OF 2022.
LARGE SLOTS OF CENTRAL AND
NORTHERN AFRICA, MIDDLE EAST,
LARGE PARTS OF ASIA AND SOUTH
AMERICA WHERE WE HAVE DATA IN
TERMS OF THE BURDEN OF STIGMA
AND MENTAL HEALTH OUTCOMES HAVE
LIMITED DATA ON INTERVENTION AND
THE VAST MAJORITY OF STUDIES ARE
DONE IN SOUTH AFRICA AND EAST
AFRICA.
AND LIMITED IN MOST SETTINGS
AROUND THE WORLD.
LEVEL INTERVENTIONS AND PEER-LED
GROUP SESSIONS, CLINICAL IN
TERMS OF HEALTH CARE WORKER
TRAINING AND POST-CLINICAL WEB
BASE AND TRYING TO INCREASE
NETWORKING AMONGST COMMUNITIES
OF GAY MEN.
IT WAS INTENDED TO ADDRESS
DIFFERENT LEVELS OF STIGMA IN
TERMED OF PERCEIVED ANTICIPATED
STIGMAS AND WHEN PEOPLE WERE IN
THE HEALTH CARE SETTING AND POST
CLINICAL IN RESILIENCE AND
STIGMA.
WE HAD STIGMA MEASURES AND
TREATMENT AND VIRAL LOAD
OUTCOMES.
AM WE ENROLLED ABOUT 200 IN THE
TRIAL AND FOLLOWED THEM ABOUT
TWO YEARS.
AND WE SAW INCREASES IN THE
ANTICIPATED STIGMA AND THEY WERE
FAR LESS LIKELY AFRAID TO SEEK
HEALTH CARE BY DOING THE
COMMUNITY LEVEL OUTREACH AND FAR
LESS FOLKS AVOIDING HEALTH CARE
BUT AND THESE WERE WITH REGULAR
TRAINING WITH THE MINISTRY OF
HELP AND COMMUNITY-BASED GROUPS
AND SAW INCREASES IN FOLKS WHERE
THEY WERE MORE LIKELY TO SEEK
CARE AND HEAR PEOPLE GOSSIP IIN.
AND THERE WAS A RECENT REVIEW
THAT HAS BEEN AND OTHERS LOOKING
AT THE STATUS OF HEALTH RELATED
DATA FOR TRANSGENDER COMMUNITIES
AROUND THE WORLD.
WE HEARD SUCH RICH DATA
PRESENTED FROM THE U.S. MOSTLY
REFLECTED THAT THE VAST MAJORITY
OF DATA WAS COLLECTED IN THE
UNITED STATES WITH FAR LESS DATA
IN WESTERN AND NORTHERN EUROPE
AND MOST THE WORLD REMAINS
UNCHARTERED IN THE BURDENS OF
CHRONIC DISEASE AND INFECTIOUS
DISEASE AND MENTAL HEALTH AND NO
INTERVENTION STUDIES IN LOW AND
INCOME STUDIES.
AND ALSO A TREMENDOUS
OPPORTUNITY IN TERMS OF BETTER
SERVING TRANSGENDER COMMUNITIES
AROUND THE WORLD.
TALKING ABOUT MORE DOMESTIC DATA
AND TRENDS IN SUBSTANCE USE.
FOR THIS I'LL LEVERAGE DATA FROM
THE AMOS SERVE LED BY EMORY AND
WORKING WITH A FOCUS ON ADDING
STIGMA INDICATORS INTO THIS.
THE ELIGIBILITY FOR THIS SURVEY
IS BEING OVER15 YEARS BEING A
CISGENDER MEN AND NEVER HAVING
HAD SEX WITH ANOTHER MAN AND
IT'S AN ANNUAL CROSS-SEXUAL
SURVEY AND I'LL NOTE IT'S BEEN
PREDOMINANTLY A WHITE SAMPLE.
THERE'S BEEN CHALLENGES IN TERMS
OF ACHIEVING BETTER RACIAL
DIVERSITY THOUGH IT'S BEEN
BETTER OVER THE YEARS AND 70%
WHITE AND 6% BLACK AND OTHER
BLACK AND AFRICAN AMERICAN AND
14% HISPANIC.
THE CHALLENGES WE SAW IN THE
DATA SUSTAINED IS THAT THERE'S A
SIGNIFICANT TREND TOWARDS
INCREASING SUBSTANCE USE BOTH
MARIJUANA AMONG PEOPLE LIVING
WITH HIV AND PEOPLE AT RISK FOR
HIV.
EVEN WHERE THERE AREN'T
SIGNIFICANT INCREASE WE'VE SEEN
NO DECREASES.
WHILE MARIJUANA IS THE MOST
COMMON DRUG AND FOLKS REPORTING
COCAINE AND PAIN KILLERS.
I WANT TO EMPHASIZE WHILE THERE
ARE INCREASING AMOUNTS OF
INTERVENTIONS AND SERVICES IN
THE CONTEXT OF SUBSTANCE USE WE
ONLY SEE INCREASE STATISTICALLY
SO IN SOME SETTINGS PARTICULARLY
IN THE SOUTH OF THE U.S. IN
MARIJUANA AND OTHER DRUGS OR
SUSTAINED DRUG USE OF OTHER
DRUGS BOTH AMONG PEOPLE AT RISK
FOR AND LIVING WITH HIV.
LOOKING AT THE 2020 AMOS SAMPLE
WE HAVE A GROUP OF PEOPLE WITH
SUICIDAL IDEATION AND WE SAW
SIGNIFICANT BURDENS OF SUBSTANCE
USE OVER ALL AND WHAT WAS
POWERFUL IN THE DATA WERE THE
CLEAR RELATIONSHIPS BETWEEN
FOLKS WHO SOUGHT IDEATION WHO
REPORTED SUICIDAL ATTEMPTS AND
FOR THOSE WITH SUBSTANCE USE
THERE'S MORE THAN TWO TIMES OF
INCREASE OF SUICIDE IN THE LAST
YEAR AND SAME WITH MARIJUANA USE
AND ALCOHOL USE AND SHOWING THE
IMPORTANCE AND UNDER ADDRESSED
INTERVENTIONS IN THE CONTEXT OF
SUBSTANCE USE AND PSYCHOLOGICAL
DISTRESS.
FOR FOLKS IN THE 2020 STUDY HALF
THE SAMPLE WAS RANDOMIZED
INCLUDING PTSD SYMPTOM SCALE AND
SAW CLEAR RELATIONSHIPS WITH
MONTHLY LISTED DRUG USE AND
PERVASIVE AND INTRUSIVE AVOID
AND THE PTSD SYMPTOM PATTERN.
THAT WAS ASSOCIATED WITH ILLICIT
DRUG USE MARIJUANA AND HIGH RISK
ALCOHOL USE AND THAT WAS THE
CASE AMONG PEOPLE LIVING WITH
HIV AND THOSE OPENLY LIVING WITH
HIV AND SAW HIGH BURDENS OF
ILLICIT DRUG USE AND PERVASIVE
PTSD SYMPTOMS AMONG CISGENDER
MEN, GAY MEN LIVING WITH HIV.
AND THIS IS A BIG TALK IN A
SHORT TIME BUT AS A 2022
PUBLISHED STUDY FEW FOCUSES ON
AND GENDER MINORITIES AND THEY
HAVE NOT ADDRESSED POLICY MAKERS
FROM ALL WE HEARD OVER THE LAST
FEW DAYS FEELS LIKE A GREAT
DISCONNECT.
THE STATE OF STIGMA INTERVENTION
RESEARCH AND HERE FOCUSSED ON
PUBLISHED RESEARCH IS REALLY
LIMITED IN RELATION TO WHAT
WE'VE SEEN ON THE STIGMA ON
BURDEN ON SEXUAL AND GENDER
DIVERSE COMMUNITIES AND THE
DISCONNECT IS THERE AND WE HEARD
OF MORE STUDIES THAT WILL SOON
BE IN THE LITERATURE BUT NOT TO
DATE.
IT'S AN OPPORTUNITY FOR
INTERVENTION WHEN WE LOOK AT
TRENDS GOING BACK FROM 2013 TO
NOW WE CONTINUE TO SEE SUSTAINED
OR INCREASING AMOUNT OF
SUBSTANCE ABUSE WHICH OFFERS AN
OPPORTUNITY FOR INTERVENTION AND
THE UNTREATED CHILDHOOD TRAUMAS,
PTSD AND SUICIDAL IDEATION AND
TEAMS.
I WANT TO THANK THE STIGMA TEAM
AT HOPKINS AND EMORY.
THE WORK WAS DONE BY THIS TEAM.
THANKS VERY MUCH.
>>THANK YOU, FOR A GREAT
PRESENTATION.
NOW I'D LIKE TO INTRODUCE
DR. AGENOR TALKING ABOUT
PROMOTING SEXUAL AND GENDER
MINORITY HEALTH EQUITY AND
ASSESSING THE IMPACT OF
U.S. STATE LAWS ON INTERSECTING
STRUCTURAL AND HEALTH
INEQUITIES.
PLEASE GO AHEAD.
>>THANK YOU SO MUCH FOR THE
INTRODUCTION AND THANK YOU ALSO
FOR THE INVITATION AS WELL AS
FOR ALL THE WORK THAT WAS DONE
BY THE PLANNING TEAM TO MAKE
THIS IMPORTANT EVENT POSSIBLE.
I'M MADINA AGENOR AND IT'S
IMPORTANT TO TALK ABOUT
PROMOTING SEXUAL AND GENDER
MINORITY HEALTH EQUITY AND
ASSESSING AND ADDRESSING THE
IMPACT OF U.S. STATE LAWS ON
INTERSECTING STRUCTURAL AND
HEALTH INEQUITIES.
I WANT TO ACKNOWLEDGE THE LAND
OF WHICH I'M ON TODAY.
IT'S LAND THAT EXPERIENCED
EXPLOITATION OF INDIGENOUS
PEOPLE NATIVE TO THE LAND AND
THOSE WHO CAME BY FORCE OR
OTHERWISE AS A RESULT OF
SLAVERY, COLONIALISM AND
IMPERIALISM.
IT SHAPED THE CONTEMPORARY AND
HEALTH INEQUITIES I'LL BE
TALKING ABOUT TODAY.
IT'S ESSENTIAL I FIRST BRING THE
INTERCONNECTED HISTORIES TO VIEW
TO CONTEXTUALIZE OUR DISCUSSION
AND IN THE HOPES OF CREATING A
DIFFERENT MORE JUST AND
EQUITABLE WORLD.
I'D LIKE TO TALK BY TALK BY
THINKING ABOUT THE ROLE OF
STRUCTURAL FACTORS AND SHAPING
HEALTH INEQUITIES WITH AN EYE
TOWARDS THINKING ABOUT
STRUCTURAL INTERVENTIONS THAT
COULD ADDRESS THEM.
AND YOU SEE THE SOCIAL
DETERMINATES OF HEALTH THAT
SHOWS MACRO LEVEL CONTEXTUAL IZE
VALUES SHAPED AND INTERACT WITH
THE SOCIAL DETERMINATES OF
HEALTH INCLUDING ACCESS TO SOCIO
ECONOMIC HEALTH CARE AND
PSYCHOSOCIAL RESOURCES AS WELL
AS EXPOSURE TO INTERPERSONAL
DISCRIMINATION AND OTHER
PHYSICAL ECONOMIC, PSYCHOSOCIAL
AND ENVIRONMENTAL HARM WHICH IN
TURN INFLUENCE HEALTH OUTCOME
ACROSS AND WITHIN SOCIAL GROUPS.
THE STRUCTURAL DETERMINATES OF
HEALTH ARE THEMSELVES EMBEDDED
IN AND INTERACT WITH MULTIPLE
INTERSECTING STRUCTURAL
INEQUITIES INCLUDING STRUCTURAL
RACISM, SEXISM AND OTHERS
INFLUENCED BY HISTORICAL
PROCESSES SUCH AS SLAVERY,
SETTLER COLONIALISM AND GENOCIDE
AND IMPERIALISM AND THE ONGOING
LEGACY.
IT'S TOGETHER THE FACTORS AND
PROCESSES INFLUENCE HEALTH OVER
ALL BUT SGM HEALTH EQUITY
ESPECIALLY FOR MARGINALIZED
PEOPLE AT DIVERSE INTERSECTION
OF GENDER IDENTITY AND RACE
ETHNICITY.
I'LL FOCUS ON THE ONE PARTICULAR
STRUCTURAL DETERMINATE OF HEALTH
HIGHLIGHTED HERE IN RED.
THIS IS A PUBLIC HEALTH LAW
FRAMEWORK WHICH SHOWS LAWS IN
CONJUNCTION WITH GOVERNANCE
STRUCTURES, RULES, REGULATIONS,
POLICIES, IMPACT BEHAVIORS AND
LAWS INCLUDING FEDERAL, STATE
AND LOCAL LAWS BOTH SHAPE AND
ARE SHAPED BY MULTIPLE
INTERSECTING STRUCTURAL
INEQUITIES INCLUDING BUT NOT
LIMITED TO RACISM, HETEROSEXISM
AND IT'S IMPORTANT TO NOTE LAWS
AND STRUCTURAL INEQUITIES ARE
THEMSELVES SHAPED BY AND
CONTINUE TO SAME THE ONGOING
LEGACIES OF HISTORICAL
PROCESSES.
AS WELL AS ECONOMIC SYSTEMS AND
POLITICAL IDEOLOGIES AND IT'S
TOGETHER ALL THESE STRUCTURAL
FACTORS AND PROCESSES INTERN
SHAPE HEALTH INEQUITIES ACROSS
SOCIAL GROUPS AND RACIALLY AND
MINORITIZED SGM PEOPLE.
AND ONE WAY TO ADDRESS
STRUCTURAL INEQUITIES AND
CISGENDERISM IS THROUGH LAWS
INCLUDING STATE LAWS IN
PARTICULAR.
AND PROMOTE OR CHALLENGE THE
INEQUITIES THROUGH A RANGE OF
MECHANISMS AND AND THEIR
POLICIES, RULES, REGULATIONS,
POLITICAL CLIMATE THEY CREATE,
THE VALUES THEY PROMOTE AND THE
IDEOLOGY-BASED SUPPORT.
AND THEY AFFECT EVERY FACET OF
AN INDIVIDUAL'S LIFE.
A KEY POINT I WANT TO MAKE BOTH
PAST AND PRESENT STATE LAWS
SHAPE THE UNEQUAL AND
INEQUITABLE DISTRIBUTION OF
HEALTH ACROSS SOCIAL GROUPS AND
INDIVIDUALS.
WHAT WE'VE SEEN LARGELY THROUGH
HISTORY IS HARMFUL STATE LAWS
AND LAWS COULD PROTECT OR
BENEFIT MARGINALIZED PEOPLE ARE
ROUTINELY AND SYSTEMICALLY
DISCRET ITTED -- DISCREDITED AND
OVERCOME AND IT SHAPES THE
POLITICAL AND HISTORICAL CONTEXT
OF CLIMATE AS WELL AS THE SOCIAL
AND CULTURAL NORMS OF PARTICULAR
STATES IN WHICH HEALTH
INEQUITIES ARE CREATED.
AS SUCH ASSESSING STRUCTURAL
INEQUITIES VIEWING STATE LAWS AS
INDICATORS TO HELP US CAN
IDENTIFY AND TARGET THE SPECIFIC
LAWS THAT INDEPENDENTLY AND IN
COMBINATION PROMOTE AND
REINFORCE STRUCTURAL INEQUITIES
THROUGH FOR EXAMPLE, POLICY
ADVOCACY AND SOCIAL MOVEMENT AND
OTHER FORMS OF COLLECTIVE ACTION
THAT DIRECTLY TARGET THE
FACTORS.
ONE STRUCTURAL INEQUITY I WANT
TO FOCUS ON TODAY AND INTERSECTS
WITH OTHERS IS GENDERISM IS
STRUCTURAL RACISM AND YOU CAN
SEE IN THE LANCET PAPER AND IN
THEIR 2021 PAPER THEY DEFINE
STRUCTURAL RACISM AS QUOTE A
SYSTEM OF INTERCONNECTED
INSTITUTIONS THAT OPERATE WITH A
SET OF RACIALIZED RULES THAT
MAINTAIN WHITE SUPREMACY.
AND SO STRUCTURAL RACISM IMPACTS
HEALTH EQUITY INCLUDING FOR
RACIALLY AND ETHNICALLY
MINORITIZED SGM PEOPLE BY
SHAPING THE UNEQUITABLE
DISTRIBUTION OF SOCIAL,
ECONOMIC, POLITICAL AND HEALTH
CARE RESOURCES AND PHYSICAL
PSYCHOSOCIAL ENVIRONMENTAL RISKS
AND HARMS OVER TIME AND SPACE.
AS WE CAN THINK OF STRUCTURAL
RACISM AS A FUNDAMENTAL CAUSE
AND WITHIN RACIALIZED SGM
GROUPS.
SO TO BE CLEAR, THERE HAS BEEN A
LONG HISTORY, A LONG RICH
HISTORY OF THEORETICAL,
CONCEPTUAL AND PRACTICE BASED
WORK ON LAWS FOR CENTURIES.
WHAT IS LIMITED IS RESEARCH THAT
ADDRESS THE LINK BETWEEN
STRUCTURAL RACISM LAWS AND
HEALTH INEQUITIES.
AND IN FACT MOST EXISTING
STUDIES HAVE LARGELY FOCUSSED ON
HISTORICAL JIM CROW LAWS FINDING
NEGATIVE IMPACT OF THESE LAWS ON
BLACK ADULT AND INFANT MORTALITY
AND BREAST CANCER RATES.
THERE'S A NEED FOR ADDITIONAL
EMPIRICAL RESEARCH ON
CONTEMPORARY U.S. STATE LAWS
BOTH EXPLICITLY AND IMPLICITLY
LINKED TO STRUCTURAL RACISM AS
WELL AS LOOKING AT THEIR AFFECTS
ACROSS DIVERSE RACIAL AND ETHNIC
GROUPS OVER TIME AND SPACE
ADDRESSING THE MECHANISMS OF
THESE AFFECTS IN ORDER TO INFORM
STRUCTURAL INTERVENTIONS THAT
ADDRESS THE PASSAGE AND
IMPLEMENTATION AND THE AFFECT OF
RACIST STATE LAWS ON HEALTH
EQUITY IN GENERAL AND SGM EQUITY
IN PARTICULAR.
TO ADDRESS THE GAPS WE DEVELOPED
A DATABASE OF STRUCTURAL RACISM
RELATED STATE LAWS FOR HEALTH
EQUITY RESEARCH AND PRACTICE IN
THE UNITED STATES.
WE CONVENED A MULTI-DISCIPLINARY
TEAM OF PUBLIC HEALTH
RESEARCHERS AND ALSO SCHOLARS
WHO WORK TOGETHER TO APPLY THE
EXPERTISE IN RACISM AND HEALTH
AND RACISM AND THE LAW USING
CRITICAL RACE THEORY AND
CRITICAL RACE THEORY TELLS US
RACISM IS EXPLICITLY AND
IMPLICITLY EMBEDDED INTO ALL OF
OUR LAWS, SYSTEMS, STRUCTURES
AND INSTITUTIONS AND SO THAT
NEEDS TO BE ADDRESSED TO ADVANCE
RACIAL JUSTICE AND EQUITY
INCLUDING IN HEALTH.
USING THE APPROACH WE DEVELOPED
THE TYPOLOGY AND IDENTIFIED AND
REFINED LAWS IN THE DOMAIN
DEFINING THE SCOPE AND FEATURES
OF EACH LAW USING PRIMARY AND
SECONDARY SOURCES.
AND USED SURVEILLANCE METHODS
AND DEVELOPED A CODE BOOK WE
APPLIED SYSTEMATICALLY TO ALL
THE LAWS AND THIS WAS APPLIED BY
TWO INDEPENDENT CODERS FOR A
SUBSET OF LAWS FOR RELIABILITY.
WE DID THIS FOR THE PERIOD OF
2010 TO 2013 FOR ALL 50
U.S. STATES AND D.C.
WE IDENTIFIED 843 U.S. STATE
LAWS THAT WERE EITHER EXPLICITLY
OR IMPLICITLY RELATED TO
STRUCTURAL RACISM DURING THE
PERIOD AND FOUND MOST STATES HAD
HARMFUL LAWS THAT NEGATIVELY
IMPACT COMMUNITIES OF COLOR AND
MOST STATES DID NOT HAVE
PROTECTIVE LAWS THAT PROHIBIT
DISCRIMINATION ABOVE AND BEYOND
FEDERAL PROVISIONS.
RECENTLY WE'VE BEEN LINKING OUR
DATABASE TO HEALTH AND HEALTH
CARE INDICATORS.
WE HAVE CREATED STATE LEVEL
INDEX WHERE WE HAVE CODED
PROTECTED LAWS AS NEGATIVE ONES,
HARMFUL ONES AS POSITIVE ONES
AND SUMS OF VALUE FOR ALL
INCLUDED LAWS AND USING THE DATA
WE HAVE FOUND POSITIVE
ASSOCIATIONS BETWEEN THE STATE
LEVEL STRUCTURAL LEGAL RACISM
INDEX AND THE RISK OF LACKING
HEALTH INSURANCE AND ABSCESS TO
HEALTH CARE AMONG YOUNG ADULTS.
WE HAVE ALSO CONDUCTED ANOTHER
ANALYSIS THAT CENTERED ON THE
IDEA THAT GROUPS OF STRUCTURAL
RACISM RELATED U.S. STATE LAWS
CAN HAVE POWERFUL INTERACTIVE
AFFECTS GREATER THAN THE SUM OF
SINGLE LAWS.
WE USED CLASS ANALYSIS TO
IDENTIFY PATTERNS OF
CO-OCCURRING STRUCTURAL RACISM
LAWS AND IDENTIFIED THREE LATENT
CLASSES OF LAWS.
CLASS ONE INCLUDES A MAJORITY OF
JIM CROW STATES THAT INCLUDE
MOSTLY HARMFUL LAWS.
A CLASS TWO MOSTLY PROTECTIVE
LAWS AND CLASS THREE, A MIX OF
HARMFUL ESPECIALLY IMMIGRATION
RELATED AND PROTECTIVE LAWS.
AGAIN WE USED INDIVIDUAL-LEVEL
HEALTH DATA FROM CDC WONDERED
AND FOUND A LINK BETWEEN THE
CLASSES AND PREMATURE MORTALITY
RATES FINDING CLASS 1 HAVE THE
HIGHEST MORTALITY RATES AND ALSO
AND THIS MAY SOUND INTUITIVE AT
FIRST BUT IT MAKES SENSE HOW THE
NARROWEST BLACK/WHITE
DISPARITIES BECAUSE BLACK AND
WHITE PEOPLE IN THOSE STATES
HAVE HIGH RATES OF PREMATURE
MORTALITY.
SO YOU SEE NARROW DISPARITIES.
IT'S IMPORTANT TO INTERPRET THAT
IN THE CONTEXT OF STATE
INFRASTRUCTURE RELATED TO THESE
LAWS.
SO IN THE LAST MINUTE THAT I
HAVE, I WANT TO TURN MY
ATTENTION TO INTERSECTIONALITY
WHICH IS EMBEDDED IN CRITICAL
RACE THEORY AND SHARES MANY OF
THE ORIGINS AND ORIGINATORS
INCLUDING KIMBERLY CRENSHAW AND
PATRICIA WILLIAMS AND OTHERS AND
INTERSECTIONALITY IS AN ANALYTIC
TOOL THAT PUSHES US TO THINK
MORE CRITICALLY AND HOWHOLIST
ABOUT THE INTERSECTIONS.
AND IT WAS STATED IN THE
COLLECTIVE FEMINIST STATEMENT OF
1977 NOTING SYSTEMS OF
OPPRESSION KNOWN AS RACISM,
SEXISM AND CISGENDERISM ARE
INTERLOCKING AND WE MUST ADDRESS
THEM ALL TO MOVE THE NEEDLE FOR
SGM PEOPLE.
I'LL JUST AND I'LL LET YOU KNOW
TO ADVANCE THE PATH AND PUSH
FORWARD ON ANALYSES INCLUDING IN
THE CONTEXT OF SGM HEALTH WE
ALSO DEVELOPED A LEGAL DATABASE
OF SEXUAL ORIENTATION AND GENDER
IDENTITY RELATED STAYED LAWS FOR
THE PERIOD OF 1996 TO 2016.
AND SO THERE'S REALLY THREE
MAJOR WAYS OF MOVING OUR
RESEARCH ON THOSE ASSESSING AND
ADDRESSING INTERSECTION
STRUCTURAL INEQUITIES USING
STATE LAWS FORWARD.
WE CAN LOOK AT THE JOINT EFFECT
OF MULTIPLE LAWS RELATED TO
DIFFERENT STRUCTURAL INEQUITIES
AND LOOK AT THEIR IMPACTS ON
HEALTH OUTCOMES AMONG
MARGINALIZED INCLUDING SGM GROUP
AND CREATE LEGAL INDICES AND
LEGAL CLASSES SUCH AS DISCUSSED
EARLIER AND LOOK AT THEIR
INTERSECTIONS ACROSS TYPE OF
INEQUITIES AND LASTLY I THINK
WHERE WE SHOULD MOVE IS THINK OF
INTEGRATED STATE LEVEL LEGAL
INDICES OR CLASSES AND LOOK AT
THE STRUCTURAL INEQUITIES.
PATRIARCHY AND THERE'S
STRUCTURAL INEQUITY AT THE STATE
LEVEL AND ALL THE LEVELS AND
ACROSS MULTIPLE SYSTEMS.
IN DOING THIS WORK, WE REALLY DO
NEED TO LOOK AT PEOPLE'S LIVED
EXPERIENCE IN THE CON TEST AND
IN THE DEVELOPMENT OF THE
MEASURES THROUGH PARTICIPATORY
PROCESSES AND MIXED METHODS
APPROACHES AND WE'RE WORK ON
THAT NOW AND TO THINK OF
INNOVATIVE WAYS LOOK AT
HISTORICAL CONTEXT WHICH IS
CRITICAL DO -- TO EVERYTHING
WE'RE TALKING ABOUT TODAY AND
CONCEPTUALIZATION BECAUSE THIS
MAY MOVE US IN A DIFFERENT
DIRECTION AND MIGHT MOVE US AWAY
FROM MEASUREMENT OR LEGAL
APPROACH AND FORCE OTHER WAYS OF
KNOWING AND ACTING SUCH AS
NARRATIVE SHIFTS.
AND THEN LASTLY, I WANT TO END
WITH THE POINT THAT WE KNOW THIS
BUT I THINK IT'S IMPORTANT TO
REMEMBER THAT WE'RE NOT JUST
FIGHTING STRUCTURAL INEQUITIES
BUT WE'RE FIGHTING FOR SOCIAL
AND HEALTH EQUITY AND JUSTICE.
SO YES, THIS WILL ABSOLUTELY
REQUIRE REPEALING AND PREVENTING
THE PASSAGE OF HARMFUL STATE
LAWS THAT ARE RELATED TO THESE
MULTIPLE SYSTEMS OF OPPRESSION I
JUST BUT IT WILL ALSO REQUIRE
MUCH MORE THAN PASSING GOOD LAWS
TO BRING MEANINGFUL STRUCTURAL
CHANGE.
WE'LL NEED COLLECTIVE
IMAGINATION AND ACTION FOR
TRANSFORMATIVE JUSTICE INCLUDING
TAKING SERIOUSLY AND DISCUSSING
THE NEED FOR REPARATION AND
ABOLITION AND THE NEW EQUITY
CENTERED SYSTEMS, INSTITUTIONS,
PRACTICES, STRUCTURES, NORMS AND
VALUES THAT ADVANCE EQUITY FOR
ALL SGM PEOPLE.
AND SO I WANT TO CLOSE BY
THANKING ALL OF MY COLLABORATORS
ON THIS WORK.
ESPECIALLY DR. AUSTIN WHO
GENERATED MANY OF THESE PROJECTS
AND HAS BEEN AN INCREDIBLE
LEADER IN OUR FIELD.
I WANT TO RECOGNIZE ALL HER
CONTRIBUTIONS THE PAST DECADE.
THANK YOU VERY MUCH.
>>THANK YOU SO MUCH,
DR. AGENOR.
GREAT PRESENTATION AND YOU GAVE
US A LOT TO THINK ABOUT.
I'D LIKE TO SHIFT TO THE Q&A
SESSION.
I THOUGHT THIS PANEL HAS GREAT
INSIGHT INTO INTERVENTIONS THE
SPEAKERS HAD DONE AND INSIDE TO
FUTURE GENERATION.
I WANT TO GO TO THE AUDIENCE
FROM THE VIDEOCAST.
HOW DO YOU DEFINE AN
INTERVENTION TARGETING POLICY
MAKERS AND HOW WOULD THEY BE
DISTINGUISHED FROM ADVOCACY OR
EDUCATIONAL EFFORTS FOCUSSED ON
REDUCING HEALTH DISPARITIES
AFFECTING SEXUAL AND GENDER
MINORITY PEOPLE.
I THINK THE QUESTION IS FOR
EVERYBODY.
>>I THINK MAYBE EMBEDDED IN THE
QUESTION IS THE ANSWER.
I THINK FORMALIZING AND
SPECIFYING AN ADVOCACY PROGRAM
AND EDUCATIONAL PROGRAM AND
TARGETING POLICY MAKERS I THINK
IN HIGH-INCOME SETTING AND IN
THE UNITED STATES AND ACROSS LOW
AND MIDDLE INCOME COUNTRIES
WOULD BE A GREAT INTERVENTION
STRATEGY.
SO I THINK IT MAY NOT BEING
DISTINGUISHED FROM ALL THE
ADVOCACY EFFORTS OTHER THAN
EVALUATED, MEASURED AND THE
DIFFERENCE IS WE DO MEASUREMENT,
MYSELF INCLUDED OF THE HARMS OF
POLICIES.
OFTEN THE HARMS OF POLICIES
SOMETIMES THE BENEFITS OF
POLICIES AND OFTEN THE HARMS OF
POLICIES.
AS A FIELD AND MYSELF AND OTHERS
WERE TRYING TO THINK HOW TO DO
THIS BETTER AND FORMALLY WORK
AND ON POLICY MAKERS TO IMPROVE
THE DECISIONS THEY MAKE WHETHER
THAT IS CHANGE IN POLICIES OR
ENFORCEMENT OF POLICIES AND
FORMALIZING RESEARCH.
I WILL ALSO NOTE IT'S ALSO HARD
TO GET THIS PASSED AND OTHERS
HAVE TRIED IN STUDY SECTIONS IT
CAN BE A CHALLENGING PROCESS
BECAUSE I THINK FOLKS HAVE
SOMETIMES TRIED AND IT'S BEEN A
CHALLENGE.
I DON'T WANT TO DENIGRATE THE
MANY EFFORTS OF FOLKS IN THE
SPACE.
THANKS.
>>I WANT TO ADD THAT I DO THINK
WE KIND HAVE TO MOVE BEYOND
SCIENCE AND POLICY CHANGE AS
BEING TWO DIFFERENT THINGS.
AND STOP THINKING THEY EXIST IN
A SILO.
WE KNOW SCIENCE AND ADVOCACY
CO-INFORM ONE ANOTHER ALL THE
TIME AND WE SPEAK WITH FOLKS IN
COMMUNITIES, IN ORGANIZATIONS IN
DECISION MAKERS ABOUT THESE
ISSUES OTHERWISE I'M NOT SURE WE
WOULD BE HERE TODAY.
SO MY KIND OF RESPONSE TO THAT
QUESTION, WHICH IS VERY HELPFUL,
WOULD BE FOR US TO THINK ABOUT
HOW WE CAN ACTUALLY PARTNER WITH
ONGOING EFFORTS ON THE GROUND
WHETHER THAT'S ADVOCACY OR
SOCIAL MOVEMENTS OR COMMUNITY
ORGANIZING TO PROVIDE THE
EVIDENCE NEEDED TO DOCUMENT WHAT
PEOPLE HAVE BEEN DOING AND ARE
ALREADY DOING AND TO THINK OF
THAT AS PART OF OUR TOOL KIT IN
BUILDING COLLABORATIONS ACROSS
SECTORS AND DOMAINS OF SOCIETY
TO MAKE MEANINGFUL CHANGE.
>>GREAT, THANK YOU.
ANY OTHER THOUGHTS FROM OUR
PANELISTS?
OKAY.
SO I GUESS I HAVE A QUESTION FOR
ALL THE PANELISTS.
WHAT DO YOU THINK IS NEEDED TO
MOVE INTERVENTION RESEARCH
FORWARD?
LIKE WHAT ARE SOME KEY RESEARCH
INTERVENTION STEPS NEEDED SO THE
RESEARCH COULD GET TO THE NEXT
LEVEL WHERE WE COULD ACTUALLY
REDUCE OR ELIMINATE DISPARITIES
FOR SGM POPULATIONS?
WHAT IS NEEDED THAT IS NOT BEING
DONE OR HAS A LOT OF BARRIERS
FOR BEING DONE?
>>IT SPEAKS TO THE PRIOR
CONVERSATION AROUND HOW TO
TARGET POLICY MAKERS.
I THINK OF MY COLLEAGUES IN
ACADEMIA AS POLICY MAKERS.
I WANT TO GET TO THE PLACE WHERE
THEY'RE PUTTING A GRANT IN AND I
DON'T HAVE TO BEG THEM TO THINK
ABOUT HOW THEY'RE GOING TO
RECRUIT LGBTQ+ PEOPLE.
PEOPLE OF COLOR AND HOW THEY'LL
BALANCE THEIR RESEARCH DESIGNS
TO BE ABLE TO DO SUB GROUP
ANALYSIS.
I REALLY HOPE WE CAN GET TO A
PLACE WHERE THE SCIENTIFIC
COMMUNITY DOESN'T THINK OF US AS
AN AFTER THOUGHT.
SO THAT TO ME IS A PLACE WHERE
SGM RESEARCHERS AND THOSE WHO
HAVE BEEN DOING SGM
INTERVENTIONS FOR A NUMBER OF
YEARS CARRY THE BURDEN BY
THEMSELVES.
WE HAVE TO GET MORE ALLIES
THROUGHOUT THE ACADEMIC
COMMUNITY TO SAY, HEY, I RAN
THIS TRIAL AND GUESS WHAT, I HAD
100 PARTICIPANTS.
DO YOU WANT ACCESS TO THAT DATA?
THAT'S THE TYPE OF VALUE I THINK
WE NEED TO START TO PURSUE.
>>AN OTHER THOUGHTS FROM THE
PANELISTS?
WE CAN GO TO THE VIDEOCAST
AUDIENCE QUESTIONS.
GO AHEAD.
>>I'LL ADD ONE THING.
WE HEARD THIS A LOT.
THERE ARE THROUGH THE C FAR WE
HAD A SERIES OF
COMMUNITY-ENGAGED AWARDS AND HAD
AN OPPORTUNITY TO STUDY AND A
MAJOR BARRIER TO MEANINGFUL
INTERVENTION DEVELOPMENT IS
COMMUNITIES BEING WELL SUPPORTED
FOR PARTNERSHIP AS PART OF THE
WORK AND SO NOT JUST IN THE
CONTEXT OF LIKE A CAB BUT AS
INVESTIGATORS, FUNDED
INVESTIGATORS, PARTNERS,ED IN
THAT.
I THINK THERE'S LIKE STRUCTURAL
BARRIERS AT THE ACADEMIC
INSTITUTION LEVELS IN TERMS OF
SUBCONTRACTING AND PARTNERSHIPS.
THERE'S FUNDAMENTAL BARRIERS IN
TERMS OF SKETCHES AND HOW
THEY'RE EVALUATED.
WE ALL BELIEVE IN THE IMPORTANCE
OF COMMUNITY AND DRIVING THESE
POLICIES AND BEING SUPPORTIVE TO
DO THAT AND I THINK THERE'S
STRUCTURAL CHANGES THAT NEED TO
HAPPEN TO ENSURE THERE'S MORE
OPPORTUNITY FOR THAT.
>>AND ONE POTENTIAL GOOD
EXAMPLE OF THAT IS NIH'S RECENT
CAMPUS INITIATIVE.
IT'S THE COMMUNITY PARTNERSHIPS
TO ADVANCE SCIENCE FOR SOCIETY
WHERE THE APPLICATIONS HAVE TO
BE LED BY P.I. AND COMMUNITY
PARTNER OR COMMUNITY
ORGANIZATION OR SCIENTISTS OR
MORE THE CO-INVESTIGATORS BUT
THE INITIATIVES OF THE COMMUNITY
WHICH CAN BE MESSIER THAN RCT
RESEARCH BUT ULTIMATELY BUT
COMMUNITY VOICES INTO PRACTICE.
>>TO ADD, I THINK THE TYPES OF
MECHANISMS ARE GREAT AND
IMPORTANT.
ALSO AT THE SAME TIME THERE IS A
NEED TO BUILD UP AND SUPPORT
COMMUNITY-BASED ORGANIZATION
CAPACITY TO LEAD RESEARCH GRANTS
ESPECIALLY THE SMALLER
ORGANIZATIONS THAT TEND TO FOCUS
ON SMALLER MULTIPLY MARGINALIZED
POPULATIONS OR SGM POPULATIONS
OFTEN DO LACK THE RESOURCES AND
SUPPORT TO BE ABLE TO TAKE
ADVANTAGE OF OPPORTUNITIES.
AND THERE'S WORK THAT ARE
COMMUNITY BASED ORGANIZATIONS OR
MULTIPLY MARGINALIZED
POPULATIONS HAVE BEEN DOING THAT
HAVE NOT BEEN DOCUMENTED BY
SCIENCE AS BEING EFFECTIVE.
WE'VE BEEN DOING SOME WORK WITH
AN LGBTQ+ ORGANIZATION SERVING
YOUTH OF COLOR SPECIFICALLY IN
BOSTON TO DOCUMENT
EVIDENCE-BASED PRACTICES THAT
THEY ARE AND HOW THEY'RE
ADDRESSING THE NEEDS OF THEIR
COMPLAINTS SPECIFICALLY TO GET
THE WORK THEY'RE DOING INTO THE
SCIENTIFIC LITERATURE SO THAT
CAN ALSO BE SEEN AS VALUABLE
>>THANK YOU.
WE HAVE QUESTIONS FROM THE
VIDEOCAST AUDIENCE.
WE'RE TALKING ABOUT CENTERING
COMMUNITY MEMBERS WITH LIVED
EXPERIENCE AND LGBTQ+ FOLKS.
HOW CAN WILL IT BUILD UP THE
PRACTICE AND THESE CAN BE COST
PROHIBITIVE AND RELEVANT AND
EXIST IN THE FORM THE COMMUNITY
WANTS SO THE END PRODUCT IS WITH
AND FOR COMMUNITY AS WELL.
ANY THOUGHTS?
>>I HOPE WE ARE ALL FOLLOWING
THE POLICY AND MAKING EVERYTHING
AVAILABLE.
ULTIMATELY IF YOU ARE FUNDED BY
A FEDERAL PROJECT IT'S NOT YOUR
DATA.
IT'S THE PEOPLE'S DATA.
AND HOW DO WE BOTH CREATE WITH
COMMUNITY?
WE HAVE BEEN TRYING TO THINK OF
A MECHANISM FOR BUSINESS
PARTNERS TO WORK WITH ACADEMICS
THROUGH THE SPIR/STTR I
MENTIONED.
WHAT WOULD IT LIKE TO HAVE A
COMMUNITY-BASED NONPROFIT GRANT
AND FIND AN ACADEMIC PARTNER TO
EVALUATE OR SCALE OR DO
IMPLEMENTATION SCIENCE FOR
BECAUSE I AGREE WITH SOME POINTS
THAT WE'RE USUALLY BUILDING
WITHIN OUR SILOS ASSUMING WE
KNOW BEST WHAT COMMUNITY NEEDS
AND OFTEN TIMES FOLKS WHO
ALREADY FIGURED OUT A PROGRAM
THAT IS IMPACTFUL AND HAVEN'T
SEEN THE LIGHT OF DAY IN THE
ACADEMIC CLASS.
>>THAT'S A VERY GOOD POINT.
>>SO THERE'S ANOTHER MESSAGE
FROM THE VIDEOCAST.
SHOULD RESEARCHERS ENGAGE
DIVERSE COMMUNITIES AND EQUITY
CENTERS THAT DO NOT CONFORM WITH
ACADEMIC THEORIES AND RESEARCH
PREFERENCES.
FOR EXAMPLE FAY COMMUNITY IS NOT
INTERESTED TO APPLY MINORITY --
GO AHEAD.
>>THAT IS AN INTERESTING
QUESTION.
THANK YOU FOR POSING IT.
I NEVER HEARD CRT DESCRIBED AS
AN ELITE SERIES BUT I GOT A
CHUCKLE BECAUSE THE ORIGIN OF
THAT THEORY IS GRASSROOTS.
IT WAS PULLED FROM THE COMMUNITY
COMING TOGETHER AND LEGAL
SCHOLARS WHO CODIFIED IT AND
INTERSECTIONALITY IS NOT AN
ACADEMIC THEORY.
IT'S A GRASSROOTS PRACT --
PRACTICE.
HOW DO WE GET IMPORTANT
MATERIALS AND FINDINGS INTO
COMMUNITIES AND MAKE THEM
COMMUNITY-OWNED.
I THINK WHAT WAS SAID EARLIER
ABOUT ASSURING OUR DATA AND
INCLUDING OUR DATABASES ARE
AVAILABLE WIDELY TO ACADEMSS -
ACADEMICS AND COMMUNITY GROUPS
IS IMPORTANT.
AND EVENTUALLY THESE KINDS OF
GROUPS WILL BE HAVE TO BE MOVED
AND THINK HOW TO GET THEM DOWN
TO LOCAL HEALTH DEPARTMENTS AND
HOW CAN LOCAL HEALTH DEPARTMENTS
GET THE INFORMATION AND
RESOURCES OUT TO THE COMMUNITIES
THEY WORK WITH?
I DON'T NECESSARILY SEE MYSELF
AS BEING THE DIRECT PERSON DOING
THAT.
I SEE THE NEED FOR COLLABORATIVE
EFFORT WITH PEOPLE WHO HAVE
RELATIONSHIPS ON TO THE GROUND
ACROSS THE COUNTRY AND GIVING
THAT INFORMATION AND FUNNELING
OUT THAT WAY.
THAT'S SOMETHING WE'RE TRYING.
I'LL BE HAPPY TO REPORT BECOME
AND LET YOU KNOW HOW IT GOES.
>>ONE THING I'VE SEEN IN OTHER
FUNDING STRUCTURE INCLUDING THE
INSTITUTE OF HEALTH RESEARCH YOU
HAVE TO PUT ASIDE 10% TO
ACKNOWLEDGE TRANSLATION
ACTIVITIES.
IN YOUR BUDGET YOU'RE MANDATED
AND IT'S OFTEN WITH
COLLABORATION WITH COMMUNITY
GROUPS FOR DISSEMINATION OF
PRODUCTS THAT SUPPORT
IMPLEMENTATION AND THEIR NEEDS.
IT'S AN INTERESTING MODEL.
IT'S BEEN MORE ABOUT CREATING
MORE OPEN ACCESS AROUND ACADEMIC
PRODUCTS BUT THERE MAY BE AN
OPPORTUNITY OF SETTING RESOURCES
ASIDE FOR THE KNOWLEDGE
TRANLATION AND DISSEMINATION
ACTIVITIES.
>>HOW DO YOU ALL THINK
IMAGINATION INFORMATION IMPACTS
POLICY AND HOW SHOULD WE THINK
ABOUT COMBATTING THIS
INFORMATION AND FURTHER
POLITICAL ENTRENCHMENT OF SGM
LIFE?
>>IF I HAD AN ANSWER TO THAT
ONE -- I DON'T KNOW.
I'M NOT SURE.
I'D LOVE TO THINK ABOUT THAT
SOME MORE.
>>WE'RE TAKING TIME FROM THE
LUNCH BREAK.
I JUST WANTED TO ASK A QUESTION
FROM THE VIDEOCAST AUDIENCE.
HOW DO WE MAKE SURE WE'RE NOT
PROMOTING LATERAL VIOLENCE WHEN
PARTNERING WITH A COMMUNITY
GROUP?
MAKE SURE WE'RE CENTERING THE
MOST MARGINALIZED NOT JUST
TOKENIZING ONE LEADER WHO MAY
NOT SPEAK FOR EVERYONE.
>>SIMILAR TO THE CONVERSATION
AROUND POLICIES AND RESEARCH
ABOUT LAW IN STUDY SECTION.
IT'S DESIGN SO WE DON'T RUN INTO
THE DISPARITIES OF THE
PARTICIPATION IN TERMS OF
COMMUNITY POWER AND CONTROL.
IT'S A PLUG TO ALSO SAY AS WE
THINK ABOUT IT FROM SCIENCE AND
HOW DO WE CREATE METHODS THAT
USE CDPR AS THE FOUNDATION.
>>I'D LIKE TO END THE
QUESTION/ANSWER QUESTION BECAUSE
PEOPLE NEED TO HAVE LUNCH.
PLEASE DISCUSS IT I DON'T WANT
TO CUT MORE IN THE LUNCH BREAK.
AFTER THE LUNCH BREAK WE'LL HAVE
THE SECOND SESSION ON
INTERVENTION RESEARCH AND SGM
HEALTH AND DR. WHITTAKER FROM
THE OFFICE OF WOMEN'S RESEARCH
IS GOING TO BE THE MODERATOR.
THANK YOU AND THIS WAS A GREAT
PANEL AND LOOK FORWARD TO MORE
THIS AFTERNOON.
THANK YOU.
I'M MIYA WHITAKER THE MODERATOR
FOR THIS SESSION.
WE BEGIN WITH A TALK LED BY
DR. AMY TISHELMAN AND THE
VIRTUAL PODIUM IS NOW YOURS.
>>I HAVE NO CONFLICTS OF
INTEREST.
I'M GOING TO TRY TO FAST LIKE AN
AUCTIONEER BUT I'M NOT REALLY AN
AUCTIONEER SO I'LL DO BY MEST.
I'LL FOCUS ON CLINICAL RESEARCH
WITH SGM YOUTH AND YOUNG ADULTS.
ALSO TALK ABOUT SOME EXPERIENCES
WITH CLINICAL INTERVENTION
RESEARCH.
I THINK MOST OF US REALIZE
THERE'S A LOT OF OPPORTUNITIES
AND NEEDS IN SGM RESEARCH.
IT'S A CHANGING LANDSCAPE.
THERE SEEMS TO BE A POLITICAL
BACKLASH TO ME AND PROBABLY MOST
OF YOU IS PRETTY ALARMING AND
WORRISOME AND UPSETTING AND
THERE'S AMPLE OPPORTUNITY WHERE
TO MAKE A DIFFERENCE AND WHERE
THE DIFFERENCE MOST IMPORTANT
WHEN WE THINK ABOUT WHAT
RESEARCH WE'RE GOING TO DO I
KNOW I'M PREACHING TO THE
CONVERTED HERE, THERE'S A LOT OF
STRENGTH WITHIN SGM COMMUNITIES.
IT'S NOT JUST ONE COMMUNITY TO
DRAW UPON AND A LOT OF
MOTIVATION TO BUILD EMPIRICAL
BASE OF COMMUNITY SUPPORT THAT
MAY HELP VULNERABLE PEERS,
YOUTH, CHILDREN, PARENTS AND
FRIENDS OF OURS WHO ARE SGM AND
FOR OURSELVES.
SO CLINICAL RESEARCH I TRULY
BELIEVE CAN HAVE A HUGE AND
MEANINGFUL IMPACT.
THERE'S A MYRIAD OF WAYS WHERE
RESEARCH HAS MADE A HUGE
DIFFERENCE IN JUSTIFYING
INTERVENTIONS POINTING TO
INTERVENTIONS THAT CAN BE
HELPFUL AND IDENTIFYING
INDIVIDUALS WHO ARE AT RISK
UNJUSTIFIABLE RISK.
I THINK THERE'S A LOT TO BE
DONE.
THERE'S ALSO A LOT OF
COMPLEXITY.
UNFORTUNATELY CLINICAL RESEARCH
IS NOT AS CLEAN.
IT'S HARD TO CONTROL FOR ALL THE
NECESSARY FACTORS AND IT'S
REALLY IMPORTANT TO REALIZE THAT
WHILE EVERY STUDY HAS LIMITATION
AND IT'S IMPORTANT TO KNOW WHAT
WE DO AND DON'T WANT TO
DEMONSTRATE WITH THE RESEARCH WE
UNDERTAKE AND TO ACCEPT
LIMITATIONS DOESN'T MEAN A
RESEARCH STUDY NOT VALUABLE AT
ALL.
IT'S JUST ONE STUDY CAN'T DO
EVERYTHING AND WHEN ONE STUDY
TRIES TO DO EVERYTHING IT DOES
NOTHING AND THERE CAN BE
REPLICATION AND EXPANSION AND
OVER TIME WE SEE THE PATTERNS IN
WHAT WE WISH TO DEMONSTRATE AND
KNOW.
I ALREADY SAID AND MANY HAVE
ALREADY SAID THIS BUT SGM
COMMUNITIES ARE HIGHLY VARIABLE
AND HETEROGENOUS THOUGH
SOMETIMES OVERLAPPING.
AND IT INCLUDES PEOPLE WITH
DIVERSE SEXUALITIES AND
DIFFERENCES IN SEX TRADES AND
DISORDERS I BEGAN USING THE TERM
VARIATION IN SEX TRADES AND I
CAN TELL YOU ONE AND AREAS WITH
STARS ARE MY OWN RESEARCH.
IT'S BEEN IN THE PAST AN AREA OF
TRAUMA AND I EXPECT THE TRAUMA
IN SGM COMMUNITIES AND I HAVE A
STRONG BACKGROUND IN TRAUMA BUT
MORE RECENTLY IN THE LAST DECADE
OR SO HAVE BEEN CONCENTRATED ON
RESEARCH WITH TRANSGENDER AND
GENDER DIVERSE YOUTH AND YOUNG
ADULTS AND INTERSECTS AND SEX
TRAITS OR WITH VARIATION OF SEX
TRAITS ALSO HAVE ISSUES AND
IDENTIFY THEMSELVES AS GENDER
DIVERSE AND HAVE DIVERSE
SEXUALITY.
THERE'S INTERRELATIONSHIP WITHIN
THESE AND MANY ARE PROBABLY
AWARE, EVERYBODY IN THE LGBTQ
COMMUNITY DOESN'T RELATE WITH
OTHERS IN THAT COMMUNITY.
THERE ARE MANY IN THE LGBTQ FEEL
THE NEED TO DISTINGUISH
THEMSELVES FROM THE TRANS
COMMUNITY AND SOMETIMES THERE
CAN BE CONFLICT.
EACH COMMUNITY HAS SUB
COMMUNITIES AND SEPARATE ISSUES
AND CONSIDERATIONS.
AS I JUST SAID NOT ALL LGBTQI
COMMUNITIES ARE SUPPORTED AND WE
CAN TODAY FINE THEM NARROWLY OR
BROADLY.
I'M GOING TO TALK MORE DEPTH
ABOUT COMMUNITY PARTNERSHIPS.
AS I'VE WORKED AS A RESEARCHER
IN CLINICAL RESEARCH I HAVE
REALIZED HOW CRITICAL IT IS TO
PARTNER.
I DON'T JUST MEAN DRAW UPON
COMMUNITIES BUT REALLY BE
RESEARCH COLLABORATORS AND
PARTNERS WITH PEOPLE IN
COMMUNITIES UNDERTAKING RESEARCH
AND I THINK IT'S CRITICALLY
IMPORTANT AND HAS BEEN
PROBLEMATIC IN THE PAST AND NOT
THAT I'M SAYING IT'S ALWAYS EASY
BUT I THINK IT'S REALLY
IMPORTANT TO ENSURE THAT THE
RESEARCH THAT'S BEING DONE NEEDS
TO BE DONE.
IT PRIORITIZES COMMUNITY NEEDS
AND THAT'S SOMETHING THAT'S A
GOAL FOR YOU TO ENSURE THE
RESEARCH METHODS AND MEASURES
AND LANGUAGES THAT ARE USED, THE
RECRUITMENT STRATEGIES ARE ALL
SENSITIVE TO THE COMMUNITY OR
COMMUNITIES INVOLVED IN THE
RESEARCH.
AND I THINK CLEARLY COMMUNITY
NEEDS TO BE DEFINED BY THE
RESEARCH ITSELF.
ACCOUNTING FOR FACTORS RELATED
TO WHO YOU ARE RESEARCHING AND
WHAT YOU'RE RESEARCH QUESTIONS
ARE.
AND MAKING SURE THE COMMUNITY
PARTNERS ARE PEOPLE WHO ARE
ENGAGED OR REPRESENT THE
SPECTRUM OF THE COMMUNITIES
YOU'RE RESEARCHING INCLUDING
RURALITY AND AGE, SOCIO ECONOMIC
FACTORS AND RACIAL FACTORS,
GENDER DIVERSITY OR SEX WHICH
CAN BE DISTINCT AND CAN BE A
BIOLOGICAL VARIABLE.
ALL THOSE FACTORS MAY NEED TO BE
CONSIDERED IN THE SPECTRUM OF
WHO IS GOING TO BE REPRESENTED
IN THE RESEARCH AS PART OF THE
COMMUNITY.
SO BROAD COMMUNITY-BASED
COMMUNITY RESEARCH, FOR
INSTANCE, IF YOU'RE BEING
INCLUSIVE OF A BROAD RANGE OF
SUB GROUPS OR COMMUNITIES CAN
REQUIRE EXTENSIVE AND
REPRESENTATIVE OF COMMUNITY
PARTNERS AND USING SOME OF MY
OWN CURRENT RESEARCH AS AN
EXAMPLE I'M DOING RESEARCH IN
VST OR INTERSECTS AND IT'S TAKEN
YEARS TO DEVELOP THESE COMMUNITY
PARTNERS BUT WE'RE ALSO USING A
BROAD TAXONOMY OF WHAT VST IS SO
OUR CLINICAL BENEFIT CAN
HOPEFULLY BENEFIT THE BROADEST
RANGE OF YOUTH OR YOUNG ADULTS
WHO COULD POTENTIALLY BENEFIT SO
OUR RESEARCH PARTNERS NEED TO BE
BROUGHT TO REPRESENT THE
DIVERSITY OF THE COMMUNIT COMMU
ENGAGED IN OUR RESEARCH.
I HOPE THAT MADE SENSE AND GAYS
AND PEOPLE OF COLOR LIVING IN
RURAL PROPERTY REQUIRE
REPRESENTATION FOR THAT SPECIFIC
COMMUNITY.
MY OWN EXPERIENCE IT CAN TAKE
TIME AND EFFORT AND EVEN YEARS
TO BUILD UP COMMUNITY NETWORK
PARTNERS AND AS A PARTNER AND
COLLABORATOR IT'S IMPORTANT TO
BE TRUSTWORTHY, COMMITTED,
RESPECTFUL AND DEFINITELY NOT
EXPLOITIVE.
IF YOU'RE WORKING WITH COMMUNITY
PARTNERS FOR YOUR RESEARCH THE
PRIORITY CAN'T BE YOUR
PROMOTION.
OR AT YOUR ACADEMIC CAREER.
YOUR PRIORITY REALLY NEEDS TO BE
DOING GOOD SCIENTIFIC RESEARCH
UTILIZING THE PARTNERSHIP THAT
YOU HAVE WITH COMMUNITY AND I
HAVE BEEN AWARE OF SITUATIONS IN
WHICH -- WHAT?
DID I HEAR A QUESTION.
WHERE COMMUNITIES HAVE FELT
EXPLOITED AND UNHAPPY WITH THEIR
PARTNERSHIPS.
IT'S REALLY IMPORTANT TO ENSURE
THERE'S A TRANSPARENT AND
POSITIVE RELATIONSHIP THAT CAN
BE MAINTAINED.
IT'S IMPORTANT THE COMMUNITY
REPRESENTATION UP YOUR CORE
RESEARCH PERSONNEL -- CAN
EVERYBODY HEAR ME?
I WANT TO MAKE SURE I'M COMING
THROUGH.
>>YES, GO AHEAD.
SOMEBODY UNMUTED.
>>I THOUGHT I WASN'T MAKING
SENSE.
OKAY.
AS AN EXAMPLE WE'RE WORKING TO
DEVELOP A SELF-ADVOCACY MEASURE
FOR YOUTH FOR VARIATIONS IN SEX
TRADES SOMETIMES REFERRED TO BY
SOME COMMUNITIES AS INTERSECTS
AND RELATED CONDITIONS AND IT'S
HELPFUL FOR BEING ABLE TO
IDENTIFY DISPARITIES IN THIS
POPULATION AS WELL AS AN
IMMEDIATE INTERVENTION AND
IMMEDIATELY USEFUL FOR CLINICAL
CARE.
IF YOU DON'T KNOW, INTERSEX
COMMUNITIES HAVE OFTEN ADVOCATED
OR IDENTIFIED THAT THEY'RE
MEDICAL CARE IS ACTUALLY HARMFUL
AND HURTFUL TO THEM.
THE WORLD HEALTH ORGANIZATION
SOMETIMES CALLED THE MEDICAL
CARE RECEIVED BY THESE
COMMUNITIES AS MEDICAL TORTURE
AND THERE'S A LOT OF
CONTROVERSY.
AS THE NOT ALWAYS
STRAIGHTFORWARD.
I'M FOCUSSING ON THIS AND I
THINK IT'S IMPORTANT TO
RECOGNIZE THEIR NEEDS.
AND BECAUSE I'M DOING RESEARCH
IN THIS AREA.
THIS IS OUR STUDY TEAM AND
OTHERS ARE INVOLVED IN THIS
RESEARCH.
AND JUST TO SHOW YOU WE HAVE
TAKEN YEARS TO DEVELOP THESE
VAST NATIONAL COMMUNITY
PARTNERSHIPS WHO ARE ALIGNED
WITH OUR RESEARCH GOALS AND ARE
REALLY INFORMING OUR RESEARCH
ASIDE FROM THE PARTNERSHIPS ON
THIS SLIDE WE HAVE OTHERS
INCLUDING COLORADO CHILDREN'S
HOSPITAL AND THE CHILDREN'S
HOSPITAL AND WITH ACCESS AND
OTHER SUPPORT AND ADVOCACY
GROUPS IN THE VST WHO REPRESENT
THE VST COMMUNITIES.
SO OUR COMMUNITY PARTNERSHIP HAS
BEEN KEY IN HELPING US TO
IDENTIFY KEY DOMAINS THAT ARE OF
CRITICAL IMPORTANCE TO INCLUDE
IN A SELF-ADVOCACY MEASURE FOR
YOUTH AND YOUNG ADULTS.
THEY HELPED US TO DEVELOP THE
INITIAL PROTOTYPE AND ITEM SET
TO MAKE SURE THEY WERE TARGETING
THE CORRECT AREAS AND THEY'VE
GIVEN US INPUT ON TERMINOLOGY
AND SENSITIVITY OF OUR LANGUAGE.
THAT'S EXTREMELY DIFFICULT IN
THIS AREA WHERE THROUGH OUR OWN
RESEARCH WE FOUND THERE IS NO
TERMINOLOGY THAT ALL MEMBERS OF
THE COMMUNITIES OF VST AGREE
UPON.
HOW WE ENDED UP WITH USING
VARIATIONS OF SEX TRADE LANGUAGE
WAS FROM FEEDBACK FROM OUR
COMMUNITIES AND AGREEMENT AND
CONSENSUS THAT WAS THE MOST
ACCEPTABLE LANGUAGE TO USE.
WE'RE USING USE COGNITIVE
INTERVIEWING FROM THE COMMUNITY
TO DETERMINE THE ADEQUACY OF OUR
MEASURE.
SO THIS IS SORT OF WHAT WE CAME
UP IN.
IT'S TOO BIG TO SEE BUT THESE
ARE THE AREAS THAT OUR PATIENTS
AND COMMUNITY PARTNERS FELT WERE
MOST IMPORTANT FOR A
SELF-ADVOCACY TOOL AND I'M
PRESENTING THAT AND USING A
COMMUNITY PARTNERSHIP TO SHAPE
YOUR RESEARCH.
THE NUMBER ONE MOST IMPORTANT
AREA ACCORDING TO OUR PATIENTS
THEMSELVES WAS PROVIDER
INTERACTIONS AND THEY CLAIM
PROVIDERS TALK TO THEIR PARENTS
AND NOT TALK TO THEM AND WE GET
A LOT OF FEEDBACK ABOUT HOW
TRAUMATIZING THE MEDICAL CARE
HAS BEEN AND GENITAL EXAMS IS
WHERE THEY FELT MOST VIOLATED
AND WE CAN SHAPE THE QUESTIONS
THEY ASK HERE SO PATIENT
EDUCATION DECISION MAKING,
ACCESS TO PSYCH SOW SOCIAL CARE
AND HEALTH IN CLINICAL CARE SUB
DOMAINS WE CAME UP WITH AND A
SECOND AREA, SEX AND GENDER
HEALTH SUBDOMAINS WHICH IS A
SECOND GRANT WE WERE AWARDED OR
A SUPPLEMENT WARDAWARDED TO LOO
GENDER AND YOUTH IDENTIFIED
GENDER IDENTITY AND EXPRESSION
AS THE MOST IMPORTANT AREA TO
FOCUS ON AS SELF-ADVOCACY
MEASURES.
WE GOT YOUTH THAT COMPLAINED
ONCE THEY GOT A DIAGNOSIS
MEDICAL PROVIDERS QUESTIONED
THEIR GENDER AND THEY FELT
NERVOUS ABOUT THEIR OWN GENDER
OR THAT HAVING A VST LET THEM
FEEL THEY'RE BODY FAILED THEM
AND THEY HAD QUESTIONS ABOUT
REPRODUCTIVE HEALTH AND
FERTILITY AND SEXUAL FUNCTION AS
WELL ASUROLOGICAL FUNCTION.
WAS THAT THE BELL?
>>YOU CAN TAKE THE NEXT MOMENT
OR SO TO WRAP UP.
>>I WANTED TO TALK ABOUT
COMMUNITY RESEARCH AND OTHER
CONSIDERATIONS ARE RECRUITMENT.
WHAT I HAVE SEEN AND I THINK
OTHERS HAVE INCLUDING SOME OF MY
OWN RESEARCH IN THE TRANS
COMMUNITY IS THAT RESEARCH
STARTED OFF RECRUITING PEOPLE
FROM GENDER CLINICS WHERE THERE
TEND TO BE HIGHER SES, MOSTLY
WHITE, PROFESSIONAL, EDUCATED
PEOPLE AND YOUTH WHO TEND TO
HAVE MORE SUPPORT FROM PARENTS.
SO FEASIBILITY OF RECRUITMENT
OFTEN DRIVES THE RESEARCH
QUESTION AND IT'S PARTICIPANTS
WHO VOLUNTEER, PARTICIPANTS FROM
EXAMPLES AND ADULT AND YOUTH WHO
CONSENTED.
IT'S NOT NECESSARILY THE PEOPLE
MOST IN NEED.
IF WE RELY ON DOING THE MOST
EASILY RECRUITED, WE REALLY DO I
BELIEVE AND I CON INCKCONCLUDEDE
YEARS, LOSE MOST IN NEED AND
FEASIBILITY SHOULD BE BALANCED
WITH NEED AND I SUGGEST IN MY
OWN HEAD AND WHAT I WANT TO DO
WITH THE REST OF MY LIFE BUT
IT'S IMPORTANT TO FIND WAYS TO
RECRUIT PEOPLE WHO ARE NOT SO
EASILY RECRUITED BUT OFTEN LEFT
OUT OF RESEARCH AND RESEARCH
THAT REACH THOSE WITH LEAST
ACCESS TO CARE AND LIKELY TO
BENEFIT FROM INTERVENTIONS IS
IMPORTANT BUT HARD.
YOU MAY BE QUESTIONED ABOUT
USABILITY.
BUT VULNERABLE POPULATION ALSO
AT HIGH RISK OF COERCION AND
RESEARCH INCENTIVES MAY CAUSE
PEOPLE TO SIGN ON TO RESEARCH
THEY'RE NOT COMFORTABLE WITH AND
I THINK THAT'S AN IMPORTANT
CONSIDERATION.
IF WE DON'T RECRUIT FROM A WIDE
SWATH OF PEOPLE THEN THE
RESEARCH WE HAVE IS LIMITED IN
GENERALIZABLE AND THAT HAS BEEN
PROBLEMATIC IN TRANSGENDER
RESEARCH.
ALSO WHEN TALKING ABOUT YOUTH
SPECIFIC COMPLEXITIES, A LOT OF
PEOPLE DON'T WANT TO DO RESEARCH
WITH YOUTH.
IT'S REALLY HARD.
HOW DO YOU CONSENT YOUTH WHOSE
PARENTS ARE UNAWARE OF THE SGM
COMMUNITY AND MAY HAVE TO USE
INNOVATIVE CONSENT STRATEGIES.
AND IRBs WILL SOMETIMES ALLOW
YOU TO ENROLL YOUTH ESPECIALLY
16 OR OVER WITHOUT PARENTAL
CONSENT BECAUSE IT'S DIFFICULT
IF YOU DON'T WANT TO OUT KIDS TO
THEIR PARENTS BUT YOU WANT TO
UNDERSTAND HOW KIDS ARE
FUNCTIONING WHEN THEY DON'T HAVE
PARENTAL SUPPORT.
AND THEN FOR OTHER RESEARCH,
PARENTS ARE THE GATE KEEPERS.
AND KIDS AND PARENTS -- WHAT I
HAVE FOUND AND WORRIED ABOUT IS
PARENTS WHO MAY BE THE MOST
REJECTING AND ABUSIVE AND
HURTFUL TO THEIR KIDS WILL NOT
LET THEIR KIDS PARTICIPATE
BECAUSE THEY DON'T WANT TO BE
OUTED FOR THE BEHAVIOR AND IT'S
HARD TO RECRUIT AND IT'S ALSO
TRUTH OF RESEARCH SPANNING A
LARGE AGE SPAN YOU NEED MEASURES
THAT ARE APPROPRIATE FOR THAT
LARGE AGE SPAN TO COMPARE AND
CONTRAST NEEDS ACROSS AN AGE
SPAN AND THAT CAN BE HARD.
THERE ARE CHILD PROTECTION AND
RISK OF SUICIDALITY IN DOING
RESEARCH WHICH YOU NEED TO BE
ABLE TO ACCOUNT FOR IN YOUR
PROTECTION AND SOME PEOPLE DON'T
WANT THAT RISK AND HEADACHE BUT
IF YOU DON'T WANT TO DEAL WITH
IT THEN YOU MAY EXCLUDE VERY AT
RISK YOUTH FROM YOUR RESEARCH.
IT'S ENDEMIC TO AT-RISK RELATED
YOUTH RESEARCH AND IMPORTANT TO
BE ABLE TO FEEL CONFIDENCE YOU
HAVE A WAY IT DEAL WITH THAT.
SO WE DON'T KNOW WHO IS NOT
INCLUDED IN RESEARCH AND WHO IS
AND I DO HYPOTHESIZE THAT A LOT
OF OUR RESEARCH GETS SKEWED BY
WHO OPTS OUT.
WE IN OUR OWN TRANS YOUTH
RESEARCH DID ACTUALLY EXAMINE
WHETHER YOUTH WHO OPTED OUT OF
RESEARCH WERE EQUIVALENT TO
THOSE WHO OPTED IN.
AND IT WAS CLINIC-BASED RESEARCH
AND DOESN'T REPRESENT ALL YOUTH
WHO ARE TRANS AND MAY BENEFIT
FROM INTERSENSE.
-- INTERVENTION.
WE FOUND THROUGH DATA ON
EVALUATIONS THEY WERE PRETTY
EQUIVALENT IN TERMS OF
PSYCHOSOCIAL ADJUSTMENT AND
DYSPHORIA FOR KIDS WHO DID OUR
RESEARCH AND IT'S UNUSUAL TO DO
RESEARCH LIKE THIS.
>>THANK YOU SO MUCH.
YOU RAISED SOME GREAT POINTS FOR
US TODAY FOR US TO CONTINUE TO
DIALOGUE ABOUT IN THE Q&A YOU'VE
GIVEN GREAT THINGS TO THINK
ABOUT AND THE IMPORTANCE OF
BEING INTENTIONAL IN CONSIDERING
THE VST COMMUNITIES AND
TAILORING CARE TO ONE'S UNIQUE
NEEDS.
WE'LL GO ON TO THE NEXT
PRESENTER AND IN THE Q&A
THERE'LL BE OPPORTUNITIES TO
SHARE MORE IMPORTANT WORK.
>>I DO HAVE MORE IF ANYONE'S
INTERESTED IN MEASUREMENT OF
GENDER AND ISSUES RELATED TO
THAT.
THANK YOU FOR THE OPPORTUNITY.
SORRY FOR TAKING SO MUCH TIME.
>>THANK YOU SO MUCH.
WE APPRECIATE IT.
NOW WE'LL TRANSITION INTO A
DISCUSSION OF KEY CONSIDERATIONS
FOR SCHOOL AND COMMUNITY-BASED
PREVENTION INTERVENTIONS FOR
LGBTQI ADOLESCENTS LED BY
DR. GOLDBACH FROM THE WASHINGTON
UNIVERSITY SCHOOL OF SOCIAL
WORK.
>>THOUGH GOLDBOND WOULD BE A
COOL NAME IT'S GOLDBACH AT THE
BROWN SCHOOL OF SOCIAL WORK AND
PUBLIC HEALTH AND I'LL TALK
ABOUT THE THINGS WE'VE BEEN
THINKING ABOUT AND LEARNING
ABOUT IN OUR WORK AROUND
INTERVENTIONS THAT ARE COMMUNITY
BASED AND SCHOOL BASED WITH
LGBTQ ADOLESCENTS.
A COUPLE DISCLOSURES THERE'S A
COUPLE GRANTS THAT SUPPORT WHAT
I'M TALKING ABOUT IN THE
SESSION.
I'LL FOCUS ON THREE KEY
TAKEAWAYS AND TRY TO PULL IT
TOGETHER IN THE NEXT 10 MINUTES
OR SO.
IN THE MAJOR HIGHLIGHT POINTS
WE'VE BEEN LEARNING, ONE, I'LL
TALK ABOUT THE DEVELOPMENT AND
HEALTH DISPARITIES DON'T OPERATE
IN A VACUUM AND IT'S IMPORTANT
THEY'RE ALSO NOT OPERATING IN
THE OVERLY STERILE ENVIRONMENT.
THE SECOND POINT WE'LL TALK
ABOUT IS THE IMPORTANCE OF
FOLLOWING THE RULES AND USING
BEST SCIENCE AND USING BEST
SCIENCE IS EXCELLENT BUT WHEN WE
WORK ON COMPLICATED PROGRAMS WE
HAVE TO BE PREPARED HOW WE'LL
HANDLE ADAPTATIONS AND TRACK
THEM AND EMPLOYEE IMPLEM MPLEMEN
SCIENCE FRAMEWORK DOING
INTERVENTIONS AND THE THIRD
POINT I'LL MAKE IS THE
IMPORTANCE OF FOCUSSING NOT JUST
ON RISK REDUCTION THOUGH IT'S AN
IMPORTANT ASPECT OF COURSE WE
ALSO WANT TO MAKE SURE WE'RE
SIMULTANEOUSLY WORKING TO BUILD
RESILIENCE AND HIGHLIGHTING THE
STRENGTHS YOUNG LGBTQ KIDS
EXPERIENCE IN THIS CHANGING
WORLD.
I'LL TALK BRIEFLY.
A LOT OF THIS COMES FROM THE
DEVELOPMENT AND WORK WE'VE DONE
AROUND A PROGRAM THAT'S MOVING
TOWARDS EVIDENCE BASED.
WE WORKED ON A LARGER RCT AND
POWER WAS DESIGN AS A 10-SESSION
INTERVENTION STARTING WITH QUEER
AND TRANS KIDS ALONG THE WAY IN
THE DEVELOPMENT AND
REDEVELOPMENT AND CONTINUING TO
PROVIDE INPUT.
STARTED WITH FOUNDATION FUNDING
WHERE WE DID LIGHT HISTORY
INTERVIEWS AND UNDERSTANDING
BROAD STRESSORS AND MOVED INTO
PSYCHO DEVELOPMENT WORK AND
UNDERSTANDING THE MINORITY
STRESS AND ADOLESCENTS AND
APPLYING MORE FRAMEWORK AND WE
IDENTIFIED 10 KEY DOMAINS
RELATED TO BEHAVIORAL HEALTH.
AND WE STARTED TO BUILD OUT
SESSIONS WE HAVE A FIVE-YEAR
STUDY LOOK AT TEMPORALITY IN
MINORITY STRESS AND MENTAL
HEALTH AND STILL WORKING THROUGH
THE DATA AND HAD A FEASIBILITY
STUDY WHERE WE STARTED TO TEST
THE INTERVENTION.
AND I WANT TO TALK ABOUT THE
COMPLEXITY.
AND FOR THOSE THAT WORK WITH
ADOLESCENTS THEY HAVE NO
SHORTAGE OF OPINIONS AND ALWAYS
HAPPY TO SHARE WITH WHAT YOU'RE
DOING AS A RESEARCHER AND WE'RE
WORKING WITH A GROUP OF YOUTH
AND BE MORE DIDACTIC IN YOUR
INTERVENTION AND WE ASKED THE
GENERAL QUESTION WAS THERE
ANYTHING ELSE WE'VE MISSED?
IS THERE ANYTHING WE'VE LEFT
OUT?
ONE YOUNG PERSON RAISED THEIR
HAND AND SAID IT'S GREAT YOU
DEVELOPED THIS PROGRAM TO HELP
SUPPORT QUEER AND TRANS KIDS AND
I CAN SEE THE TO BE IN A ROOM
WITH MY PEERS AND TALK THROUGH
MY EXPERIENCES AROUND
DISCRIMINATION AND AROUND STRESS
AND RACISM AND AROUND HOMOPHOBIA
AND TRANSNEGATIVITY.
BUT THIS ISN'T REALLY OUR FAULT.
WE'RE THE VICTIMS AND ONE OF THE
CHALLENGES IN THE PROGRAM WHERE
YOU PULL US OUT AND PUTTING US
TOGETHER TO TALK THROUGH THE
TERRIBLE THINGS HAPPENING IS THE
PROGRAM ISN'T DOING ANYTHING TO
ADDRESS THE UPSTREAM CONCERNS.
AND FOR ME THIS WAS A REALLY
IMPORTANT MOMENT IN THE
DEVELOPMENT OF THE PROGRAM AND
IN THE SMALLER STUDY AND LARGER
STUDY THAT FOLLOWED WE DID A LOT
OF WORK AND LEANED MORE HEAVILY
INTO BIGGER CONCEPTUAL MODELS
AROUND SOCIAL DETERMINATES OF
HEALTH AND IF WE'LL DO WORK WITH
LGBTQ KIDS WE HAVE TO BE
INCLUSIVE OF THE MORE UPSTREAM
ASPECTS.
WE ADDED THE SECOND COMPONENT
THE FOUR-SESSION INTERVENTION
HERE.
WE STILL WORKED WITH THE 10
SESSION SUPPORTIVE INTERVENTION
FOR YOUTH AND BRINGING IN A
POPULAR COMMUNITY LEADER PROCESS
AND IDENTIFIED PROPER OPINION
LEADERS IN THE SCHOOL.
THEY WORKED TOGETHER TO IDENTIFY
THE PEOPLE WHO THEY THINK WILL
BE BEST SUITED TO MAKE SOCIAL
NORMS CHANGE AND CONDUCT SOCIAL
ACTION INTERVENTIONS THROUGH THE
SCHOOL.
WE INCLUDE THEM AS ALLIES.
THEY WORKED TOGETHER IN
COMMUNITY ORGANIZING AND BUILT A
SOCIAL ACTION PLAN.
IT'S BEEN GREAT.
WE'RE IN THE SECOND YEAR OF THE
TRIAL NOW AND WHAT MAKES THIS
COMPLICATED IS WE HAVE TO BE
MINDFUL OF THESE MULTIPLE LEVELS
THAT ARE BEARING DOWN ON YOUNG
PEOPLE MAKING SURE WE'RE
PROVIDING THE SUPPORT NIGHT NEE
FOR THOSE EXPERIENCING TRAUMA
AND DIFFICULTIES AND
SIMULTANEOUSLY BEING MINDFUL OF
THE SYSTEMS THAT CREATED THOSE
OUTCOMES IN THE FIRST PLACE AND
MAKING SURE OUR INTERVENTIONS
ARE BOLD.
AND WHAT WE'RE LEARNING IS THE
SECOND COMPONENT FEELS JUST AS
MEANINGFUL TO THEM BECAUSE THEY
TALK TO THE CHALLENGES THEY'RE
HAVING AND GET TO BE PART OF
TRYING TO CHANGE THE SYSTEM AND
BUILD THE ENTREPRENEURIAL
LEADERSHIP POLITICAL SKILLS,
REALLY.
THE SECOND POINT WHICH TIES TO
THE FIRST AND WHAT WE'RE
LEARNING AND OTHERS LONG BEFORE
ME IS WE HAVE SCIENTIFIC METHODS
OUT THERE FOR CONDUCTING
INTERVENTION TRIALS.
THE PROBLEM IS WHEN WE'RE
TALKING ABOUT THESE COMPLICATED
AND MULTI-LEVEL AND MULTI-SYSTEM
HEALTH PATTERNS INFORMED BY
THESE SYSTEMS IT GETS MESSY.
I THINK IT'S KEY AS WE'RE
LOOKING AT WRITING OUR GRANTS
AND LOOKING AT THE WAY WE'RE
FUNDING PROGRAMS WE'RE BEING
OPEN TO THE NOTION THAT YES, WE
WANT TO FIND THE BEST PRACTICE
BUT NEED TO BE OPEN TO MAKE SURE
ADAPTATIONS ARE ALLOWABLE AND
LOOKING AT ALTERNATIVE WAYS OF
DOING TRIALS AND ALLOWING SPACE
FOR IDEAS AND APPROACH THAT MAY
NOT CONFORM TO THE GOLD STANDARD
RCT BECAUSE THE CHALLENGES WILL
ARISE REGARDLESS AND IT'S BETTER
WE'RE PREPARED WITH ALTERNATIVE
OPTIONS AND IF WE'RE TALKING
ABOUT MULTI-LEVEL, MULTI-SYSTEMS
WE HAVE TO BE MINDFUL THEY'RE
COMPLEX.
WE HAVE YOUTH, FAMILIES AND
SCHOOLS THEY'RE IN AND
COMMUNITIES THEY'RE IN AND OTHER
INFORMATION COMING IN THROUGH
SYSTEMS AND POPULAR MEDIA AND
THROUGH THE NATIONAL NEWS.
ALL THESE THINGS ARE INFLUENCING
THE WAY THE SYSTEMS WILL WORK
AND WILLINGNESS TO WORK WITH US
ON THE MULTI-LEVEL PROGRAMS.
I'M GOING TO THROW UP HERE AND I
KNOW MANY ARE PROBABLY FAMILIAR
WITH ONE OF THE IMPLEMENTATION
SCIENCE FRAME WORKS.
I THINK IT'S IMPORTANT EVEN AS
WE'RE BUILDING EFFICACY IN THE
EARLY STAGES WE ALREADY HAVE THE
EYE TOWARDS HOW WE'RE GOING TO
LOOK AT IMPLEMENTATION SCIENCE
AND HOW WE'RE THINKING ABOUT
THOSE EFFECTIVENESS ASPECTS.
BECAUSE AT EVERY SINGLE LAYER OF
THIS PUZZLE WE HAVE A LOT OF
DIFFERENT FACTS THAT WILL
INFLUENCE THE LIKELIHOOD THESE
INTERVENTIONS WORK.
I THINK IT'S IMPORTANT WE'RE
THINKING ABOUT THIS.
THESE IMPLEMENTATION SCIENCE
FRAMEWORKS.
IT'S ONE WE LIKE A LOT AND HAVE
BEEN USING EXTENSIVELY IN OUR
WORK RECENTLY.
THERE ARE OTHERS.
THE THIRD POINT I'LL MAKE
BRIEFLY IS THE IDEA OF BALANCING
RISK AND PROTECTIVE FACTORS.
I THINK MANY OF US CAN RELATE
AND WORKING WITHIN INSTITUTES OR
FUNDING STREAMS FOCUSSED ON
REDUCING HEALTH DISPARITIES AND
REDUCING HEALTH DISPARITIES
OFTEN LOOKS AT WHO HAS IT WORSE
AND THE IDEA OF FUNDING IS TO
IDENTIFY THE MOST AFFECTED AND
HAVE THE WORSE OUTCOMES AND TRY
TO MITIGATE THE RISK.
THIS CAN AT TIMES LEAVE US WITH
FOCUSSING ON THE MORE
PATHOLOGICAL ASPECTS OF HEALTH.
AND FOCUSSING HEAVILY ON
REDUCING RISK AND ALMOST AN
AFTERTHOUGHT AND OUR
INTERVENTION SHOWED DECREASING
MINORITY STRESSORS AT POST TEST
FOR THOSE THAT WENT THROUGH THE
INTERVENTION COMPARED TO THOSE
IN THE CONTROL.
I'M THROWING A SIMPLE VISUAL UP
HERE.
ONE OF THE UNEXPECTED THINGS WAS
WE DIDN'T EXPECT FOR THOSE MORE
ENVIRONMENTAL MINORITY STRESSORS
TO CHANGE.
THEY HAD EXPERIENCES IN THE
SCHOOL HAPPENING TO THEM OR THE
MORE DISTAL STRESSORS.
YOUTH WERE ABLE TO FIND WAYS TO
AVOID AND TO ENGAGE IN THE
ENVIRONMENT IN DIFFERENT DAYS
THAT ALLOWED THEM TO REPORT MORE
DISTAL STRESSORS AT THE POST
TEST.
THE OTHER THING THAT'S IMPORTANT
IS IN OUR STUDY OUR INITIAL
STUDY MANY BEHAVIORAL OUTCOMES
INCLUDING ANXIETY AND DEPRESSION
SYMPTOMS SHOWED DECREASES IN THE
INTERVENTION WE EXPECTED RELATED
TO EXPERIENCING LESS MINORITY
STRESS, THAT WAS OUR INITIAL
PREMISE.
BUT WHAT WAS IMPORTANT IS THAT
WE SAW THIS RESULT WAS DURABLE
EVEN IN THE PRESENCE OF
CONTINUED MINORITY STRESSORS.
THERE WERE YOUTH IN OUR
INTERVENTION STUDY WHO CONTINUED
TO EXPERIENCE HIGH LEVELS OF
MINORITY STRESS AND BECAUSE
OFFSET BY THEIR EXPERIENCES OF
RESILIENCE AND COPING WERE ABLE
TO SHOW IMPROVED OUTCOMES
REGARDLESS.
SO I JUST THINK IT'S IMPORTANT
AS WE'RE BUILDING THE
INTERVENTIONS WE TAKE SERIOUSLY
AND SOMETIMES WE GET A BIT OF
LIP SERVICE TO PROTECTIVE
FACTORS AND WIND UP AN AFTER
THOUGHT MAYBE AN AIM THREE OR AN
EXPLORATORY AIM AND IF WE CAN
RETOOL THE FIELD TO SEE THE
IMPORTANCE I THINK IT WOULD DO
YOUTH JUSTICE AND THERE ARE
THINGS IN THE ENVIRONMENT THAT
CAN BE DIFFICULT TO CHANGE AND
LOOKING AT COPING STRATEGIES AND
RESOURCES I THINK ARE KEY AND
NOT ALWAYS FRONT OF AND CENTER.
I'M RIGHT ABOUT AT TIME AND I'LL
STOP SHARING.
>>THANK YOU SO MUCH.
YOU RAISED WONDERFUL POINTS FOR
US TO IMPROVE THE IMPORTANCE OF
CREATING THAT YOUNG PEOPLE CAN
SPEAK TO THE CHALLENGES THEY'RE
EXPERIENCING AND CAN BE THE
CHANGE AGENT.
NOW WE'LL TRANSITION TO OUR
FINAL PANELISTS CORY CASCALHEIRA
SORRY TO BUTCHER YOUR NAME FROM
NEW MEXICO STATE UNIVERSITY AND
IAN HOLLOWAY FROM UCLA.
CORY, THE FLOOR IS YOURS AND
IAN, YOU CAN GO AFTER.
>>WE'RE TALKING ABOUT
COMPUTATIONAL METHODS AND WE'RE
LOOKING AT ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING AND NATURAL LANGUAGE
PROCESS AND WE'LL TALK ABOUT WHY
THE WORK IS IMPORTANT AND WHY WE
WANT TO USE THESE METHODS TO
DELIVER INNOVATIONS.
AND THERE'S GAPS THAT REMAIN
THAT CAN BE ADDRESSED BY
COMPUTATION.
SOME GAPS ARE RELATED TO
CONCERNS ABOUT SCALABILITY, LACK
OF PERSONALIZATION, EXISTING
DIGITAL HEALTH TOOLS ARE NOT
TAILORED TO INDIVIDUAL
EXPERIENCES AND A LACK OF
ENGAGEMENT.
THOUGH WE HAVE INTERVENTIONS SGM
PEOPLE ARE NOT REALLY USING
THEM.
COMPUTATION OF TDIs CAN BE
PERSONAL AND ENGAGING AND
SCALABLE SOLUTIONS FOR SGM
HEALTH AND WHAT NEEDS TO HAPPEN
TO REALIZE THIS?
WE'LL TRY TO ANSWER THIS
QUESTION IN THE FIRST HALF.
WE'LL TALK ABOUT EVIDENCE GAPS
AND CHALLENGES IN THE RESEARCH
DOMAIN.
IN ORDER TO TALK BE THE EVIDENCE
GAPS AND CHALLENGES WE'LL PUT
THEM IN ORDER AND IT SOUNDS LIKE
IT'S BEEN COVERED THE LAST FEW
DAYS BUT IF YOU'RE NOT FAMILIAR
WITH IT, SICIENTISTS NEED TO KNW
WHAT INTERVENTIONS ARE WORKING
AND IF IT'S EFFECTIVE AND
DISSEMINATE IT.
AND THERE'S CHALLENGES WE NEED
TO ADDRESS IF WE'RE GOING HAVE
COMPUTATIONAL ADVANCED TDIs
AVAILABLE FOR SGM PEOPLE.
ONE BASIC CHALLENGE AT THE FIRST
STAGE IS ESTABLISHING
COMPUTATIONAL CONSTRUCTABILITY.
THIS IS DIFFERENT THAN WHAT IS
TYPICALLY ESTABLISHED WITH
FACTOR ANALYSIS BECAUSE WHAT
WE'RE TRYING TO DO IS CREATE A
STATISTICAL RELATIONSHIP BETWEEN
BIG DATA SOURCES LIKE SOCIAL
MEDIA WEARABLE SENSORS AND
SCORES ON AN INSTRUMENT.
THIS FIRST STEP IS IMPORTANT
BECAUSE ONCE WE KNOW A
COMPUTATIONAL MODEL IS WORKING
WELL AND ONCE WE KNOW ARTIFICIAL
INTELLIGENCE IS PREDICTING HIV
RISK, FOR EXAMPLE THEN WE CAN
USE THE PREDICTIVE RESULTS TO
PERSONALIZE CONTENT.
THE GOOD NEWS IS THERE'S
EVIDENCE FROM OUR LABS WHERE
IT'S ESTABLISHED FOR DIFFERENT
CONSTRUCTS INCLUDING
PSYCHOSOCIAL STRESSORS , DRUG
USE AMONG DIFFERENT SGM GROUPS
AND DIFFERENT RISKS.
SOME GAPS ARE THERE'S TOO FEW
CLINICAL OUTCOMES UNDER STUDY
AND THE CONSTRUCTABILITY IS ON
THE CONTENT THEY'RE CREATING.
YOU PROBABLY SAW A CLINICAL
OUTCOME THAT'S IMPORTANT TO YOU
YOU DON'T HAVE EVIDENCE FOR AND
WE NEED TO START THINKING ABOUT
OTHER TYPES SUCH AS WEARABLE
SENSORS TO DO BETTER AT
PREDICTING THESE DIFFERENT TYPES
OF CONSTRUCTS.
AT THE NEXT STAGE OR DEVELOPMENT
STAGE, MOST COMPUTATIONAL TDIs
ARE FOR SEXUAL HEALTH WE'LL TALK
ABOUT ONE CLEAR EXAMPLE.
OTHER EXAMPLE JUST IN TIME
INTERVENTIONS FOR HIV RISK AND
CHAT BOX TO PROMOTE TESTING AND
VIRTUAL REALITY SPACING HIV
POSITIVE FOLKS CAN ENTER AND
PRACTICE DISCLOSING HIV TO
HYPOTHETICAL PARTNERS.
SOME OF THE GAPS IN THE AREA ARE
MOST OF THESE TDIs ARE AT THE
INDIVIDUAL LEVEL AND FEW USE
A.I. FOR MENTAL AND BEHAVIORAL
HEALTH.
WE NEED TO START THINKING HOW TO
CREATE COMPUTATION FOR
SYSTEMS-LEVEL INTERVENTIONS.
TARGETING PSYCHOSOCIAL STRESS IN
THE ENVIRONMENT AND ADAPTING
TAILORED INTERVENTION HAVE
PROMISE AND EVIDENCE SUCH AS
COMPUTATION AND DIGITAL
DELIVERY.
ANOTHER CHALLENGE AT THE STAGE
IS THE INTERVENTION SCIENTISTS
LACK CERTAIN SKILLS TO EMBARK ON
THIS.
IT'S IMPORTANT TO PARTNER WITH
COMPUTATIONAL EXPERTS EARLY AND
OFTEN BECAUSE THEY CAN HELP THE
USER FRIENDLY AND IMMERSIVE AND
I THINK THE FUTURE WILL BE
PARTNERING WITH COMPUTATIONAL
EXPERTS THAT OFFER DESIGN THAT'S
ALREADY WORKING WELL.
DATING APPS ARE ONE EXAMPLE OF A
DESIGN AND RIGOROUS RESEARCH
MOVES SLOW IN COMPARISON TO
TECHNOLOGY.
AND WE HAVE GREATER ACADEMIC
PARTNERSHIPS FROM THE BEGINNING
TO BALANCE THE NEED FOR
EFFECTIVENESS AND EFFICACY ON
THE ONE HAND AND THE NEED FOR
GREATER EFFICIENCY AND CUTTING
EDGE TECHNOLOGY ON THE OTHER
HAND AND PREVENT COMPUTATION AND
TDIs.
BY THE TIME WE'VE GONE THROUGH
THE WORK YOU CAN IMAGINE A
CHATBOT THAT WAS EFFECT YEARS
AGO GOES THROUGH FOR
EFFECTIVENESS TESTING AND WE
HAVE TO THINK HARD WITH OUR
COMPUTATIONAL COLLEAGUES.
ANOTHER CHALLENGE IS THE
REGULATION OF ARTIFICIAL
INTELLIGENCE IN HEALTH CARE.
THIS IS A PROBLEM BECAUSE MOST
DIGITAL HEALTH TOOLS IN GENERAL
RECEIVE LITTLE CLINICAL TESTS
BEFORE THEY'RE RELEASED TO THE
PUBLIC AND THERE'S LESS EVIDENCE
ON ENHANCED TDIs AND THIS IS
ESPECIALLY PROBLEMATIC BECAUSE
THEY HAVE ACCESS TO MORE DATA
THAT TELLS US A LOT ABOUT
PEOPLE'S LOCATION AND HOW TO
TALK TO PEOPLE IN THEIR LIVE AND
SO FORTH AND RAISES THE QUESTION
FOR A POPULATION LIKE SGM FOLKS
WHO ARE VULNERABLE AND
MARGINALIZED WHO'S PROTECTING
THEM IN THE TECHNOLOGY.
THE BURDEN OF DETERMINING
WHETHER THE APPS ARE EFFECTIVE
IS ON INDIVIDUAL PROVIDERS AND
NIGHT TO THINK OF POLICIES AS
THEY GET READY TO GO TO MARKET.
THE STORY'S SIMILAR WITH
IMPLEMENTATION AND DISSEMINATION
STAGE.
ONCE AGAIN THERE'S LITTLE
RESEARCH IN THE AREA FOR US TO
INVOKE.
AND ONE OF THOSE CHALLENGES IS
BECAUSE DELIVERING ARTIFICIAL
INTELLIGENCE BASED
SOLDSOLDIER --
INTERVENTIONS DOING THAT WITHOUT
EXACERBATING INEQUALITY IS
CHALLENGING.
WE KNOW TREATMENT DELIVERY AND
ACCESS IS UNEQUAL AMONG SOCIAL
GROUP AND A.I. IS NOT A CURE-ALL
SOLUTION AND THERE ARE SOME
DOCUMENTED CASES WHERE A.I. GOES
IN THOSE SPACES AND MAKES THE
INEQUALITIES WORSE.
THERE'S DIFFERENT SOLUTIONS WE
CAN THINK ABOUT.
ONE OF THEM ARE COMMUNITY-TAILED
ALGORITHMS.
THIS IS THE IDEA WE'RE BUILDING
ALGORITHMS FROM THE GROUND UP
WITH SGM PEOPLE EARLY IN THE
DESIGN PROCESS FUNDAMENTALLY
DIFFERENT HOW MOST ARTIFICIAL
INTELLIGENCE ALGORITHMS ARE
DESIGN AND DISTRIBUTED BY
MAINSTREAM SOCIETY AND APPLIED
TO MINORITY PEOPLE.
THIS IS A PROBLEM BECAUSE
THERE'S ALREADY A BIAS IN THE
ALGORITHMS AND WE CAN REGULARLY
AUDIT THEM TO MAKE SURE IT'S NOT
LEAKING INTO THE PERSONALIZATION
OR ENGAGEMENT CONTENT WE'RE
TEM
ATTEMPTING TO PROVIDE.
ANOTHER CHALLENGE IS FUNDING.
WHERE DO WE GET THE MONEY TO
MAKE SURE WE'RE ACCESSING BIG
DATA IN AN ETHICAL WAY.
SOME PEOPLE INTERESTED IN THE
WORK SUCH AS VENTURE CAPITALISTS
HAVE DIFFERENT MOTIVES THAN
HEALTH SCIENTISTS AND FOLKS MOST
AT NEED FOR THE WORK IN HIGH
STIGMA, LOW RESOURCE AREAS MAY
NOT BE ABLE TO AFFORD TDIs IF
THE INSURANCE COMPANIES DON'T
OFFER SOLUTIONS SO THERE'S NO
GOOD SOLUTION TO THE QUESTIONS.
AND FINALLY BEFORE I PASS IT TO
IAN WE NEED TO LOOK AT ETHICAL
CONSIDERATIONS THROUGHOUT THE
STAGES TO MAKE SURE NO HARM
COMES TO SGM PEOPLE.
SOME ARE IN THE PRIVACY SPACE
AND OTHERS HAVE TO DO WITH
ACCEPTABILITY OF EVIDENCE.
WE DON'T QUITE KNOW ENOUGH HOW
SGM PEOPLE GENERALLY AND
SUBGROUPS THINK ABOUT THIS KIND
OF RESEARCH AND DON'T KNOW YET
WHO IS RESPONSIBLE FOR CERTAIN
HIGH RISK RESEARCH AND A MODEL
LOOKING AT SUICIDE RISK IF WE
ALLOW THE MODEL TO DELIVER THE
CONTENT WE DON'T KNOW WHO SHOULD
BE RESPONSIBLE FOR THAT.
THE PROVIDER?
THE DEVELOPER OF THE APP?
WITH THAT I'LL PASS IT OVER TO
IAN.
>>THANK YOU, CORY.
I'M GOING TAKE A FEW MINUTES TO
SPEAK ABOUT ONE OF OUR ONGOING
PROJECT FUNDED BY THE NATIONAL
INSTITUTE ON DRAWING BUSE AWARD
PROGRAM.
IT'S CALLED U TECH.
I HOPE BY SHARING THE
METHODOLOGY IT WILL BE
INSTRUCTIVE FOR OTHERS
INTERESTED IN USING DATA MINING
AND ARTIFICIAL INTELLIGENCE IN
THEIR OWN RESEARCH.
THE OBJECTIVE OF THE STUDY IS TO
DEVELOP AND TEST A DATA MINING
INTERVENTIONS.
THE COMMUNITY WE'VE BEEN WORKING
WITHTO CARRY OUT THE WORK IS GAY
BISEXUAL AND OTHER GENDER
DIVERSE PEOPLE WHO HAVE SEX WITH
MEN AND EMERGING ADULT
DEVELOPMENT PERIOD.
OUR PARTICIPANTS ARE BASED
THROUGHOUT THE UNITED STATES AND
ACTIVE USERS OF TECHNOLOGIES FOR
SEXUAL AND SUBSTANCE USE PARTNER
SEEKING AND ALL ARE COMPLETED
REMOTELY.
THE STUDY BEGAN WITH A FORMATIVE
PHASE THAT INCLUDED SEVERAL
COMMUNITY ENGAGEMENT ACTIVITIES.
MANY WERE CONDUCTED IN
PARTNERSHIP WITH OUR COLLEAGUES
AT THE LOS ANGELES LGBT CENTER
AND OUR ADVISORY BOARD.
THE GOAL OF PHASE ONE WAS TO
LOOK AT THE APPROPRIATENESS AND
ACCEPTABILITY OF THE METHODS WE
HOPE TO DEPLOY IN PHASE TWO.
AND CORY SPOKE A LITTLE BIT
ABOUT THE ETHICAL CONSIDERATIONS
FOR DOING THE WORK.
WE WANTED TO MAKE SURE PRIVACY
AND CONFIDENTIALITY CONCERNS
REGARDING DATA MINING AND
PROCESSING WERE ADEQUATELY
EXPLORED BEFORE BUILDING THE
TECHNOLOGY USED FOR THE
REMAINDER OF THE STUDY AND USING
THE STRUCTURED INTERVIEWS WITH
20 PARTICIPANTS WE BUILT THE
LIBRARY OF TEXT PHRASES AND
EMOJIS USED TO INDICATE
DIFFERENT SUBSTANCE USE AND
SEXUAL BEHAVIOR ONLINE.
WE REVISITED IT REGULARLY
THROUGH COMMUNITY ENGAGEMENT
EVENTS TO KEEP IT UP TO DATE AS
THE LANGUAGE WE HOPE TO SERVE IS
RAPIDLY EVOLVING.
PHASE 2 IS AUTOMATED DATA
COLLECTION FROM PARTICIPANTS'
SMARTPHONES AND IT CAPTURED
SEVERAL TYPES OF DATA.
IT'S THEN USED TO PREDICT
SELF-REPORTED SUBSTANCE USE AND
DRUG ABUSE AND BEHAVIORS
REPORTED IN ONLINE SURVEYS EVERY
THREE MONTHS.
THERE'S THREE TYPES OF DATA
WE'RE LEVERAGING TO BUILD OUR
MACHINE LEARNING MODEL AND TEXT
FRAGMENT AND EMOJIS AND THE
SECOND IS METADATA REGARDING THE
USE OF TECHNOLOGY AND THE TIME
THEY SPENT ON SPECIFIC APPS AND
WEBSITES FOR PARTNER SEEKING AS
WELL AS THE TYPES OF APPS
THEY'RE USING AND THE THIRD IS
GEOLOCATION DATA CAPTURED BY
PARTICIPANT SMARTPHONES AND
THEIR PATTERNS IN TRAVELLING IN
WHICH THE RELATION THEY SPEND
THE MAJORITY OF THEIR TIME.
AND FOR WILLINGNESS TO SHARE
THIS TYPE OF DATA GIVEN
APPROPRIATE SAFEGUARDS FOR
CONFIDENTIALITY AND WE'RE HAPPY
TO TALK ABOUT THOSE IN THE Q&A.
WE HAVE APPROXIMATELY 300 TEXT
FIELD AND 50 EMOJIS IN OUR DATA
LIBRARY THAT ARE USED AS THE
BASIS FOR THE MACHINE LEARNING
ALGORITHM AND FOR TWO OF THE KEY
BEHAVIORS WE'RE INTERESTED IN
STUDIES, METHAMPHETAMINE USE AND
PREEXPOSURE PROPHYLAXIS OUR
MACHINE LEARNING PERFORMS WITH
ABOUT 90% ACCURACY.
WE STILL HAVE WORK TO DO ON
IMPROVING THE MACHINE LEARNING
AND DEPLOYING IT FOR HARM
REDUCTION.
AND I'D LIKE TO PROVIDE A CASE
VIGNETTE OF WHAT IT MIGHT DO IN
THE FUTURE BASED ON INTERVIEWS
IN THE STUDY.
DARYL IS A 20-YEAR-OLD AFRICAN
AMERICAN MAN LIVING IN LOS
ANGELES AND OCCASIONALLY PARTIES
USING METH AND GHB ON THE
WEEKEND AND HAS DIFFICULTY
NEGOTIATING CONDOM USE IN
PARTYING AND HE TRAVELS TO THE
HOLLYWOOD AREA AND WITH THE APP
HE COULD RECEIVE A PUSH
NOTIFICATION WHEN THE ALGORITHM
DETECTS A RISK EVENT
APPROACHING.
INFORMATION ABOUT ONDEMAND PREP
AND THE NEAREST PHARMACIES AN
CLINICS COULD BE DISPLAYED IN
HIS HOME NEIGHBORHOOD AND AROUND
HIS SPOTS AWAY A TO BE
SUPPORTIVE IN PREVENTION.
OUR TEAM HOPES THIS INDICATION
OF A RISK CAN BE ATTENUATED
THROUGH THE QUICK AND CONVENIENT
PROMOTION OF INFORMATION COUPLED
WITH ACCESS POINTS IN THEIR
PHYSICAL ENVIRONMENT.
IN CLOSING, CORY AND I ARE HAPPY
TO CONNECT WITH ANYONE
INTERESTED IN USING THE U TECH
DATA MINING PROTOCOL OR MACHINE
LEARNING ALGORITHM IN THEIR WORK
AND WANT TO ACKNOWLEDGE OUR
COLLEAGUES FOR THEIR
CONTRIBUTIONS AND THE RESEARCH
PARTICIPANTS THEMSELVES WILLING
TO SHARE PERSONAL ASPECTS OF
THEIR LIVES GIVE TO THIS
RESEARCH PROJECT.
WE'LL CLOSE THERE AND LOOK
FORWARD TO Q&A WITH THE REST OF
THE PANEL.
THANK YOU.
>>THANK YOU BOTH SO MUCH.
BEFORE WE TRANSITION TO Q&A I
WANTED TO ACKNOWLEDGE THE
THOUGHT OF THOUGHT OF ETHICS AND
MINDFULNESS AND IT'S IMPORTANT
WHEN WE THINK OF TECHNOLOGY
BASED TOOLS TO ADVANCE HEALTH
FOR US TO CONSIDER THE
POPULATIONS WE'RE INTENDED TO
SERVE AND HAVE THE FOCUS GROUPS
COLLECT DATA AND ABUT THEM TO BE
A PART OF THE PROCESS OF
DEVELOPING THE TOOLS WHERE YOU
OFTEN TIMES UNFORTUNATELY WE'RE
USING MAJORITY DATA AS YOU
MENTIONED WHICH CAN SKEW THE WAY
WE LOOK AT THE ALGORITHMS OR THE
OUTPUTS OF ALGORITHMS IN A WAY
THAT COMPARES PEOPLE
INAPPROPRIATELY.
INVOLVING DIFFERENT POPULATIONS
AND THE CRAFTING OF THE RESEARCH
FROM THE BEGINNING INSTEAD OF
RETROFITTING AT THE END OR
WHATEVER IS SO IMPORTANT.
THANK YOU FOR YOUR WORK.
GIVEN THE WONDERFUL DIALOGUE
WE'VE HAD THUS FAR IN EACH ONE
OF OUR PANELISTS SHARING WORK
STIGMA REPRESENTS AN UNDER
RECOGNIZED MECHANISM IN LOOKING
AT STRESS RESPONSES AND IT WOULD
BE AN OPPORTUNITY TO HOW HAVE
DISCOVERIES FROM YOUR LAB BEEN
IMPACTFUL WITH THE ROLE OF
STIGMA AND SHAPING THE
POPULATION ACROSS LIFE DOMAINS
AND OF COURSE TO INCLUDE WITH
RESPECT TO MENTAL HEALTH?
>>I'LL SAY BRIEFLY IN OUR WORK
AND SCHOOLS THE WAY IT'S BECOME
APPAR
APPARENT AND LOOKING AT SCHOOL
LEVEL STRATEGIES.
YOU'LL GET AN AMAZING LIAISON OR
PERSON AT THE SCHOOL WHO SEEMS
LIKE A HUGE ADVOCATE AND HUGE
ALLY AND INVESTED AND WANTS TO
MAKE IT HAPPEN AND THEN ALL OF A
SUDDEN YOU START WORKING WITH
THE SCHOOL AND THE BARRIERS
START FALLING INTO PLACE.
I THINK ONE OF THE PIECES THAT'S
BEEN INTERESTING FOR US AND PART
OF THE NEED FOR THE
IMPLEMENTATION SCIENCE FRAMEWORK
WE'VE BEEN TRYING TO ENGAGE IN
IS TO OPERATIONALIZE THE FEELING
AND THE RESISTANCE AND YOU
CAN'T -- IT'S SLIPPERY AND AT
THE END OF THE DAY DRIVING THE
INDIVIDUAL LEVEL EXPERIENCES AND
OUTCOMES FOR THE KIDS IN THE
SCHOOL.
WE TRIED TO I THINK OUR FIRST
STEP HAS BEEN TRYING TO
OPERATIONALIZE THAT AND TRY TO
DEFINE WHAT IS HAPPENING IN THE
SCHOOLS SO WE CAN BETTER
ARTICULATE WHAT IT LOOKS LIKE.
AND TO IMPROVE THE ABILITY OF
THE SCHOOLS AND OTHER
COMMUNITIES NOR INTERACTION.
THEY'RE SIMPLE THINGS, BUILD THE
GSA, IDENTIFY GENDER NEUTRAL
REST ROOMS.
GO THROUGH SAFE SPACE TRAINING.
WE'RE NOT DOING ANYTHING
PARTICULARLY INNOVATIVE TO BE
FRANK BUT THE RESISTANCE IS A
SLIBRY ONE.
-- SLIPPERY ONE.
>>THANK YOU.
WE HAVE A QUESTION FROM THE
VIDEOCAST AUDIENCE.
THE QUESTION'S ABOUT THE U TECH
APPLICATION.
THE FIRST ASPECT OF THE QUESTION
IS DOES UTECH READ TEXTS AND
ASKED HOW DOES YOUR RESEARCH
WITH ADOLESCENT ENSURE ETHICALLY
SOUND AND CONSENT PROCESS AND
ENSURE THERE'S PROTECTIONS AND
THOSE PROTECTIONS ARE
CONTINUING?
>>I'M TACKLE THE FIRST QUESTION
ABOUT THE SPECIFICS OF THE U
TECH APP.
THE APP INSTALLED ON
PARTICIPANTS PHONES USES WHAT'S
CALLED A KEYBOARD LOG.
AS PARTICIPANTS ARE TYPING INTO
DIFFERENT APPLICATIONS OR
WEBSITES THEIR TEXT IS CAPTURED
TO ONE SIDE OF THE CONVERSATION.
IT'S ONLY THE TEXT THEY'RE
INPUTTING.
IT'S THE FIRST PART OF THE PIECE
ABOUT ETHICAL CONSIDERATIONS IS
MAKING SURE THE DATA WE'RE USING
IS DATA THAT WE HAVE CONSENT TO
USE BY OUR PARTICIPANTS.
WE'RE NOT CAPTURING BACK AND
FORTH BETWEEN INDIVIDUALS WHO
ARE IN OUR STUDY AND OTHERS THEY
MAY BE COMMUNICATING WITH.
I THINK THE PARTICIPANTS IN OUR
STUDY ARE 18 OR OLDER AND I
WOULD SAY IN TERMS OF U TECH THE
PRIVACY AND CONFIDENTIALITY
MAKING SURE IT'S VERY CLEAR TO
PARTICIPANTS WHAT TYPES OF DATA
ARE BEING COLLECTED AND WHAT ARE
NOT BEING COLLECTED, HOW THOSE
DATA ARE BEING STORED AND THE
DURATION OF TIME FOR WHICH
THEY'LL BE STORED AND HOW THE
DATA WILL BE USED IN PROCESSING.
I'LL PUT OUR STUDY WEBSITE IN
THE CHAT SO FOLKS CAN SEE WHAT
WE HAVE THAT'S OUTWARD FACING
FOR PARTICIPANTS.
THEY CAN ACCESS ALL THAT
INFORMATION IN A WAY THAT'S EASY
TO DIGEST.
I'LL PASS IT OVER TO
DR. TISHELMAN.
>>I THINK YOUR QUESTION ABOUT
ETHICAL ISSUES IN WORKING WITH
ADOLESCENTS IS IMPORTANT.
I TRIED TO ADDRESS IT AS QUICKLY
AS I COULD IN THE SHORT TIME I
HAD BUT THERE'S RISKS THAT SOME
OF THE RESEARCH MEASURES MAY
HAVE AFFECTS ON YOUTH.
FOR INSTANCE, WE FOUND AND SOME
OF OUR TRANSGENDER RESEARCH AND
YOU COMPLAINED ABOUT SOME
MEASURES BEING STIGMATIZED AND
THE GENDER DYSPHORIA MEASURE.
WE ADDED TO SURVEY YOUTH ABOUT
THE MEASURES BECAUSE SOME WERE
INSENSITIVE AND I WAS GOING TO
TALK ABOUT A NEW GENDER MEASURE
GENDER MEASURES THAT ARE BINARY
AND I THINK THOSE THINGS ARE
IMPORTANT BUT THERE ARE IRBs AND
ETHICAL OVERSIGHT.
I DON'T THINK THAT'S ENOUGH.
IN THEORY WE SHOULD BE TAKING IT
QUITE CLEAR THAT NOT
PARTICIPATING IN RESEARCH WILL
NOT HARM THEM IN ANY WAY AND
KEEP THEIR CONFIDENTIALITY.
THERE CAN BE A LOT OF DISTRUST
INCLUDING DISTRUST WITH MEDICAL
AND PSYCHOLOGICAL PROVIDERS WITH
NOT ALWAYS A GREAT HISTORY.
I THINK IT'S REALLY IMPORTANT
AND IMPERATIVE THROUGH OUR
RESEARCH WE DON'T ARM WHEN WE
MEAN TO HELP.
WE SHOULD TAKE THE ETHICAL
CRITERIA SERIOUSLY.
IN TERMS OF IMPAIRED CAPACITY, I
THINK IT'S IMPORTANT.
SOME OF MY RESEARCH WITH
COLLEAGUES WHO WORK WITH
AUTISTIC USE WHO ARE ALSO GENDER
DIVERSE AND I WORKED WITH HIM ON
THE NEXT STEP AND SOMETIMES WE
NEED TO DO SCREENING OF YOUTH TO
MAKE SURE WE UNDERSTAND WHAT
THEIR CAPACITY IS TO UNDERSTAND
AND GIVE TRULY INFORMED CONSENT
WITHOUT INADVERTENTLY BIASSING
THE RESEARCH AGAINST CHILDREN
WITH NEURODIVERSITY BECAUSE
THAT'S DETRIMENTAL TO THOSE
POPULATIONS.
I DON'T KNOW IF THAT ANSWERED
YOUR QUESTION.
THAT'S MY BEST QUICK RESPONSE.
>>THANK YOU SO MUCH.
YOU HAVE ALL RAISED IMPORTANT
CONSIDERATIONS FOR RESEARCH TO
WORK WITH IN A HEALTH
DISPARITIES POPULATIONS AND FOR
THOSE MARGINALIZED.
IT'S IMPORTANT TO CONSIDER AS
MANY FACTORS AS POSSIBLE TO
ENSURE WE DON'T CAUSE ADDITIONAL
HARM AND ENDEAVOR TO SERVE THOSE
POPULATIONS WELL.
DR. GOLDBACH DID YOU WANT TO
GIVE THE LAST WORD AND I NEED
TURN THE PODIUM BACK TO RADA TO
START US IN THE BREAKOUT
SESSIONS.
>>LAST WORD?
YOU ADDED TO THE STRESS LEVEL.
>>WE KNOW YOU CAN DO IT SO WE
TRUST YOU.
>>TAKE YOUR TIME, IT'S OKAY.
I DON'T WANT TO UNDER SELL THE S
OF ETHICAL RESEARCH WITH KIDS
AND MAKING SURE WE HAVE
PROTECTIONS IN PLACE AND WAYS OF
ENSURING WE'RE MAINTAINING
SAFETY AND AUTONOMY AND WHAT I
HAVE FOUND IN MY WORK
HISTORICALLY IS THAT THE BELIEF
THAT KIDS ARE NOT ABLE TO THINK
FOR THEMSELVES IS MORE OFTEN
USED AS A WAY TO KEEP THEM OUT
OF OPPORTUNITIES OUT OF BOTH
RESEARCH AND CLINICAL CARE.
RIGHT NOW WE'RE HAVING A HUGE
THING HERE IN ST. LOUIS WITH OUR
TRANSYOUTH CLINIC UNDER FIRE
BECAUSE BASICALLY THE SAME
NOTION THAT WE'RE FORCING KIDS
TO TRANSITION AND THESE ARE
JUST -- WE'RE BASICALLY TAKING
ADVANTAGE OF THESE KIDS.
I THINK IT IS REALLY IMPORTANT
THAT WE ARE CAREFUL ABOUT HOW WE
ENSURE VOICE AND AUTONOMY AND
INDEPENDENCE AND RIGHT TO
CONSENT AND SAY NO WHILE ALSO
MAKING SURE WE'RE NOT USING THAT
AS A PANACEA TO NOT DO RESEARCH
WITH KIDS BECAUSE I THINK THEY
HAVE AN IMPORTANT VOICE THAT
DESERVE TO BE HEARD DESERVE
CARE.
>>I AGREE COMPLETELY.
>>THANK YOU SO MUCH.
>>RADA, WOULD YOU LIKE TO COME
ONLINE AND TELL US THE NEXT
ORDER OF OPERATION, SO TO SPEAK
AS IT COMES TO OUR BREAKOUT
SESSIONS?
>>THANK YOU.
>>SO RIGHT NOW WE'RE GOING INTO
BREAKOUT GROUPS.
SO FOR THE VIDEOCAST AUDIENCE
WE'LL BE ON BREAK FOR 45
MINUTES.
PLEASE COME BACK AND WATCH THE
REPORT OUT FROM THE DIFFERENT
BREAKOUT SESSIONS.
WE'RE GOING TO BE DISCUSSING
SOCIAL AND STRUCTURAL DRIVERS OF
SGM HEALTH DISPARITIES AND BE
DISCUSSING INTERVENTIONS AND
DATA NEEDS.
SO WE'RE GOING TO BE DISCUSSING
THE MAIN WAY FORWARD IN TERMS OF
RESEARCH AND IN TERMS OF WHAT
ARE THE GAPS AND THE
OPPORTUNITIES.
PLEASE COME BACK AND WATCH US
AND NOW WE CAN GO ON BREAK AND
GO TO BREAKOUT GROUPS.
>>WELCOME BACK EVERYBODY.
WE'RE NOT GOING TO REPORT OUT.
GIVE A SECOND TO GET THE SLIDES.
ALL RIGHT.
SO THESE WERE SOME OF THE
QUESTIONS THAT I OPPOSED TO THE
PANELISTS ON THIS ISSUE OF WHAT
ARE SOME OF THE CHALLENGES FOR
ETIOLOGY BASED RESEARCH AND
SOCIAL AND STRUCTURAL DRIVERS OF
DISPARITIES AND WHAT ARE
RECOMMENDATIONS FOR FUTURE
RESEARCH.
>>THESE WERE SOME OF THE
RESEARCH GAPS THAT WERE REPORTED
BY THE GROUP.
FIRST, THERE'S A FUNDAMENTAL
DIFFERENCE IN THE TIME NEEDED
FOR INEQUALITIES TO SHOW UP OVER
THE LIFE COURSE OVER 20, 30
YEARS WITH GRANT CONSTRAINTS
FROM FUNDERS.
THE MECHANISMS MAY DIFFER DURING
THE TIME PERIODS.
SO THE DIFFERENT TIME PERIODS OF
BASICALLY A PERSON'S LIFE.
SO THERE'S A NEED FOR LONG-TERM
LONGITUDINAL COHORT STUDIES AT A
LARGER SCALE AND HAVE BETTER
REPRESENTATION OF DIVERSITY WITH
ENVIRONMENTAL, CLINICAL AND
BIOLOGICAL MEASURES IN ORDER TO
SEE THE SHORT AND LONG-TERM
PROCESSES THAT ARE DRIVING
DISPARITIES AND SGM POPULATIONS
AND THE NATURE OF THE
INTERSECTION IN THESE
POPULATIONS.
SO SOME OF THE IDEAS WOULD BE TO
ADD ON AN ARM TO EXISTING COHORT
STUDIES LIKE WE HAVE AT THE NIH,
ALL OF US FOR EXAMPLE BY
RECRUITING AN SGM COHORT AND
ADDING MEASURES TO EXISTING
LARGE SCALE DATA SETS ESPECIALLY
LONGITUDINAL ONES AND GOOD
MEASURES OF LINKS BETWEEN
ADVERSITY AND SAFETY.
WE'RE TALKING ABOUT CHILDHOOD
ADVERSITY IN CHILDREN WHO LIVE
IN HOUSEHOLDS WHERE THEY MAY BE
EXPOSED TO EMOTIONAL, PHYSICAL
ABUSE, SUBSTANCE ABUSE BY THE
CAREGIVERS AND TALKING ABOUT
SPECIFICALLY SGM CHILDREN.
ALSO, SOME OF THE APPROACHES
SUGGESTED WERE DIFFERENT PEOPLE
ARE USUALLY RESEARCHERS ARE
BUILDING DIFFERENT STRUCTURAL
DATABASES AND THERE'S A LOT OF
SILOS IN THE RESEARCH COMMUNITY
AND NOT VERY GOOD COMMUNICATION
BETWEEN THE RESEARCHERS AND
THERE'S ALSO LACK OF CONSENSUS
ON MEASUREMENT, HOW DO YOU
MEASURE THESE CONSTRUCTS AND
IT'S NOT CLEAR WHAT KIND OF
GUIDANCE THERE IS FOR SHARING
THE DATA.
-- THE DATA PEOPLE COLLECT.
IT'S IMPORTANT TO INCENTIVIZE
STUDENTS AND TRAIN THEM TO
CONDUCT SECONDARY DATA ANALYSIS
AND IN SOME ACADEMIC PROGRAMS
THEY KIND OF TRY TO MAKE
STUDENTS COLLECT PRIMARY DATA
AND THERE'S SECONDARY DATA SETS
THAT COULD BE USED AND THAT
WOULD NOT TRAUMATIZE PEOPLE WHO
YOU'RE COLLECTING PRIMARY DATA
FROM.
MAKING USE OF THE SECONDARY DATA
IS IMPORTANT.
SOME OF THE RECOMMENDATIONS FOR
FUTURE RESEARCH FROM THE GROUP
CAME UP WITH MORE STRUCTURAL
MEASURES ON HOME PHOBIA,
CLASSISM AND OTHER ISMS AND
BETTER DATA FROM INVESTIGATORS
AN MAKING THE DATA AVAILABLE AND
A GAP SEVERAL SPEAKERS NOTED IN
THE LITERATURE WHICH IS
TRANS-MEN ARE USUALLY LEFT OUT
OF FUNDED STUDY AND THIS
PROPOSITION IS GROWING AND
THERE'S A LARGE NEED TO
UNDERSTAND IT AND DETERMINE THE
DISPARITIES IT ENCOUNTERS.
FOR EXAMPLE, COMPULSIVE BEHAVIOR
AFTER TAKING TESTOSTERONE AND
THE NEED FOR GENDER AFFIRMING
CARE.
THERE'S ALSO OTHER UNDER THE
RADAR BEHAVIOR WE DON'T EXPECT
AND CAN MASK EFFECTIVE COPING.
AND HEALTH CARE ACCESS MAY BE
LIMITED FOR THESE POPULATIONS
AND ONE QUESTION THAT CAME FROM
THE GROUP IS WHAT WOULD CHANGE
POLICY AND WHAT'S THE MOST
EFFECTIVE WAY.
DATA MAY NOT ALWAYS BE ENOUGH
FOR THAT.
AND MAYBE MIXED METHODS TO TRY
TO INFLUENCE POLICY AND THERE'S
A NEED TO DO MORE RESEARCH ON
REPRODUCTIVE HEALTH AFTER
MENOPAUSE AND THERE'S A NEED TO
STUDY THE MENTAL HEALTH OF SGM
RESEARCHERS AND CLINICIANS AND I
GUESS THIS WAS FROM THE OTHER --
I GUESS LIKE WE TALKED ABOUT
EXERCISE VIGOROUS EXERCISE AFTER
TAKING TESTOSTERONE THERE'S
ANOTHER UNDER STUDIED PORTION
INCLUDING GASTROINTESTINAL
ISSUES AND THESE ARE
RECOMMENDATIONS THAT CAME FROM
THE PANEL.
NOW WE GO TO THE NEXT REPORT OUT
FROM THE INTERVENTION GROUP.
>>HI.
SO I ALSO HAVE SLIDES.
DO YOU SEE THEM?
SO OUR CHARGE WAS TO DISCUSS
INTERVENTIONS WITH THE POTENTIAL
TO MITIGATE HEALTH DISPARITIES.
WE'VE DONE A LOT TO DOCUMENT AND
OBSERVE THE HEALTH DISPARITIES
AND INEQUITIES EXIST BUT WANT TO
FOCUS ON WHAT ARE THE NEXT STEPS
TO MOVING THE NEEDLE ON SGM
HEALTH EQUITY.
WITH THAT IN MIND WE SET ABOUT
WITH SIX INITIAL QUESTIONS?
AND SO THE FIRST QUESTION WAS
WHAT DO YOU SEE ARE THE BARRIERS
OF CONDUCTING RESEARCH.
FOR ONE STIGMA PROCESSES AND A
LOT OF BEHAVIORAL PROCESS
COMPLEX AND MULTI-FACTORIAL
THERE MAY BE A SENSE OF
HOPELESSNESS BEFORE THE
RESEARCHER CAN START AND THE
PROBLEMS MAY SEEM SO COMPLEX
WHERE DOES ONE START.
AND IN ADDITION AND OFTEN TIMES
NIH SOLICITED
MULTI-INTERVENTIONS BEFORE WE
DON'T HAVE SINGLE ONES FIGURED
OUT THE CART BEFORE THE HORSE
MENTALITY.
THERE'S THE IDEA OF THE MIND SET
OF RANDOMIZED CONTROL TRIALS AND
CERTAIN FIELD THAT HAVE GOTTEN
MONEY AND ATTENTION ARE THE
HIGHEST PRIORITY AND WE MAY NEED
TO DISRUPT THAT PARADIGM IF WE
WANT TO MOVE THE NEEDLE IN FIELD
THAT ARE UNDER STUDIED SUCH AS
EATING DISORDERS AND CANCER.
WE ALSO NEED TO FIND WAYS TO
GROW THE WORKFORCE AND SOME DO
IT TANGENTIALLY BUT THE
RESEARCHER POPULATION IS QUITE
SMALL WHEN IT COMES TO FOCUSSING
ON LGBTQ+ ISSUES AND THERE'S A
NEED FOR MORE SPECIALIZED
TRAINING AND THE IDEA WAS
BROUGHT UP WE CAN PUT OUT
TARGETED FUNDING OPPORTUNITIES
AND NOTICES THAT REALLY HAVE A
SPECIFIC FOCUS ON INTERVENTION
RESEARCH IN SGM POPULATIONS
OPPOSED TO JUST MENTIONING US
PERIPHERALLY AS DISPARITY
POPULATIONS OR INCLUDING SOME
LANGUAGE.
ACTUAL TARGETED FUNDING
ANNOUNCEMENTS MAY BE HELPFUL IN
THIS REGARD BUT REALIZE WE HAVE
A CONSTRAINT AS AN ODS OFFICE.
>>WHEN WE TALK ABOUT CREATIVE
IDEAS FOR MOVING THE FIELD
FORWARD GIVEN IN TERMS OF
INTERVENTION RESEARCH THE FIELD
CAN BE A BIT IN ITS NASE --
NACNECY AND THE WORK HAS CREATED
A STRUCTURE WHERE
COMMUNITY-BASED ORGANIZATIONS
CAN WORK WITH INSTITUTION
WHERE'S THERE'S A PROCESS THAT
ALLOWS FOR ITERATION TO DEVELOP
AND REFINE INTERVENTIONS AND
MOVE FORWARD.
SO BY USING THE STRUCTURE LIKE
THAT IT CREATES THERE CAN BE
SOME MOVING OF THE NEEDLE
TOWARDS BUILDING THE FIELD'S
CAPACITY OVER ALL AND THERE'S
BEEN AN EXPLOSION OF THE SCIENCE
IN THE DOMESTIC SPACE AS IT
RELATES TO HIV.
INSTEAD OF US CONTINUING TO
FOCUS ON LIKE A SPECIFIC DISEASE
WE JUST START TO THINK MORE
ABOUT LIKE THERE'S MENTAL HEALTH
CONSIDERATIONS, THERE'S TRAUMA
AND SUBSTANCE USE ISSUES THAT
ARE RELEVANT FOR THIS
POPULATION.
THERE'S A NEED FOR US TO THINK
ABOUT WAYS TO INTEGRATE THAT AND
THERE'S A WAY TO SORT OF INFUSE
THE RESOURCES AND INFRASTRUCTURE
FROM HIV RESEARCH FOR THE AREAS
THAT HAVE BEEN UNDER STUDIED AND
SO WE ALSO TALKED ABOUT HOW
THERE COULD BE AN EMPHASIS IN A
SIMILAR WAY TO THE CANCER
CENTERS AND THEY'VE USED
COMMUNITY OUTREACH AND
ENGAGEMENT IN LEVERAGING
COMMUNITY HEALTH EDUCATION
INTERVENTIONS WE COULD USE
INNOVATIVE PARTNERSHIP MODELS TO
CREATE AS PART OF LARGE GRANTS
OR WHATEVER WHERE THEY COULD BE
SOME LEVERAGING OF ORGANIZATIONS
OR PARTNERS THAT HAVE EXPERTISE
IN HELPING ACADEMICIANS HAVE
REPORT OUTS THAT ARE USABLE AND
DIGEGESTIBLE AND USING THEM AS
COMPONENTS OF GRANTS COULD BE
HELPFUL.
>>YOU COVERED A LOT OF THE
SECOND QUESTION.
ARE THERE UNIQUE APPROACHES FOR
SCIENTIFIC FIELD THAT COULD BE
BROUGHT TO BARE AND YOU CAPTURED
IT BEAUTIFULLY.
SCIENCE SAW A HUGE INFUSION OF
TRAINING AND MENTORSHIP.
IT'S A GREAT MODEL BUT WOULD
NEED TO BE ADAPTED A LITTLE BIT
AND ONE I HEARD ALL DAY
YESTERDAY WAS UTILIZATION OF
MIXED METHOD APPROACHES AND
THERE'S A CERTAIN SOMETHING THAT
QUALITATIVE RESEARCH LENDS TO
INCREASING CREDIBILITY AND
SHOWING INDIVIDUAL PEOPLE HAVE
INDIVIDUAL EXPERIENCES AND
DRAWING MEANINGFUL INSIGHT IS
ONE THING WE SHOULD DO BETTER.
ARE THERE UNDER EXPLORED
OPPORTUNITIES THAT COULD HELP
EXPAND INTERVENTION RESEARCH.
IF YOU'VE SEEN A PORTFOLIO
ANALYSIS SOME FIELD GET MORE AND
SOME GET LESS.
ONE THAT WE ALL STRONGLY AGREE
ON WAS SUICIDE AT AND PREVENTION
AND FOLKS THAT FALL IN THE SGM
UMBRELLA AND MORE WORK NEEDS TO
BE DONE ON THIS.
IT'S NOT JUST AN EMERGENT BUT
PERSISTENT NEED AND LETHAL
PROBLEM AND UTILIZING
TELEAPPROACHES WITH BROADER
AVAILABILITY AND GETTING MORE
CREATIVE FOR FOLKS WHO DON'T
HAVE INTERNET AND CAN USE RADIO
OR DOOR TO DOOR BUT MAKING SURE
OUR APPROACHES ARE REACHED BY
EVERYBODY THAT NEEDS THEM AND
CAN BENEFIT FROM THEM.
COMMUNICATION IS NOT EQUITABLE
AND HAS TO BE CONSIDERED AS
WELL.
AND THERE WERE INTERESTING IDEAS
ABOUT GREEN SPACE INTERVENTIONS
WHERE NATURE IS ACTUALLY PART OF
THE INTERVENTION AND I THINK
THIS IS A FASCINATING APPROACH
AND ONE I HAVE NOT HEARD OF BUT
ONE THAT MAKES SENSE AND IT'S A
NOVEL WAY OF ENGAGING WITH SOME
PEOPLE WHO MAY NOT HAVE ACCESS
TO SOCIAL VENUES OR WANT TO BE A
PART OF SOCIAL VENUES AND ALSO A
DEEPER FOCUS ON POPULATIONS
WITHIN SO TO SPEAK.
FOR EXAMPLE TWO SPIRIT SPOKES
WITHIN LGBTQ+ WITHIN NATIVE
AMERICAN COMMUNITIES AND MAYBE
WITHIN RURAL SETTINGS WITHIN
POLICY LANDSCAPES NOT FAVORABLE
TO LGBTQ+ PEOPLE.
WE NEED TO DIG DOWN MORE DEEPLY
AND GET TO A MORE PRECISION
MEDICINE TERM.
WHEN WE DRILL DOWN THAT FAR AS
IT STILL A SUBSTANTIAL
POPULATION OF PEOPLE AND NEED TO
DO MORE FOCUS ON THE POPULATIONS
DIRECTLY OPPOSED TO JUST HAVING
THEM BE FON COUNTING FACTORS OR
PULL OUT THE DEMOGRAPHIC
VARIABLES.
>>IN TERMS OF BUILDING CAPACITY
AROUND WORKFORCE INNOVATION WE
SHOULD THINK OF ADDING SLIDES
T32s AND R25s TO FOSTER
DEVELOPMENT IN THE SGM TRAINED
INVESTIGATOR POOL.
WE ALSO TALKED ABOUT THE FACT
THAT SOMETIMES ACADEMIC
INSTITUTIONS CAN BE ADVERSARIAL
TO HEALTH DISPARITIES RESEARCH
WHERE THERE'S SGM RESEARCHERS OR
INDIGENOUS RESEARCHERS AND BLACK
AND BROWN RESEARCHERS AND MAY BE
GOOD AT LOOK AT A COHORT
APPROACH OF HIRING WHERE
INSTITUTIONS CAN HIRE A GROUP OF
K24 PERSONS, EARLY CAREER
INVESTIGATORS WHO HAVE K12s OR
WHAT HAVE YOU AND HIRE THEM ALL
TOGETHER AND CREATE STRUCTURES
AROUND THEM WHERE WE PROVIDE
MENTORING, TRAINING, WRITING
RETREATS, COACHING AROUND HOW TO
MANAGE OR NAVIGATE
MICROAGGRESSION AND SELF-CARE,
ALL THOSE THINGS EMBEDDED WITHIN
THE PROCESS OF THE EXECUTION OF
THOSE WORKFORCE DIVERSITY
EFFORTS SO THE YOUNG PEOPLE WHEN
THEY'RE EMBARKING ON THE AREA OF
TRAINING THEY STAY IN THE
PIPELINE AND FEEL SUPPORTED AND
A RESOURCE SO THEY CONDITION ON
AND GET TO CONTRIBUTE TO THE
SCIENCE.
>>WE NEED TO GET BEHIND THE
PAYWALLS THAT OFTEN BLOCK PEOPLE
FROM GETTING ACCESS TO THE
MANUSCRIPTS THAT MAY BE HELPFUL.
ALSO TRAINING STUDENTS AND EARLY
STAGE RESEARCHERS TO LEARN ABOUT
THE MANY AVENUES TO DISSEMINATE
INFORMATION.
MANUSCRIPTS ARE NOT THE ONLY
THING.
THERE'S DIFFERENT WAYS TO GET
YOUR RESEARCH AND FINDINGS AND
RESULTS OUT THERE.
IT'S NECESSARY IF YOU WANT TO
COMMUNICATE BACK TO THE
COMMUNITIES FROM WHICH YOU DRAW
YOUR RESULTS.
WE THOUGHT HAVING A TRAINING
PROGRAM IN PLACE TO TEACH
STUDENTS ABOUT THE VARIOUS
AVENUES WOULD BE INCREDIBLY
USEFUL NOT ONLY TO THEM BUT TO
THE BROADER COMMUNITY THEY'RE
TRYING TO IMPACT AND HELP.
ALSO, DIDN'T KNOW ABOUT THIS BUT
WE HAVE THE OPPORTUNITY TO
PARTNER WITH ORGANIZATIONS OR
SPECIALIST SERVE AS BROKERS
BETWEEN SCIENCE AND PRACTICE
WHICH IS AN INTERESTING IDEA.
THIS HAS ALREADY BEEN DONE IN
THE RESEARCH SPACE.
THERE'S A BIT OF AN EXAMPLE TO
LOOK AT.
WE ALSO HAVE THE OFFICE OF
COMMUNICATION AND PUBLIC LIAISON
AT OUR OWN AGENCY WHICH SERVES
AS A LIAISON TO THE PUBLIC ABOUT
SCIENTIFIC FINDINGS.
MAYBE WE HAVE THAT AS A MODEL AS
WELL.
WE RECOGNIZED IT'S UNREASONABLE
TO ASK RESEARCHERS TO TAKE ON
THE JOB OF DOING THE RESEARCH
AND ENGAGING WITH COMMUNITY AND
SETTING UP THE BOARD AND GOING
THROUGH THE IRB AND ALSO BEING
THEIR OWN P.R. AND COMMUNICATING
IT TO THE COMMUNITIES AND ALL
MEDIA MAY DIFFICULT DEPENDING ON
THE COMMUNITY.
HAVING A DEDICATED SPECIALIST OR
ORGANIZATION WOULD BE HELPFUL IN
ALLEVIATING THE STRESS
RESEARCHERS FEEL TO NOT BE THEIR
OWN P.R. FIRM.
AND THEN FINALLY WE HAD JUST A
FEW OPEN-ENDED DISCUSSION
POINTS.
WE ALL AGREED PREVENTION IS
IMPORTANT.
SEIZING ON THE OPPORTUNITY TO
PREVENT THEM SO WE DON'T NEED AN
INTERVENTION IS AN IMPORTANT
COMPONENT OF PREVENTION RESEARCH
AND WOULD LIKE TO SEE MORE OF
THAT IN SGM COMMUNITIES LY WITH
SO MANY PROBLEMS SUCH AS
SUBSTANCE USE.
AND FOCUSSING ON HEALTH
PROMOTION AND AM RESILIENCE AND
LOOKING AT IT AS AN OPPORTUNITY
TO BETTER HANDLE EQUITY AND
ATTAIN OPTIMAL PUBLIC HEALTH.
WE HAD CONSIDERATION FOR RURAL
SETTINGS.
WE TALKED ABOUT BUILDING
CAPACITY AND RURAL SETTINGS,
FINDING CREATIVE WAYS TO WORK
WITH PARTNERS AND BEING VIGILANT
ABOUT EMERGING ISSUES IN RURAL
COMMUN
COMMUNITIES TAKING ADVANTAGE OF
WE HAVE KNOWLEDGE AND HOW THESE
CAN CREATE BARRIERS TO RESEARCH
AND HOW WE CAN INCORPORATE THEM
INTO THE RESEARCH QUESTIONS AND
APPROACHES WE'VE USED AND IT'S
ALSO IMPORTANT TO REPRESENT
FOLKS FROM DIFFERENT SETTINGS TO
UNDERSTAND THE POLICIES ON THE
GROUND CAN BE TOO FAR REMOVED
AND STILL BE POWERFUL AND
IMPACTFUL TO THE COMMUNITY.
THAT'S WHAT WE HAD AND
>>NOW WE HAVE JENNIFER
MODERATING THE DATA NEEDS.
>>NATURAL TO EVERYONE IN THE
GROUP.
THE FACILITATOR, CHRISTINA HAD
TO DROP POCH -- WE WANTED TO
TALK ABOUT ADMINISTRATIVE DATA
AND RELATED CONSTRUCTS AND
ADDRESSING THE NEEDS.
ON ADMINISTRATIVE DATA, AND
JUSTICE DATA AND OVER ALL HAVING
MINIMUM STANDARDS WHAT SHOULD BE
COLLECTED AND IMPROVING WHAT IS
COLLEC
COLLECTED ADMINISTRATIVE DATA
SETS MAY HAVE AN OVERRELIANCE ON
QUESTIONS WHERE A SINGLE
RESPONSE AND WHAT ARE YOU OR
WHICH ARE YOU OR WHAT IS THIS
PERSON AND WHAT MAY BE VALID AND
THE STANDARDIZATION OF MEASURES
ACROSS DATA SETS OR
INTEROPERABILITY AND THERE NEEDS
TO BE ROOM FOR FLEXIBILITY HOW
THINGS ARE MEASURED SO THEY CAN
BE NOT NECESSARILY ALL THE SAME
BUT HARMONIZED AND LOOKED ACROSS
DIFFERENT DATA SETS.
THERE ARE LIMITATIONS TO
ADMINISTRATIVE DATA SYSTEMS
WHERE THE PEOPLE ENTERING DATA
MAY NOT HAVE A GOOD SENSE OF WHY
THE DATA ARE IMPORTANT OR WHAT
THEY COULD BE USED FOR.
MORE TRAINING FROM LEADERSHIP OF
THE SYSTEMS AND THE JU
JUSTIFICATION FOR THE TIME AND
EFFORT FOR THE FOLKS ENTERING
THE DATA TO ENSURE COMPLETENESS
AND ATTENTION TO APPROPRIATE
DATA ENTRY.
INSTITUTIONS LIKE HEALTH CARE
SYSTEMS OR OTHER SYSTEMS MAY BE
FAIRLY BEHIND IN THEIR DATA
COLLECTION OR ENTRY.
DATA MAY NOT BE UP TO DATE AND
IT CAN TAKE YEARS TO ACCESS SOME
OF THESE DATA SETS PARTICULARLY
FOR SOME FEDERAL SURVEILLANCE
DATA THAT USED TO BE FREE TO THE
PUBLIC NOW HAVE COSTS OR YOU
HAVE TO GO TO A DATA CENTER TO
ACCESS THE DATA WHICH MAY BE
LIMIT
LIMITING FOR RESEARCHERS FROM
INSTITUTIONS FOR MORE RESOURCE
TO ADDRESS THE COSTS.
MORE THAN TO CAPTURE MULTIPLE
DIMENSIONS OF SOGI.
THE CURRENT NIH REQUIREMENTS HOW
TO REPORT SEX AND GENDER OF
COURSE IS LIMITED TO BINARY SEX
AND GENDER AND IT'S NOT CLEAR
WHAT IS BEING ASKED FOR.
IS IT SEX OR GENDER OR SEX
ASSIGNED AT BIRTH SO SOME
CLARITY THERE AND TERMS WE USE
ON THE SURVEYS MAY NOT BE
ENDORSED BY THE PEOPLE THEY'RE
SUPPOSED TO APPLY TO.
SO GREATER ATTENTION TO THAT.
IF EXISTING MEASURES HAVE NORMS
LIKE THESE ARE THE THRESHOLDS
FOR MEN AND WOMEN OR BOYS AND
GIRLS, HOW DO YOU APPLY THESE
NORMS OR THRESHOLDS TO
TRANSGENDER POPULATIONS OR NON
BINARY POPULATIONS AND CAN WE
HAVE PEOPLE TELL US HOW THEY
IDENTIFY THEMSELVES INSTEAD OF
CHECKING BOXES?
CAN WE HAVE A COMBINATION WHERE
WE HAVE CHECK BOXES BUT AND A
RESPONSE.
THERE'S ISSUES WITH CHECK BOXES
MAY BE TOO LIMITING BUT IF YOU
JUST DO FREE RESPONSE,
SELF-IDENTIFICATION THAT MEANS
THE RESEARCHERS ARE SOMEHOW
CATEGORIZING PEOPLE IN A WAY
THAT THEY MAY NOT CATEGORIZE
THEMSELVES AND ATTENTION TO
THINK ABOUT THERE'S IN ISSUE
ABOUT ASKING ABOUT LABELS AND
IDENTITIES AS A PROXY IN WHAT TO
STUDY AND IF WE'RE INTERESTED IN
SEXUAL BEHAVIOR NOT ASKING IF
YOU'RE A SEXUAL MINORITY BUT
ENGAGE IN SAME-SEX BEHAVIOR IN
THE JUST ASKING IF SOMEONE IS
TRANSGENDER AND IF SOMEONE IS
ASKING ABOUT CANCER SCREENING
WHAT ORGAN A PERSON HAS RATHER
THAN LABELS.
A NEED TO ADDRESS EXPERIENCES
RATHER THAN LABELS OR STATUSES.
SO RATHER THAN ASKING ARE YOU
OUT ASKING WHERE ARE YOU OUT.
THERE'S A NEED FOR
STANDARDIZATION OF METRIC OF
EVALUATING STRATEGIES.
SOME STANDARDIZATION OF METRICS.
THERE'S RESISTANCE IN SURVEYS OR
STUDIES THAT SAYS OVER TIME A
DESIRE TO RETAIN THE CONTINUITY
OF THE MEASURE AND THOUGH WE
KNOW SOME MEASURES ORIGINALLY
USED MAY NOT BE VERY GOOD AND
THEY TEND TO USE IDENTIFY AND
VIEW IT AS STABLE OVER TIME
RATHER THAN FLUID.
THERE MAY BE TOO MUCH EMPHASIS
ON DEVELOPING MEASURES THAT WORK
FOR THE ENTIRE POPULATION MAYBE
WEIGHING THE BENEFITS OF
CISGENDER POPULATIONS CAN ANSWER
ACCURATELY AT THE COST OF
LIMITING THE UTILITY FOR SGM
POPULATIONS.
A LOT OF MEASURES ARE STUDY
SPECIFIC, HEALTH SPECIFIC AND
POPULATION SPECIFIC.
AND WORKING ACROSS POPULATIONS
AND FOR EXISTING MEASURES TO BE
TRANSLATED TO MULTIPLE
LANGUAGES.
THERE'S SOME IN SPANISH BUT
RARELY IN OTHER LANGUAGES.
IT WAS BROUGHT UP THE DISCUSSION
OF SEX AS A BIOLOGICAL VARIABLE
ISN'T ALWAYS APPROPRIATE
DEPENDING ON THE TOPIC AND
THERE'S A NEED FOR RESEARCHERS
TO BE CLEAR ABOUT WHO IS IN
THEIR STUDIES AND IF IT'S MEN
WHO HAVE SEX WITH MEN CAN BE
PROBLEMATIC AND USING SPECIFIC
DESCRIPTORS RATHER THAN UMBRELLA
LABELS FOR WHO IS IN STUDIES.
AND WHETHER YOU HAVE STATES WHO
MAY BE DOING THIS TO TRAIN STAFF
FOR THE ACTION PLANS TO HAVE AN
IMPACT.
THERE'S A NEED FOR MORE
COMMUNITY INPUT AND
COMMUNITY-ENGAGED RESEARCH IN
THE WHICH REQUIRES CHANGES TO
THE NIH APPLICATION PROCESS HOW
APPLICATIONS ARE REVIEWED AND
SUBMIT THEM IN COMMUNITIES.
THERE WAS A SENSE THAT THE
RECENT REPORT ON THE LATEST
EVIDENCE OF HOW TO MEASURE
SOGI -- NASEM REPORT, MAY
SOMETIMES BE FRAMED AT THE FINAL
WORD THE GOLD STANDARD WHEN IT
WAS INTENDED TO BE A STARTING
POINT TO STIMULATE MORE RESEARCH
RATHER THAN BEING AN END POINT
AND FINALLY WE NEED TO
UNDERSTAND AND ADDRESS FEARS
ABOUT ANSWERING QUESTIONS IN THE
SGM SPACE.
SO PEOPLE MAY NOT WANT TO
DISCLOSE THEIR STATUS OR
BEHAVIORS IF THEY FEEL LIKE IT
MAY CAUSE THEM HARM IF THE DATA
ARE DISCLOSED OR DE-IDENTIFIED.
SO THAT WAS OUR DISCUSSION
GROUP.
FEEL FREE TO ADD ANY ELABORATION
S IF I LEFT ANYTHING OUT.
ALL RIGHT, THANKS A LOT.
>>THANK YOU, JOAN -- JENNIFER.
I GUESS WE GET TO FINISH A
LITTLE BIT EARLY.
I'D LIKE TO CLOSE THE WORKSHOP
BY GIVING A BIG THANK YOU TO OUR
FABULOUS SPEAKER FOR THE TWO
WORKSHOP DAYS.
WE LEARNED A LOT FROM YOUR
PRESENTATIONS AND DISCUSSIONS ON
WHERE THIS FIELD OF SGM HEALTH
DISPARITIES LEADS TO.
SO THANK YOU SO MUCH.
I WOULD ALSO LIKE TO THANK MY
COLLEAGUES ON THE PLANNING
COMMITTEE FOR ALL THEIR HARD
WORK.
IT'S BEEN GREAT WORKING WITH
YOU.
ALSO WOULD LIKE TO THANK
DR. KAREN PARKER WHO HELPED US
MODERATE A SESSION IN THIS
WORKSHOP.
I WOULD ALSO LIKE TO THANK STAFF
FROM COMMUNICATION AND PUBLIC
LIAISON AND STAFF FROM THE NIH
VIDEOCAST FOR ALL THEIR SUPPORT.
I WOULD LIKE TO THANK
MR. GRIFFITH AND HIS COLLEAGUES
FOR DOING GREAT JOB HELPING US
WITH THE TECHNICAL ASPECTS OF
THE WORKSHOP AND I ALSO WOULD
LIKE TO THANK OUR VIDEOCAST
AUDIENCE WHO WAS VERY ENGAGED
AND ASKED US A LOT OF IMPORTANT
QUESTIONS AND STAYED WITH US --
SOME OF YOU STAYED UNTIL THE END
OF THE WORKSHOP.
I WOULD LIKE TO THANK DR
DR. PEREZ-STABLE AND WE LEARNED
A LOT AND IT WILL BE HELPFUL
GOING FORWARD.
I WOULD LIKE TO END WITH A
HOPEFUL NOTE.
OKAY.
I WOULD LIKE TO END WITH THE
QUOTE FROM A POET FREDERICKO
GARCIA LORCA EVERY STEP WE TAKE
ON EARTH BRINGS US TO A NEW
WORLD
THANK YOU VERY MUCH.