America’s LGBTQ population faces a multitude of increased health risks compared with their heterosexual and cis-gendered peers. Experts point to systemic inequality and discrimination as two of the root causes of many of the health issues sexual and gender minority (SGM) populations experience, including high rates of depression, alcohol and drug use, and stress-related conditions such as cardiovascular disease.
Historically, public health research has overlooked the special needs of and the risk factors affecting the LGBTQ community. It wasn’t until 2010 that the National Institutes of Health (NIH) commissioned the first report on the state of LGBTQ health research. Six years later, NIH formally designated this group a health disparity population, stating: “Mounting evidence indicates that SGM populations have less access to healthcare and higher burdens of certain diseases, such as depression, cancer, and HIV/AIDS. But the extent and causes of these health disparities are not fully understood, and research on how to close these gaps is lacking.”
Other major health organizations, including the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services, are addressing the urgent need for further research in this area. And in recent years, some schools of public health have developed innovative courses, programs, and centers to help establish a foundation for the field of LGBTQ health research and to educate students who seek to improve health outcomes for SGM populations.
Drexel University Dornsife School of Public Health
Randall Sell, ScD, an associate professor in the Drexel University Dornsife School of Public Health (DSPH), has been a forerunner in SGM health research and a longtime advocate for increased education in this area. “I have been working in this field for 30 years, and for the first decade, I didn’t meet anyone else doing this kind of work,” he says. “The field is surprisingly still in its infancy, … but there really isn’t any health-related topic where sexual orientation or gender identity isn’t relevant.”
Sell directs DSPH’s Program for LGBT Health, which he and a colleague launched in 2013. Offered completely online, it provides current and future medical and public health professionals the knowledge to better serve LGBTQ patients. The only requirement for admission to the program — which offers three courses and a graduate-level certificate — is a bachelor’s degree from an accredited institution.
“The certificate is for students who want to get into this field and for people who already work in public health, like nurses, who want additional expertise,” explains Sell. “[It prepares] people … to be culturally competent enough to work in this area, whether [they want to do] their own research or … work directly with these communities.” He adds that many nurses, community-based advocates, and graduate students from institutions across the U.S. enroll in the program.
Additionally, Drexel graduate students — those in public health or related disciplines — can add LGBT Health as a graduate minor. “It’s amazing, the message that a university sends by having this type of program,” says Sell. “I think there are faculty and students at a lot of research institutions who want to be doing a lot more in this area, but it’s hard when you don’t have the support system.”
DSPH’s program consists of three courses — which typically enroll at least 10 students at a time — that concentrate on research methods, major issues in LGBT health, and intersectionality. In the first course, students learn how to assess the validity of existing research — a difficult task because so much about the field is still unknown, Sell says. “There are a lot of specific issues that need to be addressed when you’re dealing with populations that are somewhat rare or stigmatized,” he explains. “You have to be concerned any time you’re looking at these results whether they are reliable. That’s why we teach people how to use and critique the existing literature and how to add to it by conducting their own research.”
In the second course, participants receive an overview of some of the most pressing health issues for the LGBTQ population, including access to services, mental and emotional well-being, and diseases that disproportionately affect SGM populations. In the final class, students learn about “how sexual or gender minority status interacts with all the other aspects of a person’s identity, including race, ethnicity, and disability,” says Sell. “We look at how LGBT status can have a much broader context when it comes to health outcomes, which gets at the heart of what a school of public health is supposed to do.”
Sell stresses that this type of work is essential to advancing public understanding of how and why LGBTQ individuals may be more at risk for certain health conditions. As an example, he notes the spike in SGM youth who sought mental health and suicide prevention services immediately following the 2016 presidential election and the rescission of an Obama-era rule allowing transgender students to use bathrooms that correspond with their gender identity.
Recently, Sell personally helped one suicide prevention organization for LGBTQ youth — the Trevor Project — create a list of survey questions to gather information on risk factors for these young people. “That’s what the academic expertise adds to this area, … especially when the current political environment is affecting [this] vulnerable community,” he says.
University of Pittsburgh Center for LGBT Health Research
Through its Center for LGBT Health Research, the University of Pittsburgh Graduate School of Public Health (Pitt Public Health) supports faculty in their efforts to develop new methods for understanding and resolving SGM health disparities. While the school has long conducted research into HIV/AIDS prevention and treatment for homosexual men, it wasn’t until the early 2000s that it began seriously investigating other LGBTQ health topics, according to Ronald Stall, PhD, director of the center.
“In terms of sexual minority health, a majority of public funding has always gone to HIV/AIDS research, and other disparities for [gay men] were relatively unaddressed,” he explains. “For other populations, like trans women and lesbian or bisexual populations, the basic research had never even been done.”
The university established the Center for LGBT Health Research so that Pitt Public Health scholars as well as faculty in dentistry, medicine, and social work could develop a basic understanding of SGM health issues. The school also created a LGBT Health Certificate program to help further grow the field, says Stall. “We realized it was going to take a generation of researchers to do this work, but there was nothing in place to provide the basic training and mentoring required to help students become independent investigators [in this discipline],” he says.
The certificate is available to graduate students, who typically go on to work in community or government-based organizations, and PhD candidates who will further their research at the postdoctoral level.
In addition to learning the history of LGBTQ health issues and studying the psychosocial, viral, and stress-related conditions affecting these populations today, program participants develop their own research projects. “In their first course, students complete a literature review of a specific health disparity for a sexual minority population, so they become experts on that specific topic,” says Stall. “In the next course, I show them how to take their topic and turn it into a grant proposal for a research project. By the end of the class, many of them have developed applications that actually get funded.”
Past research projects have included tracking rates of smoking in lesbian women, the correlation between rates of disease and state laws governing LGBTQ citizenship rights, and the largest study to date of behavioral health risks in homosexual African American men.
“The health disparities in sexual minority populations are astounding, but when we look closely at these issues, we can see that [there’s] not something wrong with the populations themselves,” Stall says. “It [has to do with] the discrimination, exclusion, and violence victimization that results from a lack of understanding of these issues.”
Having a community of dedicated researchers and students and the backing of a major university like Pitt — although not yet common assets in the field of public health — are essential to addressing the health issues faced by the LGBTQ community, he says. By continuing to develop new knowledge, test prevention and treatment methods, and train future scholars, Stall says he hopes to see the field grow exponentially in the coming years.●
Mariah Bohanon is a senior staff writer for INSIGHT Into Diversity.