...we need to do a better job educating investigators about the importance of collecting sexual orientation and gender identity data. For tested measures of sexual orientation and gender identity I ...suggest investigators begin by reviewing research produced by the National Center for Health Statistics for the National Health Interview Survey, a report on gender identity data collection produced by the Williams Institute, and the Web site LGBTData.com.1,4,5 The goal of measures should be to provide response options that are meaningful to the respondent and whose meaning is similarly understood by both respondent and investigator. Because these meanings have evolved and will continue to evolve, measures need to also evolve. Increasing overall sample sizes of a survey is often a waste of resources when the existing sample already collects sufficient data on majority populations to yield conclusive findings. ...it often makes the most sense to add additional respondents from the underpowered groups by oversampling them and then weighting the sample.
Public health surveillance can have profound impacts on the health of populations, with COVID-19 surveillance offering an illuminating example. Surveillance surrounding COVID-19 testing, confirmed ...cases, and deaths has provided essential information to public health professionals about how to minimize morbidity and mortality.
In the United States, surveillance has also pointed out how populations, on the basis of geography, age, and race and ethnicity, are being impacted disproportionately, allowing targeted intervention and evaluation. However, COVID-19 surveillance has also highlighted how the public health surveillance system fails some communities, including sexual and gender minorities. This failure has come about because of the haphazard and disorganized way disease reporting data are collected, analyzed, and reported in the United States, and the structural homophobia, transphobia, and biphobia acting within these systems.
We provide recommendations for addressing these concerns after examining experiences collecting race data in COVID-19 surveillance and attempts in Pennsylvania and California to incorporate sexual orientation and gender identity variables into their pandemic surveillance efforts.
The few pioneering sexual and gender minority health researchers were attempting to study the health of these populations in the 1980s without any significant funding or access to ...government-controlled data sources and surveillance systems. ...yes, the National Health Interview Survey has started to collect sexual orientation data, allowing researchers to report cancer-related behaviors among lesbians as I requested so long ago.1 Unfortunately, only a tiny fraction of surveys used to monitor the health of the US population currently collect sexual orientation data, and an even smaller number collect gender identity data.2 Furthermore, because of the lack of guidance on the collection of these data, there are notable differences between surveys in the questions used to assess these constructs. At some point, the secretary of Health and Human Services needs to require the collection of sexual orientation and gender identity data in every survey they have jurisdiction over, just as a previous secretary required for race and ethnicity. ...knowing LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) people and their history, I know that the more impossible a challenge seems, the more likely they are to stand up and fight. Gonzales G, Przedworski J, HenningSmith C. Comparison ofhealth and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: results from the National Health Interview Survey. Correspondence should be sent to Randall L. Sell, ScD, MA, MS, Associate Professor, Dornsife School of Public Health, Department of Community Health and Prevention, 3215 Market Street, Room...
Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we ...synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership.
Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention ...programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
Arguments for sexual orientation data collection largely centered on the need for data concerning the spread of HIV/ AIDS, but arguments also recognized other sexual minority health concerns ...including drug, alcohol, and tobacco use; mental health; cancer; aging; and violence.2 Some researchers even argued for sexual orientation data collection in all data collection activities directly or indirectly supported by the US Department of Health and Human Services (HHS) including all research funded through the National Institutes of Health (NIH).3 The arguments and actions on the part of researchers sometimes focused on individual variables that could be added to specific surveys, but they also sometimes argued for recognizing sexual orientation as a demographic variable like race, ethnicity or age, and providing guidance for standardized sexual orientation data collection in all HHS activities in the same way the Office of Management and Budget's Directive15 provided instructions for the collection of race and ethnicity data.4 Outside of some extremely modest steps to collect sexual orientation data in relationship to understanding the spread of HIV, HHS largely ignored these calls for greater data collection.
Youth Risk Behavior Survey (YRBS) data have exposed significant sexual orientation disparities in health. Interest in examining the health of transgender youths, whose gender identities or ...expressions are not fully congruent with their assigned sex at birth, highlights limitations of the YRBS and the broader US health surveillance system. In 2009, we conducted the mixed-methods Massachusetts Gender Measures Project to develop and cognitively test measures for adolescent health surveillance surveys. A promising measure of transgender status emerged through this work. Further research is needed to produce accurate measures of assigned sex at birth and several dimensions of gender to further our understanding of determinants of gender disparities in health and enable strategic responses to address them.
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency ...of women’s overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016–2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9–16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval CI: 1.00, 1.08). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: 1.06, 3.80) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: 1.13, 3.91) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
The implementation of the New Zealand government's recently developed statistical standard for gender identity has led to, and will stimulate further, collection of gender identity data in ...administrative records, population surveys, and perhaps the census. This will provide important information about the demographics, health service use, and health outcomes of transgender populations to allow evidence-based policy development and service planning. However, the standard does not promote the two-question method, risking misclassification and undercounts; does promote the use of the ambiguous response category "gender diverse" in standard questions; and is not intersex inclusive. Nevertheless, the statistical standard provides a first model for other countries and international organizations, including United Nations agencies, interested in policy tools for improving transgender people's health.
Little is known about cardiovascular health disparities for lesbian, gay, or bisexual (LGB) persons and whether these disparities are mediated by mental health disorders due to sexual minority ...stress. We hypothesize LGB identity is associated with an increased risk of cardiovascular disease (CVD) and that major depressive disorder (MDD) and generalized anxiety disorders (GAD) may mediate this association.
The National Epidemiologic Survey on Alcohol and Related Conditions is a longitudinal, nationally-representative study of non-institutionalized U.S. adults. We cross-sectionally analyzed the second wave data (2004–2005) comparing 577 self-identified LGB persons to 33,598 heterosexuals. Multiple logistic regression modeling and mediation analysis (the product of coefficients approach) were performed.
LGB persons had significantly higher CVD prevalence adjusted odds ratio (AOR): 1.5, 95% CI: 1.2–1.9, and were more likely to be diagnosed with MDD (AOR: 1.9, 1.8–2.1), GAD (AOR: 2.2, 1.9–2.4), or co-occurring MDD and GAD (AOR: 2.2, 2.0–2.5). MDD, GAD, and co-occurrence of MDD and GAD significantly mediated 14.3%, 22.2%, and 33.3% of the association of LGB status with increased CVD prevalence, respectively.
Our findings identified a 50% increased CVD prevalence among LGB persons and this increased risk was mediated in part by MDD and GAD, both being more prevalent in sexual minority adults.
•LGB persons had a 50% higher prevalence of CVD than heterosexuals.•Major depressive disorder was more prevalent among LGB persons.•Generalized anxiety disorders was more prevalent among LGB persons.•Both disorders mediate the association between LGB status and higher CVD risk.•Efforts to improve mental health may have cardiovascular benefit for LGB persons.
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