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Our main aims in the LGBT Research Community are, in keeping with the University of Southampton’s commitment to diversity and equality, to:

• Stimulate research on any aspect of LGBT study in the humanities, social sciences and sciences at the University of Southampton
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• Encourage teaching in this area, preparing undergraduates for future postgraduate study or for careers in related areas
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• Seek to incorporate our discussions into a wider national debate about sexual diversity and tolerance in the modern world: liaison with other research centres, with the Stonewall charity, etc

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• LGBTQ+ Studies

LGBTQ+ Studies at Hofstra University focus on lesbian, gay, bisexual, and transgender people, their history, and culture. LGBTQ+ Studies examine sexualities and genders as identities, social statuses, categories of knowledge, and as lenses that help us frame how we understand our world. A minor in LGBTQ+ Studies is available to students in any major through Hofstra College of Liberal Arts and Sciences.

LGBTQ+ Studies will benefit students who plan to go on to graduate school to earn advanced degrees in business, counseling, education, law, psychology, or the humanities.

LGBTQ+ Studies is an interdisciplinary program that features a University-wide network of faculty mentors and a winter study abroad opportunity in Paris, France.

Hofstra professors from various fields teach in the LGBTQ+ Studies program, including literature (Classics, French, English, Spanish), rhetorical studies, media studies, education, and religion studies. The inherently interdisciplinary nature of LGBTQ+ Studies is thus well served by the different domains of study and their methodologies.

Faculty and staff mentors make themselves available for consultation and advising, especially as the LGBTQ+ Studies program offers the possibility of quasi self-fashioned courses with the cooperation of professors who are inclined to do so. Interested students often find it helpful to consult with a mentor to help them pattern a course or series of courses that respond to their personal interests.

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About the Program

Mission statement.

The LGBTQ+ Studies program at Hofstra University investigates the broad spectrum of sexual and gender identities from serious scholarly perspectives, including but not restricted to biology, classical studies, communications, cultural studies, fine arts, health sciences, history, literature, philosophy, psychology, and sociology. The program is interdisciplinary and designed to offer students various viewpoints from which to examine diversity – diversity of culture, but also diversity in families, communities, histories, institutions, languages and literatures, economics, and politics, as well as the complex social and cultural relations between marginalized sexualities and the heterosexual majority. Gender, sexual identities, discourses, and institutions are studied as they intersect with class, race, ethnicity, nationality, religion, and transnational movements.

Goals and Learning Objectives

Outcome assessment tools.

The LGBTQ+ Studies program uses various methods to assess the performance of students and thereby instructors and the curriculum. These methods include but are not limited to periodic exams, final exams, written assignments, term papers, research papers, creative writing projects, and class presentations.

The faculty regularly assesses the effectiveness of these goals through a cyclical examination of one or more components of the program. After careful consideration of the findings of this examination, adjustments are made to the appropriate sector of the program, if needed.

Learning Goals

Learning Goal #1:  Students will demonstrate knowledge of social, economic, political, intellectual, and cultural contributions of LGBTQ+ people of the past and present.

Objectives:

• Describe the social, economic, political, intellectua,l or cultural contributions of one or more LGBTQ+ person.
• Analyze scholarship, literature, art, music, dance, theater, or film created or performed by one or more LGBTQ+ person.

Learning Goal #2: Students will develop an understanding of how sexual identity and gender identity combine with nationality, race and ethnicity, religion, social class, and physical ability to shape the experiences of LGBTQ+ individuals.

• Evaluate scholarship on LGBTQ+ intersectionality.
• Describe the similarities and differences among LGBTQ+ people in different cultural and historical contexts.

Learning Goal #3: Students will acquire a basic understanding of LGBTQ+ history and queer theory.

• Summarize major developments in LGBTQ+ history since the 19th century.
• Appraise the thought and scholarship of one or more queer theorists.

Learning Goal #4:  Students will engage in interdisciplinary approaches to LGBTQ+ Studies.

• Evaluate inter- or multidisciplinary scholarship on LGBTQ+ topics.
• Employ at least two different disciplinary perspectives in a paper, oral presentation, or research project on an LGBTQ+ topic.

Symposia and Conferences

Click on the title of each event for more information.

• “Deviant” Pasts, Subversive Futures? Thursday, April 23, 2020
• Michel Foucalt 2014: Beyond Sexuality Thursday and Friday, March 27-28, 2014
• Queer Rhetoric: The 6th Annual LGBTQ+ Studies Conference Friday and Saturday, March 16 and 17, 2012
• Sexual Identity: They Ain't What They Used to Be 4th Annual LGBTQ+ Symposium Friday and Saturday, March 5-6, 2010
• Queer Iconography Friday and Saturday, November 7-8, 2008
• Queer Exoticism Thursday and Friday, October 11-12, 2007
• What Does Gay Mean Today? Wednesday, October 11, 2006

LGBTQ+ Studies Program Director Lisa M. Dresner Room 305 Mason Hall Department of Writing Studies and Rhetoric Office Phone: 516-463-0075 Email

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Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011.

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

• Hardcopy Version at National Academies Press

1 Introduction

At a time when lesbian, gay, bisexual, and transgender ( LGBT ) individuals are an increasingly open, acknowledged, and visible part of society, clinicians and researchers are faced with incomplete information about the health status of this community. Although a modest body of knowledge on LGBT health has been developed over the last two decades, much remains to be explored. What is currently known about LGBT health? Where do gaps in the research in this area exist? What are the priorities for a research agenda to address these gaps? This report aims to answer these questions.

• THE LGBT COMMUNITY

The phrase “lesbian, gay, bisexual, and transgender community” (or “ LGBT community”) refers to a broad coalition of groups that are diverse with respect to gender, sexual orientation, race/ethnicity, and socioeconomic status. Thus while this report focuses on the community that is encapsulated by the acronym LGBT, the committee wishes to highlight the importance of recognizing that the various populations represented by “L,” “G,” “B,” and “T” are distinct groups, each with its own special health-related concerns and needs. The committee believes it is essential to emphasize these differences at the outset of this report because in some contemporary scientific discourse, and in the popular media, these groups are routinely treated as a single population under umbrella terms such as LGBT. At the same time, as discussed further below, these groups have many experiences in common, key among them being the experience of stigmatization. (Differences within each of these groups related to, for example, race, ethnicity, socioeconomic status, geographic location, and age also are addressed later in the chapter.)

Lesbians, gay men, and bisexual men and women are defined according to their sexual orientation, which, as discussed in Chapter 2 , is typically conceptualized in terms of sexual attraction, behavior, identity, or some combination of these dimensions. They share the fact that their sexual orientation is not exclusively heterosexual. Yet this grouping of “nonheterosexuals” includes men and women; homosexual and bisexual individuals; people who label themselves as gay, lesbian, or bisexual, among other terms; and people who do not adopt such labels but nevertheless experience same-sex attraction or engage in same-sex sexual behavior. As explained throughout the report, these differences have important health implications for each group.

In contrast to lesbians, gay men, and bisexual men and women, transgender people are defined according to their gender identity and presentation. This group encompasses individuals whose gender identity differs from the sex originally assigned to them at birth or whose gender expression varies significantly from what is traditionally associated with or typical for that sex (i.e., people identified as male at birth who subsequently identify as female, and people identified as female at birth who later identify as male), as well as other individuals who vary from or reject traditional cultural conceptualizations of gender in terms of the male–female dichotomy. The transgender population is diverse in gender identity, expression, and sexual orientation. Some transgender individuals have undergone medical interventions to alter their sexual anatomy and physiology, others wish to have such procedures in the future, and still others do not. Transgender people can be heterosexual, homosexual, or bisexual in their sexual orientation. Some lesbians, gay men, and bisexuals are transgender; most are not. Male-to-female transgender people are known as MtF, transgender females, or transwomen, while female-to-male transgender people are known as FtM, transgender males, or transmen. Some transgender people do not fit into either of these binary categories. As one might expect, there are health differences between transgender and nontransgender people, as well as between transgender females and transgender males.

Whereas “ LGBT ” is appropriate and useful for describing the combined populations of lesbian, gay, bisexual, and transgender people, it also can obscure the many differences that distinguish these sexual- and gender-minority groups. Combining lesbians and gay men under a single rubric, for example, obscures gender differences in the experiences of homosexual people. Likewise, collapsing together the experiences of bisexual women and men tends to obscure gender differences. Further, to the extent that lesbian, gay, and bisexual are understood as identity labels, “ LGB ” leaves out people whose experience includes same-sex attractions or behaviors but who do not adopt a nonheterosexual identity. And the transgender population, which itself encompasses multiple groups, has needs and concerns that are distinct from those of lesbians, bisexual women and men, and gay men.

As noted above, despite these many differences among the populations that make up the LGBT community, there are important commonalities as well. The remainder of this section first describes these commonalities and then some key differences within these populations.

Commonalities Among LGBT Populations

What do lesbians, gay men, bisexual women and men, and transgender people have in common that makes them, as a combined population, an appropriate focus for this report? In the committee's view, the main commonality across these diverse groups is their members' historically marginalized social status relative to society's cultural norm of the exclusively heterosexual individual who conforms to traditional gender roles and expectations. Put another way, these groups share the common status of “other” because of their members' departures from heterosexuality and gender norms. Their “otherness” is the basis for stigma and its attendant prejudice, discrimination, and violence, which underlie society's general lack of attention to their health needs and many of the health disparities discussed in this report. For some, this “otherness” may be complicated by additional dimensions of inequality such as race, ethnicity, and socioeconomic status, resulting in stigma at multiple levels.

To better understand how sexuality- and gender-linked stigma are related to health, imagine a world in which gender nonconformity, same-sex attraction, and same-sex sexual behavior are universally understood and accepted as part of the normal spectrum of the human condition. In this world, membership in any of the groups encompassed by LGBT would carry no social stigma, engender no disgrace or personal shame, and result in no discrimination. In this world, a host of issues would threaten the health of LGBT individuals: major chronic diseases such as cancer and heart disease; communicable diseases; mental disorders; environmental hazards; the threat of violence and terrorism; and the many other factors that jeopardize human “physical, mental and social well-being.” 1 By and large, however, these issues would be the same as those confronting the rest of humanity. Only a few factors would stand out for LGBT individuals specifically. There would be little reason for the Institute of Medicine ( IOM ) to issue a report on LGBT health issues.

We do not live in the idealized world described in this thought experiment, however. Historically, lesbians, gay men, bisexual individuals, and transgender people have not been understood and accepted as part of the normal spectrum of the human condition. Instead, they have been stereotyped as deviants. Although LGBT people share with the rest of society the full range of health risks, they also face a profound and poorly understood set of additional health risks due largely to social stigma.

While the experience of stigma can differ across sexual and gender minorities, stigmatization touches the lives of all these groups in important ways and thereby affects their health. In contrast to members of many other marginalized groups, LGBT individuals frequently are invisible to health care researchers and providers. As explained in later chapters, this invisibility often exacerbates the deleterious effects of stigma. Overcoming this invisibility in health care services and research settings is a critical goal if we hope to eliminate the health disparities discussed throughout this report.

It is important to note that, despite the common experience of stigma among members of sexual- and gender-minority groups, LGBT people have not been passive victims of discrimination and prejudice. The achievements of LGBT people over the past few decades in building a community infrastructure that addresses their health needs, as well as obtaining acknowledgment of their health concerns from scientific bodies and government entities, attest to their commitment to resisting stigma and working actively for equal treatment in all aspects of their lives, including having access to appropriate health care services and reducing health care disparities. Indeed, some of the research cited in this report demonstrates the impressive psychological resiliency displayed by members of these populations, often in the face of considerable stress.

As detailed throughout this report, the stigma directed at sexual and gender minorities in the contemporary United States creates a variety of challenges for researchers and health care providers. Fearing discrimination and prejudice, for example, many lesbian, gay, bisexual, and transgender people refrain from disclosing their sexual orientation or gender identity to researchers and health care providers. Regardless of their own sexual orientation or gender identity, moreover, researchers risk being marginalized or discredited simply because they have chosen to study LGBT issues ( Kempner, 2008 ), and providers seldom receive training in specific issues related to the care of LGBT patients. In addition, research on LGBT health involves some specific methodological challenges, which are discussed in Chapter 3 .

Differences Within LGBT Populations

Not only are lesbians, gay men, bisexual women and men, and transgender people distinct populations, but each of these groups is itself a diverse population whose members vary widely in age, race and ethnicity, geographic location, social background, religiosity, and other demographic characteristics. Since many of these variables are centrally related to health status, health concerns, and access to care, this report explicitly considers a few key subgroupings of the LGBT population in each chapter:

• Age cohort —One's age influences one's experiences and needs. Bisexual adolescents who are wrestling with coming out in a nonsupportive environment have different health needs than gay adult men who lack access to health insurance or older lesbians who are unable to find appropriate grief counseling services. In addition, development does not follow the same course for people of all ages. An older adult who comes out as gay in his 50s may not experience the developmental process in the same fashion as a self-identified “queer” youth who comes out during her teenage years. Similarly, as discussed further below, experiences across the life course differ according to the time period in which individuals are born. For example, an adolescent coming out in 2010 would do so in a different environment than an adolescent coming out in the 1960s. Moreover, some people experience changes in their sexual attractions and relationships over the course of their life. Some transgender people, for example, are visibly gender role nonconforming in childhood and come out at an early age, whereas others are able to conform and may not come out until much later in life.
• Race and ethnicity —Concepts of community, traditional roles, religiosity, and cultural influences associated with race and ethnicity shape an LGBT individual's experiences. The racial and ethnic communities to which one belongs affect self-identification, the process of coming out, available support, the extent to which one identifies with the LGBT community, affirmation of gender-variant expression, and other factors that ultimately influence health outcomes. Members of racial and ethnic minority groups may have profoundly different experiences than non-Hispanic white LGBT individuals.
• Educational level and socioeconomic status —An LGBT individual's experience in society varies depending on his or her educational level and socioeconomic status. As higher educational levels tend to be associated with higher income levels, members of the community who are more educated may live in better neighborhoods with better access to health care and the ability to lead healthier lives because of safe walking spaces and grocery stores that stock fresh fruits and vegetables (although, as discussed in later chapters, evidence indicates that some LGBT people face economic discrimination regardless of their educational level). On the other hand, members of the LGBT community who do not finish school or who live in poorer neighborhoods may experience more barriers in access to care and more negative health outcomes.
• Geographic location —Geographic location has significant effects on mental and physical health outcomes for LGBT individuals. Those in rural areas or areas with fewer LGBT people may feel less comfortable coming out, have less support from families and friends, and lack access to an LGBT community. LGBT individuals in rural areas may have less access to providers who are comfortable with or knowledgeable about the treatment of LGBT patients. In contrast, LGBT people living in areas with larger LGBT populations may find more support services and have more access to health care providers who are experienced in treating LGBT individuals.

Although these areas represent critical dimensions of the experiences of LGBT individuals, the relationships of these variables to health care disparities and health status have not been extensively studied.

• STATEMENT OF TASK AND STUDY SCOPE

In the context of the issues outlined above, the IOM was asked by the National Institutes of Health ( NIH ) to convene a Committee on Lesbian , Gay , Bisexual , and Transgender Health Issues and Research Gaps and Opportunities. The 17-member committee included experts from the fields of mental health, biostatistics, clinical medicine, adolescent health and development, aging, parenting, behavioral sciences, HIV research, demography, racial and ethnic disparities, and health services research. The committee's statement of task is shown in Box 1-1 . The study was supported entirely by NIH.

Statement of Task. An IOM committee will conduct a review and prepare a report assessing the state of the science on the health status of lesbian, gay, bisexual, and transgender (LGBT) populations; identify research gaps and opportunities related to LGBT (more...)

Although intersexuality constitutes an additional type of “otherness” that is stigmatized and overlaps in some respects with LGBT identities and health issues, the committee decided it would not be appropriate to include intersexuality in the study scope. The majority of individuals affected by disorders of sex development do not face challenges related to sexual orientation and gender identity, although homosexuality, gender role nonconformity, and gender dysphoria (defined as discomfort with the gender assigned to one at birth [see Chapter 2 ]) are somewhat more prevalent among this population compared with the general population ( Cohen-Kettenis and Pfafflin, 2003 ). The committee acknowledges that while very little research exists on the subject of intersexuality, it is a separate research topic encompassing critical issues, most of which are not related to LGBT issues, and hence is beyond the scope of this report.

In a similar vein, the committee decided not to address research and theory on the origins of sexual orientation. The committee's task was to review the state of science on the health status of LGBT populations, to identify gaps in knowledge, and to outline a research agenda in the area of LGBT health. The committee recognized that a thorough review of research and theory relevant to the factors that shape sexual orientation (including sexual orientation identity, sexual behavior, and sexual desire or attraction) would be a substantial task, one that would be largely distinct from the committee's main focus on LGBT health, and therefore beyond the scope of the committee's charge.

• STUDY APPROACH

This study was informed by four public meetings that included 35 presentations (see Appendix A ). Three of these meetings were held in Washington, DC, while the fourth took place in San Francisco. In addition, the committee conducted an extensive review of the literature using Medline, PsycInfo, and the Social Science Citation Index (see Appendix B for a list of search terms), as well as other resources. The committee's approach to the literature is described below, followed by a discussion of the various frameworks applied in this study. A brief note on the terminology used in this report is presented in Box 1-2 .

A Note on Terminology. As discussed, the committee adopted the commonly used shorthand LGBT to stand for lesbian, gay, bisexual, and transgender. In cases in which the literature refers only to lesbian, gay, and bisexual populations, the term LGB appears (more...)

Approach to the Literature

While acknowledging that peer-reviewed journals are the gold standard for the reporting of research results and making every effort to consult works published in major research journals, the committee chose to include in this study what it judged to be the best empirical literature available: journal articles, book chapters, empirical reports, and other data sources that had been critically reviewed by the committee members. Recognizing that academic journals differ in their publication criteria and the rigor of their peer-review process, the committee gave the greatest weight to papers published in the most authoritative journals. Given that chapters, academic books, and technical reports typically are not subjected to the same peer-review standards as journal articles, the committee gave the greatest credence to such sources that reported research employing rigorous methods, were authored by well-established researchers, and were generally consistent with scholarly consensus on the current state of knowledge.

With respect to articles describing current health issues in the LGBT community, the committee attempted to limit its review to these articles published since 1999. In the area of transgender populations, however, much of the most current research was conducted prior to 1999 and is cited throughout the report. Likewise, in the case of history and theory, the committee reviewed and cites older literature.

When evaluating quantitative and qualitative research, the committee considered factors affecting the generalizability of studies, including sample size, sample source, sample composition, recruitment methods, and response rate. The committee also considered the study design, saturation (the point at which new information ceases to emerge), and other relevant factors. In some cases, the committee decided that a study with sample limitations was important; in such cases, these limitations and limits on the extent to which the findings can be generalized are explicitly acknowledged. The inclusion of case studies was kept to a minimum given their limited generalizability.

Research on U.S. samples was given priority. In cases in which no U.S.-based data were available or the committee determined that it was important to include research on non-U.S. samples, however, this research is cited. This was frequently the case for research involving transgender people. Only English-language articles were considered.

The committee considered papers whose authors employed statistical methods for analyzing data, as well as qualitative research that did not include statistical analysis. For papers that included statistical analysis, the committee evaluated whether the analysis was appropriate and conducted properly. For papers reporting qualitative research, the committee evaluated whether the data were appropriately analyzed and interpreted. The committee does not present magnitudes of differences, which should be determined by consulting individual studies.

In some cases, the committee used secondary sources such as reports. However, it always referred back to the original citations to evaluate the evidence.

Conceptual Frameworks

In understanding the health of LGBT populations, multiple frameworks can be used to examine how multiple identities and structural arrangements intersect to influence health care access, health status, and health outcomes. This section provides an overview of each of the conceptual frameworks used for this study.

First, recognizing that there are a number of ways to present the information contained in this report, the committee found it helpful to apply a life-course perspective. A life-course perspective provides a useful framework for the above-noted varying health needs and experiences of an LGBT individual over the course of his or her life. Central to a life-course framework ( Cohler and Hammack, 2007 ; Elder, 1998 ) is the notion that the experiences of individuals at every stage of their life inform subsequent experiences, as individuals are constantly revisiting issues encountered at earlier points in the life course. This interrelationship among experiences starts before birth and in fact, before conception. A life-course framework has four key dimensions:

• Linked lives— Lives are interdependent; social ties, including immediate family and other relationships, influence individuals' perspective on life.
• Life events as part of an overall trajectory— Significant experiences have a differential impact at various stages of the life course.
• Personal decisions— Individuals make choices influenced by the social contexts in which they live (e.g., family, peers, neighborhood, work setting).
• Historical context— A historical perspective provides a context for understanding the forces and factors that have shaped an individual's experiences; those born within the same historical period may experience events differently from those born earlier or later.

From the perspective of LGBT populations, these four dimensions have particular salience because together they provide a framework for considering a range of issues that shape these individuals' experiences and their health disparities. The committee relied on this framework and on recognized differences in age cohorts, such as those discussed earlier, in presenting information about the health status of LGBT populations.

Along with a life-course framework, the committee drew on the minority stress model ( Brooks, 1981 ; Meyer, 1995 , 2003a ). While this model was originally developed by Brooks (1981) for lesbians, Meyer (1995) expanded it to include gay men and subsequently applied it to lesbians, gay men, and bisexuals ( Meyer, 2003b ). This model originates in the premise that sexual minorities, like other minority groups, experience chronic stress arising from their stigmatization. Within the context of an individual's environmental circumstances, Meyer conceptualizes distal and proximal stress processes. A distal process is an objective stressor that does not depend on an individual's perspective. In this model, actual experiences of discrimination and violence (also referred to as enacted stigma ) are distal stress processes. Proximal, or subjective, stress processes depend on an individual's perception. They include internalized homophobia (a term referring to an individual's self-directed stigma, reflecting the adoption of society's negative attitudes about homosexuality and the application of them to oneself), perceived stigma (which relates to the expectation that one will be rejected and discriminated against and leads to a state of continuous vigilance that can require considerable energy to maintain; it is also referred to as felt stigma ), and concealment of one's sexual orientation or transgender identity . Related to this taxonomy is the categorization of minority stress processes as both external (enacted stigma) and internal (felt stigma, self-stigma) ( Herek, 2009 ; Scambler and Hopkins, 1986 ).

There is also supporting evidence for the validity of this model for transgender individuals. Some qualitative studies strongly suggest that stigma can negatively affect the mental health of transgender people ( Bockting et al., 1998 ; Nemoto et al., 2003 , 2006 ).

The minority stress model attributes the higher prevalence of anxiety, depression, and substance use found among LGB as compared with heterosexual populations to the additive stress resulting from nonconformity with prevailing sexual orientation and gender norms. The committee's use of this framework is reflected in the discussion of stigma as a common experience for LGBT populations and, in the context of this study, one that affects health.

In addition to the minority stress model, the committee believed it was important to consider the multiple social identities of LGBT individuals, including their identities as members of various racial/ethnic groups, and the intersections of these identities with dimensions of inequality such as poverty. An intersectional perspective is useful because it acknowledges simultaneous dimensions of inequality and focuses on understanding how they are interrelated and how they shape and influence one another. This framework also challenges one to look at the points of cohesion and fracture within racial/ethnic sexual- and gender-minority groups, as well as those between these groups and the dominant group culture ( Brooks et al., 2009 ; Gamson and Moon, 2004 ).

Intersectionality encompasses a set of foundational claims and organizing principles for understanding social inequality and its relationship to individuals' marginalized status based on such dimensions as race, ethnicity, and social class ( Dill and Zambrana, 2009 ; Weber, 2010 ). These include the following:

• Race is a social construct. The lived experiences of racial/ethnic groups can be understood only in the context of institutionalized patterns of unequal control over the distribution of a society's valued goods and resources.
• Understanding the racial and ethnic experiences of sexual- and gender-minority individuals requires taking into account the full range of historical and social experiences both within and between sexual- and gender-minority groups with respect to class, gender, race, ethnicity, and geographical location.
• The economic and social positioning of groups within society is associated with institutional practices and policies that contribute to unequal treatment.
• The importance of representation—the ways social groups and individuals are viewed and depicted in the society at large and the expectations associated with these depictions—must be acknowledged. These representations are integrally linked to social, structural, political, historical, and geographic factors.

Intersectional approaches are based on the premise that individual and group identities are complex—influenced and shaped not just by race, class, ethnicity, sexuality/sexual orientation, gender, physical disabilities, and national origin but also by the confluence of all of those characteristics. Nevertheless, in a hierarchically organized society, some statuses become more important than others at any given historical moment and in specific geographic locations. Race, ethnicity, class, and community context matter; they are all powerful determinants of access to social capital—the resources that improve educational, economic, and social position in society. Thus, this framework reflects the committee's belief that the health status of LGBT individuals cannot be examined in terms of a one-dimensional sexual- or gender-minority category, but must be seen as shaped by their multiple identities and the simultaneous intersection of many characteristics.

Finally, the social ecology model ( McLeroy et al., 1988 ) draws on earlier work by Bronfenbrenner (1979) , which recognizes that influences on individuals can be much broader than the immediate environment. This viewpoint is reflected in Healthy People 2020. In developing objectives to improve the health of all Americans, including LGBT individuals, Healthy People 2020 used an ecological approach that focused on both individual-and population-level determinants of health ( HHS, 2000 , 2011 ). With respect to LGBT health in particular, the social ecology model is helpful in conceptualizing that behavior both affects the social environment and, in turn, is affected by it. A social ecological model has multiple levels, each of which influences the individual; beyond the individual, these may include families, relationships, community, and society. It is worth noting that for LGBT people, stigma can and does take place at all of these levels. The committee found this framework useful in thinking about the effects of environment on an individual's health, as well as ways in which to structure health interventions.

Each of the above four frameworks provides conceptual tools that can help increase our understanding of health status, health needs, and health disparities in LGBT populations. Each complements the others to yield a more comprehensive approach to understanding lived experiences and their impact on LGBT health. The life-course perspective focuses on development between and within age cohorts, conceptualized within a historical context. Sexual minority stress theory examines individuals within a social and community context and emphasizes the impact of stigma on lived experiences. Intersectionality brings attention to the importance of multiple stigmatized identities (race, ethnicity, and low socioeconomic status) and to the ways in which these factors adversely affect health. The social ecology perspective emphasizes the influences on individuals' lives, including social ties and societal factors, and how these influences affect health. The chapters that follow draw on all these conceptualizations in an effort to provide a comprehensive overview of what is known, as well as to identify the knowledge gaps.

• REPORT ORGANIZATION

This report is organized into seven chapters. Chapter 2 provides context for understanding LGBT health status by defining sexual orientation and gender identity, highlighting historical events that are pertinent to LGBT health, providing a demographic overview of LGBT people in the United States, examining barriers to their care, and using the example of HIV / AIDS to illustrate some important themes. Chapter 3 addresses the topic of conducting research on the health of LGBT people. Specifically, it reviews the major challenges associated with the conduct of research with LGBT populations, presents some commonly used research methods, provides information about available data sources, and comments on best practices for conducting research on the health of LGBT people.

As noted, in preparing this report, the committee found it helpful to discuss health issues within a life-course framework. Chapters 4 , 5 , and 6 review, respectively, what is known about the current health status of LGBT populations through the life course, divided into childhood/adolescence, early/middle adulthood, and later adulthood. Each of these chapters addresses the following by age cohort: the development of sexual orientation and gender identity, mental and physical health status, risk and protective factors, health services, and contextual influences affecting LGBT health. Chapter 7 reviews the gaps in research on LGBT health, outlines a research agenda, and offers recommendations based on the committee's findings.

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• Bronfenbrenner U. The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press; 1979.
• Brooks KD, Bowleg L, Quina K. Minority sexual status among minorities, Sexualities and identities of minority women. Loue S, editor. New York: Springer Science; 2009. pp. 41–63.
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This latter phrase carries quotation marks because it is drawn from the preamble to the Constitution of the World Health Organization ( WHO, 1946 ), which defines health broadly, and appropriately, as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” For the purposes of this report, the committee defines “health” broadly in accordance with this definition. Therefore, health encompasses multiple dimensions including physical, emotional, and social well-being and quality of life.

• Cite this Page Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011. 1, Introduction.
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• URL: https://libguides.depaul.edu/lgbtq

Chapter 1: An Open Invitation to LGBTQ+ Studies

Learning objectives, deborah amory.

Given this definition of LGBTQ+ Studies, we have identified the following learning objectives for the textbook. After having read this textbook, learners should be able to:

• Identify key approaches and debates within the field.
• Distinguish legacies and intellectual histories.
• Define sex, gender, and sexuality.
• Summarize the history of nonnormative genders and sexualities, including homosexuality, bi/pansexuality, and transgender, in terms of queer identity and activism.
• Identify cross-cultural examples of same sex desire and contemporary LGBTQ lives.
• Describe the connections between identities and embodied experiences
• Identify structures of inequality that shape our experience of gender, sexuality, class, race, ethnicity, ability, etc.
• Analyze how key social institutions shape, define and enforce these structures of inequality, both in North America and globally.
• Describe/illustrate several examples of LGBTQ activism, particularly in relation to other struggles for civil rights.
• Recognize that “progress” faces resistance and does not follow a linear path.
• Identify forms of LGBTQ activism globally.
• Define key terms relevant to particular methods of interpreting LGBTQ people and issues, such as anthropology and ethnography; cultural studies and representation; history and primary sources; methods of “queering”.
• Discuss at least one approach in detail.
• Summarize the personal, theoretical, and political differences of the sexual liberation, gay liberation, radical feminism, LGBT civil rights and “queer” movements.
• Explain how various understandings of sexuality and gender differently impact on self- and community-understanding of LGBTQ people.
• Authored by : Deborah Amory. License : CC BY: Attribution

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Peer-reviewed

Research Article

News media coverage of LGBT identities over 10 years in a 400-million-word corpus

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore, Lloyd’s Register Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore

Roles Writing – original draft, Writing – review & editing

Affiliation Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore

Roles Data curation, Formal analysis

Affiliation Lloyd’s Register Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore

• Reuben Ng, 
• Ting Yu Joanne Chow, 
• Wenshu Yang

• Published: April 10, 2024
• https://doi.org/10.1371/journal.pone.0300385
• Reader Comments

This study is the first to analyze LGBT portrayals in a news media dataset over a decade (2010–2020). We selected Singapore as a country of interest, emblematic of a nation grappling with state-encouraged heteronormativity and a remnant colonial law against homosexuality (377A), fraught with calls for its repeal that was only enacted in 2022. Our study is interested in this period bookended by challenge and change, particularly in newspaper portrayals of LGBT narratives. Newspapers are an important source of current information and have the power to shape societal perceptions. We lay the groundwork and provide a framework to analyze news media narratives of other Commonwealth nations with colonial pasts and inherited laws criminalizing LGBT communities.

This study analyzes LGBT portrayals in a 400-million-word news media dataset over a decade (2010–2020). First, we aimed to track the volume of LGBT media coverage over time and elucidate differences in coverage of different identity markers. Second, we aimed to track sentiments on LGBT portrayals. Third, we aimed to track salient narratives circulated about LGBT stories.

The study leveraged a 400-million-word corpus from news media in Singapore, identifying the following target keywords: LGBT , Lesbian , Gay , Bisexual , Transgender , Pink Dot (a local Pride event), 377A . First, coverage volume was tracked using annual changes in keyword mentions per million, elucidating differences in coverage of different sub-groups. Second, sentiment analysis on a valence scale was conducted on LGBT collocates. Third, we distilled salient narratives about LGBT identities using thematic labelling of top-frequency collocates.

First, overall coverage of LGBT steadily increased over the decade, though Gay identities evidenced asymmetrical coverage—outstripping ‘Bisexual’ keywords by seven times, ‘Lesbian’ by four, ‘Transgender’ by two. Second, sentiment scores for Pink Dot (a local pride event) were most positive; Lesbian , Gay , LGBT , Transgender were neutral; Bisexual and 377A dipped slightly negative. Third, topics differed across the four identities: uniquely, ‘Lesbian’ collocates related to sensationalized cinema; ‘Gay’ about hate crimes; ‘Bisexual’ about population surveys; ‘Transgender’ about challenges (transitioning, alienation, suicide).

Conclusions

Practically, we presented a decade-long barometer of LGBT sentiments and themes on a national level, providing a framework to analyze media for more effective communication strategies—applicable to Commonwealth countries with similar inherited colonial laws. Salient repetition through media association may unwittingly frame certain issues negatively; caution is prudent in representing each sub-group adequately, rather than portraying the LGBT identity as monolithic.

Citation: Ng R, Chow TYJ, Yang W (2024) News media coverage of LGBT identities over 10 years in a 400-million-word corpus. PLoS ONE 19(4): e0300385. https://doi.org/10.1371/journal.pone.0300385

Editor: Stefano Federici, University of Perugia: Universita degli Studi di Perugia, ITALY

Received: January 30, 2023; Accepted: February 27, 2024; Published: April 10, 2024

Copyright: © 2024 Ng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data Accessibility: Data are publicly available at www.english-corpora.org .

Funding: We gratefully acknowledge support from the Social Science Research Council SSHR Fellowship (MOE2018-SSHR-004) and the Commonwealth Fund’s Harkness Fellowship in Healthcare Policy and Practice. The funder had no role in study design, data collection, analysis, writing, and decision to publish. There was no additional external funding received for this study.

Competing interests: The authors have declared that no competing interests exist.

Introduction

While there has been invigorated interest in LGBT-related research topics within academia [ 1 ], publications have mostly delved into focus-group data or the analysis of a specific issue within the demographic [ 2 , 3 ]. Comparatively few studies have taken a big data approach to systematically analyze online mainstream news media for overall coverage of LGBT narratives, with research especially lacking in Asian nations [ 4 ], which may be useful for communication strategists or policymakers in evaluating the impact of media messaging on a population’s attitudes toward non-heterosexuality [ 5 ]. In this study, we leveraged a database of over 400 million words over the span of 11 years from 2010–2020 (henceforth referred to as the 2010s decade as shorthand), to identify trends in mainstream media coverage about the LGBT demographic.

Specifically, our study focused on news media coverage of this demographic over the decade. Within Singapore, this demographic occupies a curious societal grey-area, where the state encourages heteronormativity, but does not fully condemn homosexuality. While a law against homosexuality—Penal Code Section 377A (colloquially, 377A), prohibiting homosexual male partners from consensual sexual acts—has existed since the country’s independence in 1965 and only repealed in 2022, the law was tenuously-enforced, existing to placate conservative swathes of society [ 6 , 7 ]. In 2007, the nation’s Prime Minister conceded that 377A was not to be proactively enforced, but would remain unrepealed given its status as societal lightning rod [ 8 ]. Despite this, LGBT groups continued to face polarized resistance [ 9 , 10 ] amidst a struggle to repeal 377A [ 11 ] and against a backdrop of state-encouraged heteronormativity—in which only straight couples are allowed to marry, apply for public housing—mandating the careful negotiation LGBT individuals in a liminal societal space [ 12 ].

Within a culturally conservative Southeast Asia, political and social stressors affect LGBT individuals more than cisgender or heterosexual people: a systematic review of quantitative studies about LGBT Southeast Asians indicate a higher prevalence of mental health difficulties [ 13 ], and suicidal ideation in non-heterosexual Singaporean men [ 14 ]. Ethnographic interviews with gay Singaporean men revealing hesitance to ‘come out’ as gay due to fear of prosecution and discrimination [ 15 ]; and ambivalence at occupying societal marginality [ 16 ].

Such negativity is compounded by representations in media—especially in traditional offline media—that portray LGBT identities as one-dimensional, often ignoring many LGBTQ sub-groups in favor of other, more prominent ones (e.g., gay identities) [ 17 ]. These trends in media representations carry implications in socially constructing and shaping the way LGBT identities are perceived by the wider public [ 18 ], in many cases implicitly constructing them as ‘other’ [ 19 ]. Evidence suggests that mainstream media plays a mediating role in exposing LGBT stories to individuals unfamiliar with, or without LGBT acquaintances in their social circles, mainstreaming themes like tolerance and acceptability [ 20 ], making the mass-mediated medium important to study [ 21 ]. Media scholars also highlight the impact of news media on public perceptions, particularly as certain narratives are foregrounded via agenda setting [ 22 ], mainstreaming and magnifying certain broad narratives [ 23 ], thus shaping perceptions on social issues [ 24 ]. As such, news media must be interrogated for balanced and socially-responsible reporting on LGBT issues due to its mediated impact on community cohesion [ 25 ] and perceptual legitimacy [ 26 ].

The significance of such an undertaking is underscored by the higher susceptibility of LGBT populations to social inequality [ 27 ], discrimination [ 28 ], and hate speech [ 29 ]; impacting mental and physical health: increased risk factors for mental health issues [ 30 ] and healthcare hurdles [ 31 ]. Despite these risk factors, research into this demographic has only gained more traction in recent years [ 1 ]; such pertinent social issues present impetus for researchers to address, and for policymakers to pay crucial attention to.

Research aims and objectives

With an established context highlighting existing issues of marginality of LGBT individuals in Singapore, the mediating role of news media in constructing LGBT identities, and the higher negative health outcomes associated with this marginal demographic, this study conducted an exploratory investigation into three metrics to understand mainstream news media narratives of LGBT in Singapore using big-data corpus analysis. First, we tracked the coverage size of LGBT topics over the decade to establish overall trends in mainstream media foci, and to elucidate if any volumetric differences existed in the coverage of different identity markers. Second, we tracked the average sentiment score of LGBT collocates. Third, we tracked the thematic content of top-frequency LGBT collocates, highlighting the salient narratives circulated about LGBT identities.

Materials and methods

Dataset pre-processing.

All news articles from January 1, 2010, to December 31, 2020, were extracted from the News on the Web Corpus, culminating a dataset of 409,621,090 words. The corpus contains data from web-based newspapers and magazines from 2010 to the present time. Of this dataset, all news articles containing the following keywords were selected as part of the corpus, and split into the following categorial brackets: LGBT identities in general ( LGBT , LGBTQ , GLBT , Homosexual , Genderqueer , Pansexual ), Gay identities ( Gay(s) , including Gay man/men ), Lesbian identities ( Lesbian(s) ), Bisexual identities ( Bisexual(s) , including Bisexuality ), Transgender identities ( Transgender , Transsexual , Transvestite —a term now considered derogatory in modern social contexts (barring reclamation by the community) but included in the study due to its common use in older news articles —Trans Man , Trans Woman ), Pride Event Pink Dot ( Pink Dot , Pinkdot ), and Anti-homosexual law 377A ( 377A , including Penal Code 377A , Section 377A ).

Collocate selection, sentiment coding and thematic analysis

All articles in the selected corpus were subsequently pre-processed by tagging for their word, lemma, and part-of-speech; using these tags, the dataset was cleaned by filtering and removing redundant parts of speech, including—but not exhaustively—proper nouns; personal pronouns like I , he , she , they , them , him , her , us , we , you ; subordinating conjunctions like if , because , unless , so , for; coordinating conjunctions like and , or; articles like a , an , the; forms of ‘be’ (finite/infinitive) like is , are , was , were , be , being , been , am; forms of ‘have’ like have , had , having , has . This filtering process ensured that content-heavy words (i.e., adjectives, nouns, verbs, adverbs) remained, ensuring that subsequent collocate analysis would yield meaningful results.

Our first investigative aim pertained to tracking the coverage size of LGBT topics in the decade. The volume of the following LGBT keyword categories was tracked in mentions per million, per annum from 2010 to 2020: LGBT , Lesbian , Gay , Bisexual , Transgender ; to obtain a big-picture view of changes over time, and establish overall trends in mainstream media foci, and whether any coverage bias (i.e., differences in frequency of mentions indicating a skew in publication focus toward each sub-group) was present in representing various LGBT identity markers.

Our second and third investigative aim involved the analysis of LGBT collocates (i.e., words that co-occurred most frequently and in proximity to our target LGBT keywords). Specifically, our second aim focused on sentiment analysis of LGBT collocates, and the third aim on thematic analysis of LGBT collocates. To obtain this data from our corpus, we shortlisted all LGBT collocates based on the following criteria: First, collocates had to occur in a relevant context within a lexical proximity of ±6 words, coming either before or after the target LGBT keyword.

For instance, a sample of a news article from our selected corpus contained the following line:

She cited the example of families bullying LGBTQ individuals with verbal abuse , harassment , and the performance of religious rituals and prayers over the individual to “correct” their sexuality . [ 32 ] (Published October 14 , 2019)

Within this sample text, the data pre-processing stage removed personal pronoun she , determiner the , prepositions of and with , conjunction and ; leaving meaningful collocates like cited , example , families , bullying , individuals , verbal , abuse , harassment , performance , religious within the lexical proximity (±6 words) of the “LGBT” target keyword.

This process culminated in 8295 unique collocates that met the selection criteria.

Upon qualifying for our selection criteria, these collocates were rated on a valence scale of 1 (very negative) to 5 (very positive) by two independent raters; a validated methodology in tracking sentiment trends over time [ 33 – 38 ]. For instance, in the above example text, words like bullying , abuse , harassment were rated 1 (very negative). Other examples of words in the corpus that were rated 1 were: shocked , disappointed , backlash , disparagingly , scorned , hate-motivated , degrading , cyber-bullying . Words like co-parenting , reassignment , masculine , autobiographical , societal , oft-discussed , duality , transitioning were rated 3 (neutral). Words like affirming , assured , empowered , commendation , praiseworthy , inclusivity , encouragingly , upliftment were rated 5 (very positive). These collocate sentiment values were then used to produce an overall sentiment score—which were averaged and normalized by its frequency of appearance in the corpus.

The results from this process were used to fulfil our second investigative aim of tracking the sentiment score of LGBT collocates. Specifically, each category of keywords LGBT , Lesbian , Gay , Bisexual , Transgender , Pink Dot (the local Pride event), 377A contained a sub-set of associated collocates that were rated on this valence scale.

Our third investigative aim of tracking the thematic content associated with LGBT identities was achieved by obtaining a sample of 100 top-frequency collocates from each keyword category: LGBT , Lesbian , Gay , Bisexual , Transgender , with each identity marker generating a different set of highest-frequency collocates unique to the category. This list was thematically labelled by two independent researchers to track salient narratives encoded in mainstream media. All data pre-processing, text analytics and statistical analyses were conducted in Python 3.7 and Origin Pro 2019b.

Coverage size of LGBT categories over a decade

Over the 2010–2020-decade, coverage (average keyword mentions per million) about the LGBT demographic increased steadily over time in the 400-million-word news media dataset ( Fig 1 ). All the respective trends were statistically significant at p < .01 (taking into account multiple comparisons, using the Bonferroni correction). Slope coefficients were above zero, indicating that the mean increase in coverage of respective keywords were positive, and that this gradual year-on-year slope of increase was significant. It was notable, however, that ‘Gay’ keywords evidenced the highest coverage over the decade, compared to other LGBT keywords ( Fig 2 ).

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Overall increase in mainstream media mentions of LGBT keywords over the decade from 2010 to 2020. Coverage was skewed in favor of keywords related to gay identity markers, followed by transgender identity markers, and with lesbian and bisexual identity markers lagging in comparison.

https://doi.org/10.1371/journal.pone.0300385.g001

Over the span of the decade (2010–2020), comparative disparities in coverage volume were evident. On average, Gay identity markers (keywords including ‘gay(s)’ , ‘gay man/men’ ) were mentioned at a higher frequency than other identity markers; with coverage of this group outstripping Bisexual keywords (including ‘ bisexual(s)’ , ‘bisexuality’ ) by seven times, Lesbian (keywords including ‘lesbian(s) ’) by four, Transgender (keywords including ‘transgender(s)’ , ‘transsexual(s)’ , ‘transvestite(s)’ ) by two, even outnumbering general keywords denoting LGBT identities as a collective whole (including keywords ‘LGBT(Q)’ , ‘GLBT’ , ‘homosexual(s)’ , ‘pansexual(s)’ ).

https://doi.org/10.1371/journal.pone.0300385.g002

Description of sentiment scores of LGBT categories

Overall, the sentiment score of LGBT collocates in mainstream media ( Fig 3 ) hovered around the neutral score of ‘3’. Coverage about Pink Dot was comparatively the most positive (3.24), followed by neutral scores for Lesbian (3.07), Gay, LGBT (3.06), Transgender (3.05). The only set of keywords that dipped slightly below the neutral threshold were Bisexual (2.97) and 377A (2.91).

Sentiment scores are assigned to collocates on a valence scale of 1–5, where 1 (very negative), 3 (neutral), 5 (very positive). Given that a neutral score is denoted by ‘3’, coverage about Pink Dot (the local pride event) was comparatively the most positive, followed by neutral scores for Lesbian, Gay, LGBT, Transgender. The only set of identity marker keywords that dipped slightly below the neutral threshold were Bisexual and 377A (the law against homosexual relations).

https://doi.org/10.1371/journal.pone.0300385.g003

Differing themes among LGBT and its component categories

We delved into the top collocates (descriptors) of the general keyword ‘LGBT’ in Singaporean mainstream media over the 2010–2020-decade, and discuss their thematic significance ( Table 1 ). We further investigated the nuances of L, G, B, and T news narratives by means of their individual top collocates, providing evidence that the keywords Lesbian , Gay , Bisexual , and Transgender evinced different top collocations, suggesting divergence between mainstream depictions of these identities. These differing descriptors associated with each category—i.e., emergent unique standout themes specific to each identity marker—provide qualitative insights into how Singaporean news media construct and commonly portray L, G, B, and T stories.

https://doi.org/10.1371/journal.pone.0300385.t001

Findings suggested that over the 2010–2020-decade, local mainstream media coverage about the LGBT demographic steadily increased, which may be taken as a positive signal toward increasing visibility, representation, and discussion in local mainstream media. However, there was an evident sexuality bias, with the ‘G’ demographic dominating LGBT-related media coverage, leaving the ‘L’, ‘B’ and ‘T’ sub-groups comparatively under-mentioned. The fact that ‘G’ keywords were mentioned over 4 times more often than ‘L’ keywords may indicate a disparity in representation; a finding that is echoed in other LGBT media literature [ 3 , 17 ].

We also found that sentiment scores about LGBT topics in Singapore’s mainstream news media over the 2010–2020 period remained relatively neutral on average. On a valence score of 1 to 5, with 1 being the most negative, 3 neutral, and 5 being the most positive, coverage about Pink Dot was comparatively the most positive (3.24), followed by neutral scores for Lesbian (3.07), Gay and LGBT (3.06), Transgender (3.05). The only set of keywords that dipped slightly below the neutral threshold were Bisexual (2.97) and 377A (2.91). The neutral scores were likely due to adhering to journalistic conventions of state media, delivering news as objectively and impartially as possible. Notably, however, Pink Dot , the local pride event, trended toward the most positivity, since collocates were often in relation to support and solidarity. A measure of caution may also be prudent given that of all LGBT identity markers, bisexuality skewed the most negative in comparison, suggesting that the portrayal of this demographic in mainstream media may benefit from careful messaging, to avoid skewing too negative. The topic of 377A trended toward the most negativity in terms of average collocate sentiment score, which was rather unsurprising given its incendiary nature: its news coverage often accompanied by conversations about pushback , resistance , and rejection from various sects.

‘LGBT’ themes

Thematic analyses suggested that overall, Singapore’s mainstream news media over the 2010–2020 decade overwhelmingly politicized the non-heterosexual identity: the lexical field of legality was frequently represented among the top collocations of ‘LGBT’ as a target keyword. The presence of words like repeal , law , legislation , legal , penal code , supreme court , constitutional debate , appearing in the context of whether 377A ought to be repealed, implies that LGBT issues have become intrinsically politicized and frequently collocated in contexts of legislation. Beyond that, words like petition , activist , movement , campaign , civil , rights , protect , protection suggest that LGBT narratives in mainstream media were also entwined with active campaigning on the grassroots level—reflective of a nation on the cusp of civil change [ 39 ]. In the context of mainstream media having the power to shape public attitudes and perceptions, it may be prudent to consider decoupling the connection between non-heterosexuality as a matter of legality; instead placing more focus on human interest features and away from overt politicization [ 20 ].

Top-frequency collocates also involved words in objection to, and in support of, LGBT causes. The former included pejoratives, running the gamut from the negatively-charged objectionable , issue , oppose , refuse , discretion , discrimination , discriminate , minority , to the outright vitriolic violence , assault , hateful , hate . The latter included positive words connoting to tolerance: allow , accept , tolerate , recognize , reasonable; and celebration of LGBT identities: pride , parade , celebrate , equal , equality , support , openly , march , promote . The theme of social sects, such as religion: Christian , church , catholic , religion , Muslim , and various social groups and relations, such as conservative , school , military , organization , society , social , culture , cultural , ethnicity , friend , parent ; appeared in relation to numerous articles discussing support for, or opposition to, LGBT rights from various points of views. It was noteworthy that of top LGBT collocates, only a small handful were about self-expression and identity: identify , expression , status , sexuality , sex , love ; suggesting that the state of LGBT representation and discussion in mainstream media was largely entrenched within the confines of legality compared to portrayals of self-expression—a trend representative of legal pragmatism within the confines of state-controlled media [ 40 ].

These findings provide food for thought about how LGBT issues have become synonymous with themes about polarized politicization. Given that media content, particularly those produced by state media and thus consumed by a wide audience, help sets the national agenda and contextual lens through which these groups are viewed, it may be prudent to assess whether such stories and themes should continue to percolate in the representation and viewing of this demographic.

‘Lesbian’ themes

Of the top-frequency collocates associated with the ‘Lesbian’ keyword, they shared thematic similarity with ‘LGBT’ collocates in the semantic fields of legality, objection and support, echoing similar polarizing themes. Beyond that, a new set of collocates emerged, particularly about the theme of identity expression, with the presence of more feminine relational terms like female , mother , daughter , feminist . Notably, the emergence of a new theme- largely about film- movie , character , show , scene , story , festival (i.e., film festival ) and feature (i.e., feature film ) suggests increasing representation of lesbian content in films and television, with these features discussed in mainstream news media contexts. The presence of words denoting sensuality and sexual violence: affair , kiss , rape suggest that the contexts of such stories may have had an added element of sensationalism.

‘Gay’ themes

In a similar vein, top-frequency collocates associated with ‘Gay’ as a target keyword contained common themes of legality issues and equal parts objection ( homophobic , discrimination , oppose ) and support ( celebrate , equality , love , movement ) and commonly occur in relation to social—often either religious or conservative —sects. Collocates about film were present ( character , actor , scene , film ); from movie coverage about the demographic, or news about certain celebrities who have publicly come out as gay. Unique themes that emerged included the presence of violence: hate , kill , attack , death , shooting ; in relation to articles published about hate crimes enacted upon gay men (for instance, nightclub and club in relation to a terrorist attack on a gay nightclub in Florida, 2016 [ 41 ]. Notably, aids was a top collocate for this group; owing to the upsetting cultural association linking this identity marker with AIDS, in spite of the possibility of heterosexual transmission [ 42 ]. Overall, these negative words have become collocated with this subgroup, suggesting that more may be done to decouple negativity from their stories—or to include more uplifting news into the mix.

‘Bisexual’ themes

Of the top-frequency collocates associated with the ‘bisexual’ identity marker, the themes of legality, objection and support were similarly present. Uniquely, collocates associated with identity were less affirming compared to the latter categories—containing words relating to uncertainty ( questioning , question ) and including terms from opposite ends of the dichotomized spectrum of sexuality ( straight , heterosexual ; asexual ). The presence of these collocates is emblematic of this sexuality often being comparatively overlooked in a mediatized version of bisexual erasure [ 43 ]. Interestingly, collocates about population studies were common for this group ( research , study , report , population , survey , percent ), and relating to the medical field ( diagnose , blood , mental , health )—from articles and reports that include this target group in nation-wide survey results.

‘Transgender’ themes

Of the top-frequency collocates associated with the ‘transgender’ demographic, common themes of legality, objection and support, and identity were present. Unique collocational themes included myriad challenges faced by this community: for instance, collocates bathroom and restroom are indicative of the struggle many transgender individuals face in using public bathrooms aligned to their gender identity, and pushback from detractors who cite instances of misuse [ 44 ].

Other collocates like military service and troop appeared in relation to a published story from 2016 [ 45 ]: a Singaporean transgender woman sought asylum in the UK to avoid serving reservist time in the military, as she was by then living as a woman and uncomfortable with being in the same bunk as multiple other men. Such news stories gained local traction due to the presence of unique circumstances: transgender women are exempt from performing national service in Singapore only if they have undergone gender-affirming surgery. Similarly, the collocate prison appeared, in relation to the circulation of several stories related to assault of a partner; and a story about a transgender inmate—who had an identification card aligned with his gender identity and had not undergone gender-affirming surgery—sentenced to a male prison; sparking discussion on whether he would potentially be harassed in prison [ 46 ].

Other collocates like murder and suicide made the list due to the increased likelihood of transgender youths and adults being prone to suicide ideation and attempts compared to other demographics [ 47 ]. Collocates about medically transitioning ( treatment , surgery , medical , experience , change ) speak to the experience of pursuing and undergoing sex reassignment surgery. Collocates like social , worker , center were also collocated with this group, against the backdrop of strong social services like the T project, Singapore’s first and only shelter for homeless transgender women [ 48 ].

Lastly, film-related collocates ( character , role , film , show , play , feature ) and professions ( actor , athlete , model ) suggested greater representation for this demographic; though the presence of collocates like athlete due to debates surrounding transgender athletes, with questions on whether elevated testosterone or average strength may give athletes unfair advantages in competitive sporting events [ 49 ].

These findings, taken together, suggest that even among each sub-group (L, G, B, T), certain groups occupy the discursive margins of this already marginalized demographic. Each sub-group contained different issues that may have become salient as top collocates through repetition via media association and frequent reporting—certain themes may have unwittingly been framed as strongly associated with specific groups. These findings suggest that more nuance and a greater diversity of stories may revitalize conversations surrounding these sub-demographics, rather than monolithically and one-dimensionally representing such identities.

This study acknowledges several limitations. First, our corpus is limited to news articles written in English. Further study may be required to elucidate differences in representation, particularly across media written in different languages. Second, our use of big data is a double-edged sword: while we have provided societal-level insights, such socially divisive issues also require nuanced interpretations afforded by close reading (e.g., discourse studies that monitor subtle shifts in tone across individual articles written across a decade). Hence, this study’s conclusions are meant to be interpreted as a large-scale overview of prominent trends in media representation that supplement nuanced analysis of the LGBT discoursal landscape; finer-grained analysis across smaller time-scales may be conducted in follow-up studies. For instance, our collocational methodology may be replicated on a year-by-year level to identify granular stories or themes that were most dominant within that year, for each identity category.

This exploratory study found three main insights about LGBT representation in Singapore mainstream media from 2010 to 2020. First, overall coverage size was significantly following a positive linear increase. However, Gay identity keywords appeared in the corpus more frequently than Lesbian, Bisexual, and Transgender keywords. Second, collocate sentiment scores for Pink Dot were most positive; Lesbian , Gay , LGBT , Transgender were neutral; Bisexual and 377A dipped slightly negative. Third, top LGBT collocates occupied the lexical field of legality; uniquely, ‘Lesbian’ collocates related to sensationalized cinema; ‘Gay’ about hate crimes; ‘Bisexual’ about population surveys; ‘Transgender’ about challenges like transitioning, alienation, and suicide.

Practically, this study presents a replicable framework and lens through which the methodology may be repeated across other Southeast Asian nations that have inherited similar anti-homosexuality laws from old colonial rule. Significantly, these results present a large-scale overview of state media from a large swathe of news articles spanning a decade and provide key insights into how LGBT identities and issues were saliently portrayed in mainstream media.

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Goal: Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender people.

Lesbian, gay, bisexual, and transgender (LGBT) people are more likely to experience certain health-related challenges and disparities. For example, LGBT adolescents are especially at risk for being bullied, which can contribute to them thinking about and dying from suicide or using illegal drugs. School- and family-based interventions can help reduce bullying and violence against LGBT adolescents, address drug use and mental health problems, and improve health.

Healthy People 2030 supports improving the health and well-being of LGBT populations through health behavior objectives, objectives to address systemic problems, and objectives to increase data collection on LGBT health and well-being. Some of these objectives measure LGBT population data, while other objectives have a documented relationship to LGBT populations but may not yet measure LGBT population data.

Collecting population-level data is key to meeting the needs of LGBT people, but not all state and national surveys include demographic questions on sexual orientation and gender identity. Adding comprehensive demographic questions to surveys can help inform effective health promotion strategies for LGBT people.

Objective Status

Learn more about objective types

Related Objectives

The following is a sample of objectives related to this topic. Some objectives may include population data.

Adolescents

Drug and alcohol use.

• Mental Health and Mental Disorders

Public Health Infrastructure

• Sexually Transmitted Infections

Tobacco Use

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• Health Care Access and Quality
• Social and Community Context

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• Healthy People 2030 LGBT Objectives

Assessing the Healthy People 2030 LGBT Objectives

In August 2020, the US Department of Health and Human Services (HHS) released Healthy People 2030 , its set of national public health objectives for the next decade. These data-driven, science-based health objectives look at specific health conditions and behaviors, as well as different populations of people, health settings and systems, and social determinants of health. Taken together, the Health People 2030 objectives provide a robust picture of current and emerging national health challenges and identify goals for the improvement of Americans’ health and wellbeing over the next 10 years. Once again, Healthy People included objectives specific to lesbian, gay, bisexual, and transgender (LGBT) populations. Healthy People 2020 , the predecessor to this current iteration, had two objectives focused on increasing the collection and use of data on LGBT populations and a series of “related objectives” that were relevant, but not specific, to LGBT health. By comparison, the 2030 LGBT objectives are more numerous and detailed. We spoke with ISGMH postdoctoral scholar Christopher Owens , Ph.D., M.P.H., about the Healthy People 2030 LGBT objectives. Owens explained the three main themes of the LGBT objectives and identified three shortcomings of these objectives.

Focus Areas of the Healthy People 2030 LGBT Objectives

Improving the health of LGBT young people “A number of the LGBT objectives focus on sexual and gender minority (SGM) adolescents and youth, particularly high school students in grades 9-12. There is no focus on elementary or middle school students. These objectives are centered on bullying, illicit drug use, and suicide. We know these are major health concerns for SGM adolescents, who are disproportionately affected by all three.”

Increasing the collection of SOGI measures on national surveys “We won’t understand the disparities faced by SGMs at-large and cannot create baseline data about their experiences if we don’t collect data on sexual orientation and gender identity (SOGI) on huge national surveys, such as the Youth Risk Behavior Surveillance System (YRBSS) or the Behavioral Risk Factor Surveillance System (BRFSS). There is a familiar saying among researchers that ‘if you aren’t counted, you don’t count’—we have to ask questions about sexual orientation and gender identity for SGM people to see themselves reflected in surveys themselves and the data collected from surveys. For most large national surveys, individual states decide whether to ask questions about sexual orientation and gender identity—these SOGI measures are considered ‘module’ topics that states can opt into asking in addition to mandatory ‘core’ topics. Healthy People 2030 encourages more states to include SOGI module topics in surveys.”

Improving HIV prevention and care efforts “The 2030 objectives look at reducing HIV infections and improving the HIV care continuum by increasing testing, increasing linkage to care for individuals diagnosed with HIV, and increasing the percentage of people living with HIV who have achieved viral suppression. This is an essential health prerogative because HIV disproportionately affects SGM populations, especially among young sexual minority males and transgender women.”

How Could the Healthy People 2030 LGBT Objectives be Improved?

Stronger transgender student objectives “Healthy People 2030 separates lesbian, gay, and bisexual (LGB) high school students from transgender high school students in their objectives focused on bullying, illicit drug use, and suicidal thoughts. The reason is that we don’t have strong baseline data about transgender, non-binary, and gender diverse students because questions about gender identity aren’t asked in enough nationally representative surveys. We really need to change this so that gender diverse people are counted, so that they are represented in national data, and so that they see themselves reflected in surveys questions.”

Focus on structural disparities “The LGBT objectives don’t address underlying structural disparities like cisgenderism and heterosexism that affect sexual and gender minorities, particularly young people. Objectives or indicators about access to primary care, mental health care services, and HIV care are also missing or left vague—even though we know that there is a shortage of healthcare infrastructure that addresses the needs of SGM people in many areas of the country.”

More precise terminology and measurements “What is bullying and how do we measure it? Where are high school students who identify as non-binary, queer, asexual, or unsure/questioning represented? How is linkage to HIV care beyond an initial CD4 t-cell count test measured? The terminology used in some objectives is too vague to ensure that we measure what we intend to measure, implement changes, and sustain target goals.” 

• Research article
• Open access
• Published: 24 September 2021

Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes

• Sally Crowe 1 ,
• Eleanor Barker 2 ,
• Meg Roberts 3 ,
• Lucy Lloyd 4 ,
• Clara M. de Barros 5 ,
• Ben Rebelo-Harris 5 ,
• Catherine Meads 6 &
• Catherine L. Saunders   ORCID: orcid.org/0000-0002-3127-3218 4  

Research Involvement and Engagement volume  7 , Article number:  64 ( 2021 ) Cite this article

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Conversations about research priorities with members of the public are rarely designed specifically to include people who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers.

Generally, to address this gap, and specifically, to inform future research for CLS, we carried out a rapid review of published research priority sets covering LGBTQ+ topics, and an online workshop to prioritise identified themes.

Rapid review: results.

The rapid review identified 18 LGBTQ+ research priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five addressed transgender and gender non- conforming populations. All of the research priority sets originated from English-speaking, high and middle-income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Prioritization approaches were wide-ranging from personal commentary to expert workshops and surveys. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in this review were then grouped into themes which were prioritised during the workshop.

Workshop: results.

For the workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert to a public involvement in research matching website to take part in an online discussion workshop. Those that took part were offered payment for their time in preparing for the workshop and taking part. Participants personal priorities and experiences contributed to a consensus development process and a final ranked list of seven research themes and participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units added additional context.

Conclusions

From the workshop the three research themes prioritised were: healthcare services delivery , prevention, and particular challenges / intersectionality of multiple challenges for people identifying as LGBTQ+. Research themes interconnected in many ways and this was demonstrated by the comments from workshop participants. This paper offers insights into why these priorities were important from participants’ perspectives and detail about how to run an inclusive and respectful public involvement research exercise. On a practical level these themes will directly inform future research direction for CLS.

Plain English Summary

Conversations about research priorities with members of the public who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers are not common.

We reviewed published research priorities covering LGBTQ+ topics and held an online workshop. The review identified 18 LGBTQ+ research published priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five were on transgender and gender non- conforming populations. Priorities were achieved by different methods such as workshops and surveys. People involved in setting priorities mostly included researchers, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in the review were grouped into themes which were prioritised during the workshop.

For the online workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert and offered payment for their time. Participants personal priorities and experiences contributed to agreeing a final list of seven research themes in priority order. Participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units were helpful.

From the workshop the three top research themes were: healthcare services delivery , prevention, and particular and multiple challenges of people identifying as lesbian, gay, bisexual, transgender or queer. Research themes interconnected in many ways as shown by the comments from workshop participants. This paper describes why these priorities were important from participants’ perspective and offers information about how to run an inclusive and respectful public involvement research exercise.

Peer Review reports

The aim of this research was to orientate future research projects and funding applications, (primarily for CLS), and to develop research priorities in collaboration with LGBTQ+ public, mainly through an online workshop informed by a rapid review. This article describes the process and outcomes of the exercise, with reflections from the team and public participants. This work was not intended to produce a generic LGBTQ+ healthcare research priorities list.

Regarding terminology, in this article we refer to Lesbian, Gay, Bisexual, Transgender, Queer plus (LGBTQ+) public participants. The plus including other forms of identification such as non-binary, asexual and intersex. Elsewhere in the article we refer to sexual and gender minority health in terms of research priorities. Public involvement is used as a short hand phrase to describe a process of working with the public as part of a research process, not as participants of a research study.

Research agendas are often set by public policy, health professionals, guideline developers, researchers and research funders. Less common is the clear and inclusive involvement of the public in research priority decisions. This can lead to research priorities that don’t necessarily reflect the needs and preferences of the public [ 1 , 2 ].

However, the recent growth in reports and descriptions of research priority setting suggests that working in partnership with the public (patients, carers, service users etc.) to determine research priorities is becoming more common, especially with the adoption of frameworks that set out clear methods and considerations for equitable participation [ 3 ]. Examples of frameworks include: James Lind Alliance [ 4 ]; Dialogue Model [ 5 ]; surveys [ 6 ], Q Sort [ 7 ]; and more recently online ‘crowd sourcing’ approaches [ 8 ]. Common features of frameworks for research priority setting with the public are: stated values and expectations; guidance on and considerations for involving the public; a process flow of steps to describe and prioritise research questions or themes and a plan for what happens to priorities [ 9 ].

There is evidence of health inequalities in LGBTQ+ populations, for example in mental health [ 10 ], suicide [ 11 ], substance use [ 12 ], and health screening [ 13 ]. These health inequalities have activated calls to highlight evidence gaps for future research and policy consideration, but also address the needs and concerns of LGBTQ+ people using healthcare systems. While there is strong evidence describing large disparities in health and healthcare outcomes [ 14 ], detailed evidence on how to address these disparities still emerging, not least because of limitations in sexual orientation collection and monitoring in health data used for research. Prioritisation work with public involvement is required to understand where research is most needed.

Published existing research priority sets can help researchers coming to an area of interest assess what appears to be important and to whom. Assembling these publications in a review (scoping or systematic reviews) [ 15 , 16 ] provides further clarity. Combining a review of research priority sets in LGBTQ+ health with LGBTQ+ lived experience of health and social care provides a more complete approach to setting research priorities.

We identified a lack of involvement of people that identify as LGBTQ+ in healthcare research priority setting. Prior to applications for research funding CLS wanted to orientate research ideas towards topics that were considered important and reflect published accounts of research priority setting in LGBTQ+ healthcare.

From a methodological perspective, the growth in reports and descriptions of research priority setting that involve the general public provides more evidence and analysis of different frameworks and approaches, however how these exercises were conducted and who was involved is often under reported making it difficult to assess the exercise and outcomes. Nine common themes of good practice in priority setting [ 17 ] and more recent REPRISE guidance [ 18 ] for reporting accounts of research priority setting helped the team to agree a short set of criteria for appraising published research priority sets for inclusion in the rapid review.

Our approach to this project was therefore inspired by the James Lind Alliance (JLA) [ 9 ] and the Ensuring Value in Health Care Research movement [ 19 ], combining inclusive approaches to research priority setting and an evidence informed approach. This translates to a rapid review of published research priority sets in LGBTQ+ healthcare, and the recruitment of relevant public to provide insights and experiences, primarily through an online workshop.

We used the UK Standards for Public Involvement [ 20 ] to guide our work with the public, and in reporting this project, we use the GRIPP 2 checklist [ 21 ] so that the specific elements of public involvement are described and evaluated.

Rapid review methods

The search strategy was developed and conducted by a medical librarian (EB). Prior to conducting the searches, the search terms were peer reviewed by another medical librarian according to PRESS criteria [ 22 ]. The databases (platforms) Medline (via Ovid), CINHAL (via Ebscohost), Embase (via Ovid), Web of Science (core collection) and PsycINFO (via Ebscohost) were searched from inception to June 2020 with variants of the following search terms, which were in the title and abstract fields, as well as in the subject heading (MESH) term field when these existed in the database. The author team acknowledge the complexity of language associated with gender and sexual identities, that they change over time and that some may be stigmatizing. Our intention with this list of terms was to capture studies that may be relevant to the review acknowledging that some of the search terms reflect historical language rather than current usage.

The Medline search is reproduced below;

((research adj3 (priorit* or agenda* or consult* or consensus)) OR ((patient* or public or stakeholder* or communit*) adj3 (engag* or involv* or empower* or activat* or participat*)) OR (“patient centered research” or “patient centred research”)).ti,ab. OR Health Priorities/.

(homosexual* or gay* or lesbian* or bisexual* or “sexual minorit*” or “sexual orientation” or transsexual* or trans-sexual or transgender* or queer* or “gender fluid” or “gender nonconforming” or LGBT* or non-binary or nonbinary or bisexual or bi-sexual or MSM or MSW or WSW or “men who have sex with men” or “men who have sex with women” or “women who have sex with women” or “gender reassignment” or pansexual or asexual or “sexual identity”).ti,ab. OR exp. Transgender Persons/ or exp. Gender Dysphoria/ or exp. Sexuality/ or exp. Gender Minorities/ or exp. Homosexuality/ or exp. Bisexuality/.

In addition, Google was searched using the following search “research priority setting” AND lgbt (site:.edu OR site:.ac OR site:.gov OR site:.org).

We additionally reviewed references identified from LGBT Magazine Archive and LGBT Thought and Culture Database, searching for the term research priorit*.

We screened abstracts and then full text. Abstracts that only identified health needs rather than research priorities, and sources that identify a very general statement of “more research needed” were excluded. Inclusion criteria for the review were: accounts that identify any LGBTQ+ research priorities; research priority sets based on all methodologies and exercises published in the last 5 years (on the premise that research priorities are time sensitive).

Quality assessment of the priority sets was conducted by (CLS, MR, SC) using adapted from the REPRISE framework. These included; country, population and focus, methods for prioritization, participants in the process, number of priorities, stated strategy/plan for priorities and research-specific calls for action/innovation. We additionally used the Strength of Recommendation Taxonomy (SORT) approach to evaluate the strength of patient-oriented evidence in each paper.

Extracting the priorities and identifying themes was conducted by CLS using an iterative approach, meaning that themes across priorities were developed during the analysis. However, two identified priority sets [ 23 , 24 ] provided lists of priorities that fell under all of the identified priority themes and for the workshop the team combined these two approaches. (CLS, MR and SC) matching the individual priorities from these two sets independently to the identified themes and following discussion a final amalgamated set of themes with example priorities were agreed for discussion in the workshop.

Workshop methods

Criteria for people to apply to participate in the process were that they needed to be 18 years and over, identify as LGBTQ+ and either have good health, or use health and social care services. Experience of chronic and long-term conditions, disability and caring roles were also highlighted. Potential participants needed to be able to speak, read, and understand English. We did not attempt to include those who did not speak and understand English. We limited recruitment of researchers (in LGBTQ+ research or other) as we felt that they already have the potential to influence LGBTQ+ research priorities through their work and publications. We were primarily interested in the views of non-researchers that are less likely to have this influence.. Recruitment was UK wide, from urban and rural settings and we prioritised recruitment of participants from black, Asian and other ethnic minority backgrounds.

Recruitment took place over 3 months, following ethical approval for the work from the University of Cambridge Psychology Research Ethics Committee (Application No: PRE.2020.112). A ‘stakeholder map’ was developed of local (to Cambridge) and national LGBTQ+ community groups and organisations. This was followed up with formal (use of mailing list) and informal (conversations and social media) networking by (MR, SC) and an advert was placed in the ‘People in Research’ matching website [ 25 ].

We specified that ideally participants would have access to a device (laptop, tablet) to join the workshop (as a mobile phone experience would not be optimal), however this was not a barrier to participating. Participants were offered £100 for 1 h of preparation, taking part in a 2-h online discussion and 1 h follow up activity, this is in line with guidance from NIHR Centre for Engagement [ 26 ].

Project information was sent to interested people and organisations with a deadline to respond. Interested candidates were encouraged to make personal contact with the organiser (SC) helping to establish relationships, identify needs to participate fully and troubleshoot/rehearse technical requirements.

Selected participants were sent via email pre workshop materials including; participant information and consent, a workshop programme, an exercise in personal ranking of research themes identified during the rapid review (Additional file 1 ), a participant list (including people’s interests and motivations to take part), and a ‘wellbeing document’ acknowledging that for some participants the discussion might prove painful or triggering and how to address that (Additional file 2). Material was provided in alternative formats to support inclusion of participants with specific disabilities.

A slide set for use during the workshop, and a detailed set of team notes for each step of the process were developed following team conversations. The use of pronouns (e.g., he/him, she/her, they/them) during the workshop was encouraged, but it was not a requirement. Similarly, participants were encouraged to keep their cameras on during the workshop, but again this was not compulsory.

Before the workshop, participants personally ranked the research themes (1 = most important, 7 = least important), considered the research questions in each theme and chose two that they most resonated with. They were encouraged to record their reasons for these choices.

At the workshop, following an introductions exercise and ‘scene setting’ participants split into two smaller groups, with a facilitator, observer/note taker in each. Another member of the team provided technical support across the two groups and was available for any other issues during the workshop. Facilitators had prepared to maintain a safe space for discussion and ensured that all participants had their say on what was important to them.

Participants referred to their workshop preparation and discussed their top two themes. Facilitators made a note of important themes allocating pre-agreed scores (Number 1 theme = 2 points; Number 2 theme = 1 point). Facilitators encouraged participants to share issues that were considered important, but missing from the research themes list. Facilitators ranked the themes accordingly and shared their screens, inviting comments. Ranked scores were combined across the two small groups and the resultant priority themes were assembled during a short break in the workshop. The whole group appraised, discussed and challenged the overall results. Scores were not changed at this stage, but challenges were heard and discussed. The process concluded with sharing next steps, assessing interest in these and thanks to participants.

Following the workshop, the results were analysed by the research team using a narrative summary approach and were shared with participants, who were invited to comment and add to the themes. Some also sent in their pre workshop notes on the themes providing further context and rationale for their choices.

Rapid review results

Initially 7809 abstracts, papers and priority sets were identified from across all sources, following de duplication this reduced to 5061. Of these 155 were relevant identified from abstract screening. Further screening of full texts reduced this to 18 relevant reported research priority exercises of which three were removed as they were ongoing studies [ 27 , 28 , 29 ]. This resulted in 15 relevant studies for the review. After the workshop while writing up this report three additional relevant priority sets were identified and added in, resulting in 18 relevant studies. The three reports added later were not appraised by workshop participants and did not form part of the framework used in the workshop, however we include them for completeness (Fig.  1 ).

Flow chart of literature search and results

Of the 18 research priority sets included, four had a broad sexual and gender minority health focus [ 30 , 31 , 32 , 33 ] three concerned young people (plus school contexts) [ 34 , 35 , 36 ], three focussed on older people [ 37 , 38 , 39 ], one on lesbians [ 40 ] and one on family units [ 41 ]. Six specifically addressed transgender and gender non-conforming populations [ 42 , 43 , 44 , 45 , 46 , 47 ] (Table  1 , included at the end of this manuscript).

All the included research priority sets originate from English speaking, high and middle- income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Their prioritization approaches ranged from personal commentary, literature reviews, expert workshops, surveys, to ‘in person’ public consultation and meetings and workshops. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations. We noted that two studies involved LGBTQ+ public in their process and four provided consistent patient-oriented evidence (SORT criteria A).

Some exercises focussed on small numbers of priorities [ 3 ], others had much larger sets requiring themes and further categorisation.

Of note is that only three exercises had an explicit strategy, action or implementation plan for their priorities, these were direct commissioning (papers for research articles, systematic reviews and meta-analyses) calls, and a special journal issue.

The majority of the exercises [ 13 ] suggested methodological developments such as; new and more sensitive theoretical frameworks, increased implementation science studies, recruiting more minority participants in studies, larger and more diverse research cohorts, and research in outcome measures. Several called for more inclusion of LGBTQ+ people in research priority setting and other aspects of research design.

The included priority sets yielded 123 identifiable priorities for research. Numbers of priorities and their specificity varied across reported priority sets. Some were one word e.g., ‘ depression’ , others were more specific ‘ identifying points of intervention in the pathways through which minority stress impacts depression, anxiety and suicidal ideation and behaviours’ . Some of the shorter word priorities had descriptive context and considerations for researchers and research funders.

There were common themes across the priorities including: research methodology and theory development (e.g. prevalence, comparative designs); intersectionality (e.g. race/ethnicity, deprivation, age, trans health priorities (e.g. healthcare access and quality); health literacy; LGBTQ+ health in relation to families and other settings (e.g. school); health care delivery; health promotion and ill health prevention; mental health, emotional wellbeing and stressors; relationships ; policy evaluation; and sexual health and relationships. The group decided to put to one side priorities concerned with research methodology and theories as this wasn’t in the remit of the study.

The final themes agreed from the research priority sets identified pre-workshop (CLS, SC and MR) were: Health services delivery; Health and social policy; Preventing ill health; Developing or evaluating treatments and interventions; LGBTQ+ specific issues; Particular challenges/intersectionality and Health condition specific.

Workshop results

Workshop recruitment.

Initially the aim for was 10 people to take part, however the recruitment process resulted in 17 potential participants so we expanded our planning to accommodate everyone that applied. On the day 14 took part as three sent apologies beforehand (one for personal circumstances and 2 were work related). Characteristics of participants were diverse and are described in Table  2 ;

There was an intention to have a diverse project and workshop team and this was achieved.

Of the 14 that took part in the project, eight remain connected to the team, and interested in future developments, some have participated in the preparation of this manuscript.

Workshop consensus

The seven themes were ordered into priorities by workshop participants. Firstly, in two smaller groups then a combined list was appraised. The small group results were similar with the identical 1st and 3rd and 7th themes, but also some differences. The collective top three research themes were ‘Health Services Delivery’, ‘Prevention’ with ‘Particular Challenges /Intersectionality’. Table  3 (included at the end of this manuscript) contains the full rank order the research themes with additional comments from workshop participants.

For priority theme 1, ‘Health Services Delivery’ there were common experiences of challenges “Primary care (GP) is the front door, coming out can be exhausting and potentially risky” . Research into effective training, guidance and support for front line workers in health and social care was considered important. The balance of ones’ identity being acknowledged, but not pathologized was also clear, ‘being LGBTQ+ is not an illness’ . Mental health was singled out as very important especially in relation to domestic violence. Finally, a focus on older people (and inclusive care homes) was felt to be missing in this theme.

For ‘Prevention’ research, (priority number 2), many participants wanted to improve the overall health of LGBTQ+ people, for example with cancer screening and HIV prevention. Of particular note was participants’ reflections on issues of bullying and violence, substance misuse and stress which were thought to be generally under reported and addressed. As one participant said “We are here, we have feelings, I need to be cared for sometimes, I want to be able to breathe” “it feels like ‘living in a world of isolation”.

The particular challenges and intersectionality (priority 3) in LGBTQ+ healthcare experiences were vividly described in the workshop, with particular emphasis on race and inequalities. Additionally, stigma particularly in Asian communities, living with neuro diversity and disability were cited as areas research could usefully address. Experiencing racism at work, or in accessing healthcare with “homosexuality on top of that feels like you are the lowest of the low’. Finally, people of colour needed to be part of the research conversation, otherwise intersectionality between gender and sexual identity and race would not be taken seriously. “ We need a stronger focus on how structural racism and colonialism impacts our health care and health care options”.

Other commentary on the themes ranged from inclusion of more working-class LGBTQ+ public in healthcare research, recognising the role of “ factors with roots outside healthcare settings (such as criminal justice, care homes, reporting of violence etc.) for an effective investigation”. There were also observations about different types of research such as population studies where “Poor ‘counting’ which means it is difficult to assess and prevent ill health in this group ”.

Despite achieving general agreement or consensus of the top research themes across the two small groups some people’s priorities weren’t reflected in the top 3. The workshop framework accounted for this and individual challenges to the priority order were discussed, once the whole group reassembled. One example was the lower rank of the research theme ‘Health and Social Policy’. One participant who was familiar with this area through activism was disappointed that others hadn’t seen this as an important research theme. An engaging discussion about the proximity of policy to people’s lives took place and the challenger was content that their point of view had been discussed. There was a similar debate about the different research issues associated with gender non-conforming and transgender needs as distinct from those of lesbians, gay and bisexual people. This is reflected to some extent in the findings in the literature review where transgender research priorities were considered separately in some studies.

The facility for individuals to challenge the results of a group priority setting exercise is an important methodological feature. Whilst these discussions were facilitated, the rank order of research themes weren’t open for re-ranking. Authors were encouraged by the candid and frank exchange of views in the group, who were never intolerant or disrespectful of each other. The workshop closed with participants content with the outcome.

Workshop experience

Participants reflections on their experience of being part of the project and the workshop were submitted during the workshop verbally or in the chat function and after via email.

“It was a great workshop, thank you so much. I must say, it was one of the best conducted ones I have attended, from start to finish”. Clara, workshop participant.

“I'd like to be forward in thanking you for hosting a culturally diverse group. Whether this was organic or thought about doesn't matter; it was extremely welcomed and was very different from other LGBTQ projects/spaces I've been involved with in Cambridge.” Jade, Workshop participant.

“I have been involved in Patient and Public Involvement and Engagement (PPIE) for over three years and this is the first invitation I have had to explore LGBTQ+ matters”. Rumi, Workshop participant.

Researcher and facilitator reflections are also important in exercises such as these, including reflection on how much does identity reflect our approach to the exercise and how we interpret the results?

“as a straight woman facilitating the process, my role is to support and enable participants to speak their truth. I have no vested interest in the outcomes but care greatly about how they are achieved”

“I learned more about is the critical importance of sensitivity and recognition of the tensions people might (very legitimately) bring from difficult experiences/bias/discrimination. I really noticed that use of language, pre-briefings, use of pronouns, pre briefings and careful preparation by the team etc all had an impact on helping participants feel safe and respected and therefore able to express views/discuss/disagree without any difficulties”.

“It has felt extremely validating to work on a project that genuinely puts LGBTQ+ voices at the centre of the research but doesn't put the burden of labour on LGBTQ+ people. It often feels like the only way for LGBTQ+ research to get done is for the LGBTQ+ community itself to initiate, advocate and keep the momentum going, so it was lovely to be part of a project that fully engaged with the community and amplified the LGBTQ+ experience without demanding extensive work from the participants. I felt like a really valued member of the team, and felt my perspective as a queer person was being taken into account at every stage. The thoughts and experiences shared in the workshop and the paper feel very true to my own experience of healthcare and I'm pleased that we've been able to capture them in a tangible and useful way.”

We carried out a rapid review of published accounts of research priority setting in LGBTQ+ healthcare. The results of this informed an online workshop with 14 members of the public that identified as LGBTQ+. In this workshop a consensus was agreed on a priority order of 7 research themes and their associated questions. Priority themes were Health Services Delivery, Prevention, and Particular Challenges and Intersectionality; the other four were prioritised less highly but were nonetheless still identified as important within the exercise. We recognise that this was a relatively small group of people, and that their views will be shaped by their personal experiences, the current sociocultural climate, and maybe even the COVID 19 pandemic. Within each theme there was variety of specific questions and points raised by workshop participants. Workshop participants highlighted the inter connectedness of themes, for example, there were overlaps in themes especially between Intersectionality [ 3 ] and LGBTQ+ Specific [ 4 ] themes where mental health featured in both.

A strength of this exercise has been assembling a set of published existing priority sets in LGBTQ+ research, which shows the breadth of approaches used to establish priorities and more understanding of the nature of participants in these processes, and the breadth of areas where research is had been identified as required. Having developed the themes independently through the rapid literature review we noted that they have a lot of overlap with the research areas defined by the Health Research Classification System which encompass all aspects of health-related research activity [ 48 ].

It has also pointed to a ‘western’ view of LGBTQ+ research, with all the priority setting processes focussing on high- and middle-income countries. This fits with the Western, Educated, Industrialized, Rich and Democratic (WEIRD) [ 49 ] bias in social science research. It is worth noting that although included priority sets were from 2016 onwards, earlier priority sets relating to research priorities in HIV/AIDS from low- and middle-income countries might have addressed this bias.

Another strength is the ethnic diversity, age and inclusion of people that experience disability in different forms that took part in the workshop. We set out to recruit people from different backgrounds, ethnicity and contexts, whilst acknowledging the WEIRD context of the prioritisation process, and this was achieved. The rapid literature review showed a tendency not to involve LGBTQ+ non-researcher public in healthcare research priority setting; many participants mentioned the novelty of their experience in this regard “LGBTQ+ folk are overlooked and this definitely could be pursued”.

Strengths in the process were noted by several contributors, such as the critical importance of sensitivity and recognition of the tensions people might bring from difficult experiences, discrimination and homophobia. The careful use of language, pronouns, expectation management and preparation by the team “all had an impact on helping participants feel safe and respected ”. This helped people to express their views, discuss and disagree without any difficulties. The financial incentive to take part helped people commit to the process in terms of their time and they were generous with extra feedback and insights subsequent to the workshop.

There were weaknesses in this exercise . We started with the results of a rapid literature review, rather than from where participants wanted to start [ 50 ]. Many priority setting exercises gather ideas for research themes initially and then prioritise these. This doesn’t discredit our approach and asking for comments on the themes and ‘missed issues’ helped balance up our quicker method. From a methodological perspective, the themes were presented in the same order to all workshop participants; it is possible that this had an unconscious influence on the prioritisation outcomes, although hopefully mitigated through the wider discussion part of the workshop.

We did not involve our participants in the rapid review process due to the scheduling of the project, however some members of the project team identify as LGBTQ+ and provided expertise in relation to search terms, journals etc. and critique on the results. CLS and SC also corresponded with international authors in LGBTQ+ research to inform aspects of the project. Recent research databases such as ‘knowsy’ [ 51 ] will further support work in this area.

We did not attempt to include those who did not speak and understand English, due to the small scale of the project and funding. We stated in recruitment materials and processes that applicants needed to ‘identify under the umbrella of LGBTQ+’. On contact we did not ask them to disclose their identity, but all did. By not seeking participants that have not disclosed their sexual or gender identity is a potential limitation to interpreting our results. The low number of younger people involved in this process is a limitation and might have influenced the nature of priority topic areas identified.

We note that trans healthcare can be very different and separate from LGBTQ+ community health issues generally and that transgender perspectives are represented more fully in the results of the rapid review than from the workshop.

Some participants joined via mobile phone; whilst this wasn’t a barrier to take part it was potentially less satisfying for them. Some participants didn’t come on camera for the workshop, again this wasn’t a barrier to take part but it did make it harder for the facilitators and other participants to connect. Conversely being off camera may have made it easier for some people to take part especially if they weren’t ‘out’ to others about their identity. With a relatively small number of ‘people in the room’ the outputs were always going to reflect the priorities of those taking part. However, as the starting point of the workshop reflected the current published evidence from research priorities in LGBTQ+ research perhaps this represents a balance of approaches and outcomes? Finally, the presentation of the themes (Additional file  1 ) was on the whole descriptive, but in one instance a theme hinted at the result from the rapid review and this may have biased participants view of the themes.

There are implications for LGBTQ+ research from our exercise, both in terms of identified priorities that future research should focus on and on a practical level making sure that the work from this exercise is used and taken forwards CLS is pursuing these currently as an individual researcher. These prioritised themes are also more widely relevant for research funders and commissioners. The second set of implications from this research are in setting a template and reflecting on considerations for involving LGBTQ+ public in strategic research conversations.

Health services delivery, prevention and the intersectionality of sexual orientation and gender identity with other disadvantage were highlighted as research priorities for LGBTQ+ health from workshop participants in this shortened research prioritisation exercise. The challenge now to the research team, the wider LGBTQ+ research community and to research funders is to commission, plan and carry out research that addresses these priorities.

Availability of data and materials

No additional data or materials are available.

Abbreviations

Lesbian, Gay, Bisexual, Transgender and Queer, the + denotes other dimensions of sexuality and gender that may exist

Men who have Sex with Men

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Acknowledgements

Thanks to workshop participants: Katherine Barrett, Mark Caruana, Emily Dixon, Frankie Frangeskou; Rumi Kidwai; Manos Kumar; John Marsh, Jade Pollard-Crowe and Azim Richardson. Thank you also to workshop participants and those that contributed to this paper that wish to remain anonymous. Recruitment was greatly assisted by Cici Carey Stuart from the Encompass Network. Thanks to Elisabeth Sandler for considerations about workshop design and Naoise Murphy for directing us towards the QTI Coalition of Colour and other local groups. Finally, thanks to Katherine Cowan for workshop facilitation.

This project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project reference SPCR-2014-10043 Capacity Building Award 10a SPCR). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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Crowe, S., Barker, E., Roberts, M. et al. Are we asking the right questions? Working with the LGBTQ+ community to prioritise healthcare research themes. Res Involv Engagem 7 , 64 (2021). https://doi.org/10.1186/s40900-021-00298-7

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• Competency within each functional area for working effectively with LGBTQ+ people

LGBTQ+ Social Justice Leadership Development

• Staff and faculty campus-wide who lead their peers toward greater LGBTQ+ inclusion
• Effective student leadership to develop and sustain LGBTQ+ communities throughout the campus

LGBTQ+ Student and Community Development

• Sufficient incoming LGBTQ+ students to ensure a critical mass
• Retention, persistence, and graduation rates of LGBTQ+ students on par with or greater than the general student body
• Development of confident identities with a sense of belonging at the University
• Establishment of habits promoting wellness and resiliency
• Visible and vibrant LGBTQ+ communities throughout the campus

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for stronger lgbt+ communities

LGBT+ Sector Outcomes Framework

Accessibility support, if you require support using our website, please do get in touch: 020 7064 6500 | [email protected], a common outcomes framework for the lgbt+ sector..

This Framework has been produced in collaboration with a range of LGBT+ groups. It seeks to act as an initial reference point for organisations to critically reflect on what outcomes they are best placed to achieve and potential areas of collaboration with others.

In creating this Framework, Consortium aims to help LGBT+ voluntary and community sector organisations identify the difference that their everyday activities have on the people and communities they work with.

In combination with a draft reference list of suggested outcomes measures, the Framework also seeks to act as a tool to help organisations of all sizes demonstrate that they are working towards the most pressing priorities for LGBT+ people in the UK.

The framework sets out a standardised structure of five core areas of impact and associated sub-outcomes, as well as three underlying principles.

Find out more about each of the outcome areas

Healthy living rests on multiple, interconnected dimensions of wellbeing. This includes emotional wellbeing, physical wellbeing and, critically for LGBT+ people, subjective wellbeing – life satisfaction and happiness in oneself and one’s identity.

These can be broken down as follows:

1. Improved personal wellbeing LGBT+ people… • Embrace who they are and feel a positive part of the community • Feel empowered to be themselves • Have improved expectations of what they deserve 2. Improved emotional wellbeing LGBT+ people have… • Improved understanding of minority stress and how it can affect individuals • Improved self-esteem • Improved quality of life • Increased confidence, choice and control Everyone has… • Improved understanding of minority stress and how it can impact individuals 3. Improved physical wellbeing LGBT+ people … • Enjoy the best health and wellbeing for them • Are supported to take control of their own and others' health

To build strong networks for LGBT+ people and those connected LGBT+ people and the wider community, physical and virtual spaces need to be created to connect individuals from all walks of life and celebrate and amplify LGBT+ stories.

1. Facilitating and building capacity for communication among LGBT+ people LGBT+ people have… • Access to physical and virtual spaces which facilitates connections with others • Access to skills-based and interest-based networks • Ways to amplify their stories across various networks and platforms • Accessible support to reduce social isolation 2. Increased discussion and understanding about LGBT+ lives Everyone has… • More exposure to positive messaging and celebration of LGBT+ lives, rather than the current emphasis on issues faced • Increased awareness of LGBT+ lives and their positive contribution across workforce, education, cultural sectors and voluntary sectors 3. Foster diversity in local and public life Everyone has: • Increased exposure to a greater variety of LGBT+ people in local and public life, including in positions of authority • Increased representation among LGBT+ people including those from minority identities, focusing on intersectionality • Improved understanding of minority stress and the effects it can have

Creating safe communities for LGBT+ people means that individuals have safe online or physical spaces to go where they can access support. It also means ensuring that LGBT+ feel not only safe, but empowered to be themselves wherever they are. These can be broken down as follows: 1. Individuals feel safe and supported to be open about themselves LGBT+ people feel… • Safe wherever they are - in public and private spaces including care homes and sheltered housing. • Empowered to come out at work and public forums including work and school. • That they have allies across all life domains Everyone… • Challenges heteronormativity and cisnormativity in education, employment and public places, so ‘coming out’ is no longer required 2. Improved visibility of LGBT+ issues • More compassionate media coverage that respectfully represents stories about LGBT+ people 3. Reduced societal homophobia/ transphobia / biphobia and reduction of harm resulting from it LGBT+ people have… • Increased awareness of safe online and physical spaces for support to build resilience and reduce harm. 4. Greater compassion and fostering of diversity within LGBT+ communities including intersectionality and socio-economic differences LGBT+ people have… • Increased representation, recognition and inclusion for those within multiple minority identities

There is a need to increase the quantity and improve the quality of services for LGBT+ people – placing LGBT+ care within the heart of mainstream services and providing appropriate training to staff. The best services are co-designed with the individuals that they are providing services for. These can be broken down as follows: 1. Increased amount of mainstream support available LGBT+ people have… • Increased provision of partnership-based LGBT+ specialist services • Appropriately affirmative services that are linked to mainstream services • Improved quantity and quality of provision in rural areas • More access to services catering positively to the diverse backgrounds and needs of LGBT+ individuals. 2. Services are confident in welcoming LGBT+ people and vice versa: Services have… • Improved understanding and awareness of LGBT+ needs and experiences including those with multiple minority identities. 3. Meaningful person-centred approaches in all services and settings: Services have… • Been co-produced with LGBT+ people who use them. • Improved participation of LGBT+ people within decision making processes. • LGBT+ people have… • Support in engaging with services, especially more vulnerable individuals who have had previous negative experiences 4. Improved perceptions of mainstream and specialist services: LGBT+ people feel… • Increased confidence in seeking support and know where to go. • Increased confidence that the challenges they face are not their fault and services should exist to support them

Effective policymaking requires a robust understanding of individuals needs and what works to meet them (or otherwise). By developing more systematic data collection around a common consensus, LGBT+ organisations can better demonstrate the benefits of interventions. Professional bodies and policymakers must also be supported in better understanding LGBT+ specific issues. These can be broken down as follows: 1. Robust evidence of need, including social and economic impact of prejudice: Across the sector there is… • A more common understanding within the sector of what research and evidence is needed. • Increased implementation of sexual orientation and trans status monitoring. • Improved approaches to monitoring and evaluating service use and impact among LGBT+ organisations. 2. Professional Bodies and Policy Makers have increased understanding of LGBT+ issues: Across the sector there is… • Increased provision of training that demystifies LGBT+ issues. • More systematic, comparative analyses of LGBT+ monitoring data and general population data. • Increased representation of academics on LGBT+ sector boards. 3. Increased LGBT+ influence and ownership: Across the sector there is… • Increased variety of easy-to-access feedback routes to encourage a diversity of LGBT+ participation. • Improved promotion and support of community leaders' voices • Increased representation of LGBT+ individuals, with various experiences and backgrounds, in the public domain. • Core principles and areas of consensus identified by the LGBT+ sector.

Why is this important?

The LGBT+ voluntary and community sector is extremely diverse, composed of a wide range of organisations that vary significantly in size, form and focus.

All of these organisations face significant service pressures in the wake of public/statutory funding reductions for their services, and increased demand as general provision and support has also been reduced for LGBT+ people.

Within this context, organisations face increased competition for resources and more limited opportunities for collaboration. Organisations also have limited resources to direct towards monitoring, evaluation and learning, creating an evidence gap around the achievements of the LGBT+ sector in the UK.

This framework seeks to act as an initial reference point for organisations to critically reflect on what outcomes they are best placed to achieve and potential areas of collaboration with others. In combination with a draft reference list of suggested outcomes measures, it also seeks to act as a tool to help organisations of all sizes demonstrate that they are working towards the most pressing priorities for LGBT+ people in the UK.

How has this been produced?

The framework was co-produced with LGBT+ sector organisation representatives. Traverse – an independent social research and evaluation consultancy – delivered an exploratory workshop in March 2019 to identify if common priorities existed across a subset of LGBT+ organisations.

They then reviewed available literature and created a draft outcomes framework, which was revised by organisations in May 2019.

This was then tested by a wider range of LGBT+ organisations, which fed into the development of the final common outcomes framework.

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LGBT Health and Well-being

Hhs lgbt issues coordinating committee 2015 report.

Introduction

2016 Objectives

2015 Accomplishments

PDF(150 KB)

Introduction:

The U.S. Department of Health and Human Services (HHS) is committed to advancing the equality, health, and well-being of all Americans, including lesbian, gay, bisexual, and transgender (LGBT) individuals and their families. Therefore, the Department is pleased to present notable accomplishments from the past year and highlight HHS’s objectives for the coming year in this fifth annual report on LGBT health and well-being. The Department also wishes to acknowledge the steadfast commitment of colleagues from across HHS, including members of the LGBT Issues Coordinating Committee, who were instrumental in developing this report.  

The Department also recognizes that this year marked a watershed moment for LGBT individuals when the U.S. Supreme Court recognized marriage equality across the entire United States in a historic ruling on June 26 th . Following the Obergefell v. Hodges decision, HHS coordinated a review of relevant programs and policies to determine what guidance or other action might be needed to help ensure the swift and smooth implementation of the decision. The Department anticipates that those efforts will continue into FY 2016.

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FY 2016 Objectives:

1. connecting consumers with quality care through the affordable care act.

Since the passage of the Affordable Care Act (ACA) five years ago, more than 17.6 million uninsured people have gained health coverage, resulting in the largest reduction of uninsured individuals in four decades . At its core, the ACA strives to reduce health inequities, and improve health care access, affordability and quality.

However, the Department recognizes that disparities in health coverage and services for LGBT individuals still exist. In addition, many newly insured individuals are navigating coverage for the first time and may be unsure how to manage health care systems. HHS is committed to implementing the ACA so that its promise is fully realized for everyone and so that consumers are able to become engaged and empowered. We have made great strides towards that goal this year, and we are committed to taking further steps in FY 2016 to improve health care access and enrollment for the LGBT community:

• Non-discrimination protections: Section 1557 - Section 1557, the civil rights provision of the ACA, has been in effect since its enactment. Section 1557 marks the first time that a federal civil rights law has prohibited sex discrimination in health programs or activities, expanding the protections afforded to individuals seeking health care and OCR’s jurisdiction to address discrimination against them. In September 2015, the Office for Civil Rights (OCR) issued a Notice of Proposed Rulemaking (NPRM) entitled, Nondiscrimination in Health Programs and Activities , which incorporates longstanding and familiar civil rights principles. The proposed rule includes discrimination based on gender identity and discrimination based on sex stereotyping in the definition of sex discrimination. As such, the proposed rule specifies that individuals cannot be denied health care or health coverage based on their sex—including their gender identity—and that individuals must be treated consistent with their gender identity, including in access to facilities. The proposed rule also prohibits denial or limitation of sex-specific care just because the person seeking such services identifies as belonging to another gender. Finally, the proposed rule prohibits explicit categorical exclusions of coverage for all health care services related to gender transition. Making clear its commitment, as a matter of policy, to preventing discrimination based on sexual orientation, OCR has solicited comment on how to ensure that the final rule includes the most robust set of protections against discrimination that are supported by the courts on an ongoing basis.

Section 1557 has been in effect since its enactment in 2010. In July 2015, OCR announced its first voluntary resolution agreement under Section 1557, in which The Brooklyn Hospital Center (TBHC) agreed to ensure that transgender patients at TBHC receive appropriate and equitable care and treatment. The voluntary resolution agreement resolved a complaint filed by a transgender individual who alleged discrimination on the basis of sex in the assignment of patient rooms. TBHC committed to revising its Admissions Policy and Procedure to ensure equal access for all patients; implementing an intake process that affords patients an opportunity to provide both their legal name and a preferred name as well as to identify their sex and/or gender; revising its room placement and nondiscrimination policies; and training staff on these policy changes.

OCR plans to issue a final rule implementing Section 1557 in 2016, after considering comments received on the NRPM.

• Gender transition-related care exclusions: As HHS works to ensure that more LGBT people have access to quality, affordable health coverage, we recognize that many transgender individuals are still unable to acquire coverage that adequately meets their needs. Many plans still exclude transition-related care from coverage, whether or not it is determined to be medically necessary by an individual’s provider. The proposed OCR regulation implementing Section 1557 of the ACA would prohibit explicit categorical exclusions in insurance coverage for all health care services related to gender transition or otherwise discriminating against an individual because they are transgender. After the rule is finalized, HHS will disseminate information to issuers highlighting obligations under Section 1557.
• Non-discrimination: Conditions of Participation - By the end of FY 2016, the Centers for Medicare & Medicaid (CMS) expects to issue an NPRM that prohibits discrimination based on sexual orientation or gender identity in the provision of services by participating hospitals and critical access hospitals to patients of Medicare and Medicaid. This NPRM follows the release of guidance in 2011 clarifying the visitation rights of LGBT individuals in Medicare and Medicaid participating hospitals, critical access hospitals, and nursing homes.
• Enhancing Electronic Health Records: As the health care market moves towards streamlined and interoperable methods of collecting and sharing information, we recognize that sexual orientation and gender identity (SOGI) have important health implications, and that processes for sharing that information must be carefully considered and developed. Self-reported sexual orientation and gender identity information collected in electronic health records (EHRs) can be appropriately used to both improve the health care of LGBT individuals and to support the ability to track health outcomes of LGBT individuals in population health. The Office of the National Coordinator for Health Information Technology (ONC) has included requirements for the structured recording of an individual’s sexual orientation and gender identity in the 2015 Edition Health IT Certification Criteria final rule. This requirement is included in the certified EHR technology (CEHRT) definition for the EHR Incentive Programs. Providers may use EHR technology certified to this recording capability to meet the CEHRT definition beginning 2016 and are required to have EHR technology certified to this capability beginning in 2018 to meet the CEHRT definition. The EHR Incentive Programs final rule also specifically emphasizes the inclusion of capabilities to record sexual orientation and gender identity data with certified EHR technology under the EHR Incentive Programs.
• Data Collection in Marketplace Enrollment: The Center for Consumer Information and Insurance Oversight (CCIIO) within CMS will convene a work group to develop a common strategy for the inclusion of SOGI questions in enrollment data. Among other issues, this group will seek to clarify the existing question regarding sex on the federal Marketplace application, provide guidance for state Marketplaces seeking to add SOGI questions to their applications, and explore the feasibility of adding SOGI questions to the federal Marketplace application.
• Cultural Competency for Marketplace-Approved Assisters: CCIIO will provide ongoing LGBT cultural competency training for Marketplace-approved assisters in Federally-facilitated Marketplaces, and will work towards systemic integration of LGBT content into resources and training used for Marketplace consumer support. Specifically, it will continue to educate Navigators, certified application counselors, and non-Navigator assistance personnel through webinar presentations, newsletter updates, and other technical assistance on best practices for reaching and assisting LGBT consumers to help them enroll in coverage through the Marketplaces.

These objectives follow the work that others in the Department have done to encourage and support LGBT enrollment:

In November 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) published Affordable Care Act Enrollment Assistance for LGBT Communities: A Resource for Behavioral Health Providers , which guides health professionals in helping LGBT individuals enroll in health insurance coverage and understand their health insurance options, particularly with regard to mental health and substance abuse benefits and services.

In June 2015, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report, Outreach and Enrollment for LGBT Individuals: Promising Practices from the Field , which described promising practices for Marketplace and Medicaid outreach and enrollment for LGBT individuals.

2. Institutionalizing an HHS Focus on LGBT Health and Well-Being

In the past five years, HHS has taken significant strides towards advancing the health and well-being of LGBT individuals. Recognizing the importance of continuing to reduce the health disparities experienced by the LGBT community, in FY 2016 the Department will move to further institutionalize this work within the Office of the Assistant Secretary for Health (OASH). OASH currently tracks Departmental progress on LGBT initiatives through Healthy People 2020, and has served as a co-chair of the Committee since its inception in 2010. Consequently, the Office is well-positioned to serve as a home for cross-cutting LGBT policy initiatives at HHS. In January 2016, the Assistant Secretary for Health will host a stakeholder listening session to solicit feedback on how to best institutionalize this work.

3. Developing an LGBT Research Working Group

Acknowledging significant health disparities facing LGBT populations, HHS has taken steps to fill the gaps in research that will help the Department understand how to better meet the needs of LGBT communities. In the coming year, the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), and other HHS divisions will convene and open a cross-Department dialogue designed to harmonize efforts and prevent duplication with respect to LGBT research.

4. Removing the Gender Marker from the Medicare Card

As part of the initiative to remove Social Security Numbers from the Medicare card, CMS is taking every permissible step to minimize harassment and violations of privacy throughout the process of obtaining health care services, including removing the gender marker in the card redesign process.

5. Advancing Equality in the U.S. Public Health Service Commissioned Corps

In June 2015, the U.S. Surgeon General established the Sexual Orientation and Gender Diversity Advisory Group in the U.S. Public Health Service Commissioned Corps (USPHS). This is the first officially sanctioned group of LGBT public health officers. The Advisory Group creates a safe space within the Corps to discuss issues and concerns unique to LGBT officers and their allies, acknowledges evolving policies and practices relevant to sexual and gender minorities (SGM) at the state and federal levels, and serves as a resource to provide culturally appropriate and medically accurate care to diverse communities. Recognizing the important role of the nation’s doctor, the Advisory Group also will advise the Surgeon General on health issues faced by LGBT individuals.

In addition, the Surgeon General has tasked senior leadership from the Division of Commissioned Corps Personnel and Readiness to work with colleagues from the other uniformed services in reviewing and reforming policies related to transgender individuals in the uniformed services. The Surgeon General is committed to lifting barriers to commissioning transgender individual into the USPHS.

6. Improving HHS Data to Enhance LGBT Health and Well-Being

HHS will develop an issue brief delineating HHS’s strategy and implementation plans to add SOGI questions to national surveys, administrative data systems, and EHRs. This brief will build on the success of previous Departmental efforts and current HHS data enhancements for LGBT health.

FY 2015 Accomplishments:

The following are key accomplishments from this past year in the area of LGBT health and well-being. In addition to reporting on the commitments we made last year, we also highlight several major accomplishments that were not included in the 2014 report.

Enforcing Civil Rights and Nondiscrimination Protections

The Assistant Secretary for Financial Resources continues to work to extend Departmental non-discrimination policies to HHS discretionary grantees. This effort follows the Department’s previous action to eliminate discrimination through guidance in 2011 that established sexual orientation and gender identity-inclusive non-discrimination policies applicable to services provided to HHS program beneficiaries by HHS employees and contractors.

Reaffirming Access to Preventive Services for All Consumers

In May 2015, CMS issued sub-regulatory guidance clarifying that the preventive services available under the ACA are available regardless of an individual’s gender identity, sex assigned at birth, or recorded gender. More specifically, Section 2713 of the Public Health Service Act, as amended by the ACA, requires most health insurance plans to cover certain recommended preventive services at no out-of-pocket cost to consumers, regardless of gender. In FY2016, the Health Resources and Services Administration (HRSA) will disseminate materials for education, outreach, and training to help providers better understand the importance of access to preventive services for LGBT individuals.

Updating the Blood Donation Deferral Policy

Following the completion of its research analysis, the Food and Drug Administration (FDA) issued draft guidance proposing changes to its Blood Donor Deferral Policy in May 2015. The FDA will convene a series of stakeholder listening sessions throughout the country beginning in early 2016 to hear directly from stakeholders, including the LGBT community and blood donation centers, on how an updated policy can best be implemented and how it can be improved in the future based on the most current and accurate scientific evidence available.

Meeting the Needs of People Living with HIV and AIDS

In 2015, CDC began a four-year demonstration project designed to improve outcomes for gay, bisexual, and other men who have sex with men (MSM) of color. (Up to $60 million from the Secretary’s Minority AIDS Initiative Fund will be invested in the project). Seven health departments—in jurisdictions with a high burden of HIV among Black and/or Latino MSM—will establish collaborations with community-based organizations, clinics and other health care providers, and behavioral health and social services providers to deliver comprehensive HIV prevention and care services for MSM of color.

The HHS Office of Minority Health awarded more than $2 million in grant funding to community-based organizations participating in its HIV/AIDS Initiative for Minority Men (AIMM) program. The AIMM program addresses the unmet needs of young racial and ethnic minority men who have sex with men between the ages of 20-29, young minority males living with HIV/AIDS, or those at high risk for HIV infections.

Supporting LGBT Youth

Ending Conversion Therapy by Supporting and Affirming LGBTQ Youth: In October 2015, SAMHSA published a report on positive and appropriate ways to address distress related to sexual orientation, gender identity, and gender expression with children, adolescents, and their families. This report, which was developed in collaboration with the American Psychological Association and a panel of behavioral health experts, is the first federal in-depth review of conversion therapy. As SAMHSA reported, variations in sexual orientation, gender identity, and gender expression are normal. Conversion therapy is not effective, reinforces harmful gender stereotypes, and is not an appropriate mental health treatment. Beginning this year, SAMHSA will work with partners to broadly disseminate this information to providers and other stakeholders.

Campaign to prevent and reduce youth tobacco use – The FDA has developed a public health education campaign to educate at-risk LGBT young adults about the dangers of tobacco products with the intent of preventing and reducing tobacco use among this priority population. Extensive research with LGBT young adults was conducted as part of the Agency’s rigorous campaign development process, including focus groups in seven cities across the country. The campaign is scheduled to launch in 2016, and will focus on creating a strong presence on social media platforms and at social events.

Addressing the Unique Needs of Other Populations

• Two-Spirit, American Indian, Alaska Native, and Native Hawaiian populations – The Indian Health Service (IHS) hosted a series of listening sessions on LGBT health issues in July and September 2015. IHS also instituted several training initiatives for employees this year that focused specifically on the LGBT and Two-Spirit communities. In addition, IHS funded the National Indian Health Outreach and Education II Cooperative Agreement, which was a one-year limited competition that included $100,000 for HIV/AIDS activities, explicitly inclusive of LGBT populations. Elsewhere in the Department, ACF’s Administration for Native Americans (ANA) hosted staff training on LGBT/Two Spirit issues in the fall of 2015. In addition, ANA will conduct a session on LGBT/Two Spirit issues during its 2016 Tribal Grantee Meeting, which will focus on the services for and needs of LGBT/Two Spirit youth. These efforts complement ANA’s ongoing efforts to leverage existing technical assistance, project development, webinars, and other communications to ensure inclusiveness in all its projects. Lastly, the Office of Intergovernmental and External Affairs will formally integrate Two-Spirit health and human services issues into the 2016 tribal consultation cycle. Tribal consultations are held each year and are designed to solicit Tribes’ priorities and needs on health and human services and programs. The sessions provide an opportunity for Tribes to articulate their comments and concerns on budgets, regulations, legislation, and policy matters. Tribal consultations are held in Washington, DC, and in each HHS Regional Office.
• Refugees, People Seeking Asylum, and Immigrants - The Department supports refugees, people seeking asylum, and those seeking to immigrate to the United States, and is LGBT-inclusive in its efforts. Representatives from ACF, and the Office of Intergovernmental and External Affairs attended events highlighting World Refugee Day (June 20). This stakeholder engagement will continue, and the Department also is exploring ways to strengthen technical assistance, and incorporate this population into ongoing Departmental LGBT initiatives and further engagements.
• Faith-based Communities – In May 2015, the Center for Faith-based and Neighborhood Partnerships (Partnership Center) hosted “Welcoming Faith Leaders,” a convening of faith leaders from across the country to discuss ways in which the faith community and health and human services agencies could partner to address LGBT health disparities. Faith leaders are often the first community partners engaged in addressing health disparities impacting historically underserved populations, including individuals who are LGBT. The Partnership Center will partner with the faith community by providing health-related information and appropriate referrals.

Advancing Data Collection and Research

Data collection.

HHS continues to make progress towards improving data on LGBT populations. In June 2015, ASPE convened the LGBT Data Working Group under the auspices of the HHS Data Council to assess survey questions on sexual orientation and gender identity currently used in HHS surveys, share best practices, coordinate plans, and identify approaches for making the data available for assessing the health and wellbeing of the LGBT population. Elsewhere in the Department, other work is ongoing to ensure that LGBT populations are included in HHS data collection efforts.

• ACF’s Office of Planning, Research, and Evaluation (OPRE) developed and implemented data measures for LGBT youth in foster care as part of the RISE study (Recognize Intervene Support Empower). OPRE worked with the Los Angeles LGBT Center to develop methods for accurate, sensitive, and safe identification of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth in foster care, as well as on the development of evaluation measures to assess family acceptance and cultural competency of families, caregivers, staff, and service systems. The measures were implemented via the Los Angeles Foster Youth Survey and findings are outlined in the report entitled, Sexual and Gender Minority Youth in Foster Care: Assessing Disproportionality and Disparities in Los Angeles . The report represents a first step toward population-based data collection on LGBTQ foster youth and highlights areas where further research can be conducted with LGBTQ youth in foster care.
• Administration for Community Living (ACL) : ACL added questions on sexual orientation to the National Survey of Older Americans Act Participants (NSOAAP), an annual national survey of recipients of select services under the Older Americans Act (OAA). The survey obtains performance outcome information, identifies service gaps, and supports program improvements. The most recent survey in FY 2014 is the first NSOAAP to identify sexual orientation for those receiving services under the OAA.
• CDC’s National Center for Health Statistics will release a report from the second year of sexual orientation data collection on the National Health Interview Survey (NHIS) . The report will include national estimates for health status, access to care and service utilization by sexual orientation using data from the 2014 NHIS .
• CDC’s Youth Risk Behavior Surveillance System (YRBS): For the first time, the 2015 national YRBS questionnaire contained two questions measuring sexual minority status – one on sexual orientation and one on sex of sexual contacts. In addition, the same two questions were added to the standard YRBS questionnaire for the first time. The standard YRBS questionnaire is used by states and cities as a starting point for their own customized YRBS questionnaires.
• CMS is testing sexual orientation and gender identity items for inclusion on the Medicare Current Beneficiary Survey .
• In September 2015, the CMS Office of Minority Health (OMH) unveiled its Equity Plan for Improving Quality in Medicare, which focuses on six priority areas and aims to reduce health disparities in four years.The Plan focuses on Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers accessing care.These include racial and ethnic minorities, SGMs, people with disabilities, and those living in rural areas.
• HRSA’s Bureau of Primary Health Care included SOGI questions in the 2014 Health Center Patient Survey . The public use file will be available in FY2016.
• HRSA’s HIV/AIDS Bureau revised the Ryan White HIV/AIDS Program Services Report in 2014, requiring recipients of Ryan White funding to collect new data, including clients’ sex assigned at birth. (Funding recipients were already required to collect data on clients’ gender).
• The 2014 National Health Service Corps and NURSE Corps Participant Customer Satisfaction Surveys were conducted in June and July 2015, and included a question regarding gender identity for the first time.
• The National Institute of Drug Abuse , a component of NIH , has included sexual orientation and gender identity questions on its Population Assessment of Tobacco Health Study . A longitudinal study of tobacco and health, sexual orientation and gender identity are asked of all adults as well as youth ages 14 and older.
• NIH: The Patient Reported Outcomes Measurement Information System project added targeted recruitment of additional lesbian, gay, and bisexual cancer patients and survivors through online communities to assist in the development and testing process for new chronic disease measures to ensure items are appropriate for this population
• Office of the Assistant Secretary for Health (OASH ): Healthy People 2020, a national health promotion and disease prevention initiative, added two new objectives in the fall of 2014. One objective is focused on lesbian, gay, and bisexual populations, and the second objective is focused on transgender populations. These objectives track Healthy People 2020 data systems that include any data on or for LGBT populations. There are now six data systems that include validated questions on sexual orientation, and two that include validated questions on gender identity.
• SAMHSA successfully implemented sexual orientation questions in the 2015 National Survey on Drug Use and Health , and data will be publicly available in 2016. SAMHSA has also included sexual orientation in the new Common Data Platform for grantees. The Center for Behavioral Health Statistics and Quality is currently working with the Office of Management and Budget on approaches for the collection of gender identity in administrative systems.
• ACF’s OPRE published an extensive needs assessment report entitled, Human Services for Low-Income and At-Risk LGBT Populations: An Assessment of the Knowledge Base and Research Needs , which documented the human services needs of low-income and at-risk LGBT populations, and areas of future research needs. Additionally, these findings have been abbreviated and divided into briefs in three topic areas: low-income and at-risk LGBT populations , the child welfare system and LGBTQ youth and LGBT adults , and LGBTQ youth (particularly runaway and homeless youth and sexual health).
• CDC’s Office of Minority Health and Health Equity continues to provide technical assistance to the SGM Workgroup on structuring a workgroup survey and administrative process for the review of current epidemiological and intervention activities on LGBT health and to inform consideration of future studies.
• The CMS OMH launched an effort to promote health equity research to support researchers in implementing health services research activities to meet the needs of diverse CMS beneficiary populations.OMH will make available five “seats” (individual users) in its Virtual Research Data Center, which is an online platform for accessing and analyzing CMS data for research purposes.Initially, OMH is focusing on minority populations which are experiencing health care inequities due to race, ethnicity, sexual orientation, gender identity, or a disability.
• The CMS Medicare-Medicaid Coordination Office added six new condition flags to the Chronic Condition Warehouse to promote research on individuals with HIV/AIDS enrolled in Medicare and Medicaid.The new HIV/AIDS-related flags include: HIV screening; antiretroviral medication use; HIV/AIDS health care services contact; HIV/AIDS program participation; and SSA disability-qualifying primary and secondary diagnoses.
• NIH completed its strategic plan for SGM health research and released it to the public in October 2015.
• In August 2015, NIH released an administrative supplement to expand existing research to focus on SGM health.This intra-NIH effort, which involves multiple Institutes, Centers and Offices, is intended to encourage investigation in this underrepresented, yet growing field of research.The application due date is November 30, 2015.
• In the spring of 2015, the National Institute of Child Health and Human Development (NICHD), the National Institute of Allergy and Infectious Diseases, and the National Cancer Institute co-sponsored a workshop to discuss research gaps related to the health care needs of transgender people.This meeting, jointly organized by and supported by NICHD and a conference grant to TransNet, drew together a diverse national group of experts and promising new scientists to advance the state of the science in the study of transgender health and medicine.The workshop area focused on: health disparities; gender identity development across the lifespan; clinical management of gender nonconforming children and adolescents; the safety and efficacy of transgender hormone regimens; innovative research methods; and opportunities for collaboration. A report from the workshop is being developed and several of the papers presented will be published.
• The Office on Women’s Health’s Healthy Weight in Lesbian and Bisexual Women Initiative has completed its landmark ten-city prevention trainings to achieve healthy weight in over 350 lesbian and bisexual women.The study tested a culturally sensitive 12 to 16-week curriculum focusing on healthy weight.In addition, two sites (San Francisco and Washington D.C) developed and tested a provider curriculum.The final results of this successful project (seven journal articles) were published in a supplement of the journal Women’s Health Issues in the fall of 2015.

In 2010, the Secretary of Health and Human Services established a Department-wide LGBT Issues Coordinating Committee in response to the President’s directive to identify steps the Department could take to improve the health and well-being of the LGBT community. The Committee, on behalf of the Secretary, developed the Secretary’s Recommended Actions to the President to Improve LGBT Health and Well-Being, which were sent to the President and released to the public in 2011. This fifth annual report demonstrates the Department’s commitment to these issues in the coming year and beyond. While the Department has made significant strides with regard to LGBT health and human services, HHS recognizes that there is more work to be done. The Department looks forward to the continued engagement of health experts, advocates, and community members in addition to health care providers and other partners who work hard every day to ensure that LGBT individuals have the same rights, protections, and access to quality affordable health care as all Americans.

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The Good, the Bad, and the Ugly of Real-World AI Use

Join researchers from RTI International for an insightful webinar exploring the transformative impact of AI in healthcare, informatics, and the research community. We'll kick off with a brief overview of AI's role in the sector, highlighting its integration with Clinical Decision Support (CDS) systems, applying AI in Large-scale EHR Data Repositories, and how LLMs are more than just Gen AI. Following this, we'll delve into two practical application examples, showcasing AI's real-world benefits. The session will conclude with an examination of AI governance, ensuring ethical and effective implementation, and an engaging Q&A segment. Don't miss this opportunity to learn from experts and gain valuable insights into the future of AI in healthcare.

Learning Objectives

• Understand the Responsible Use of AI in Healthcare through Real-world AI Applications
• Explore Applications of AI in Large-scale EHR Data Repositories
• Discover the Capabilities of Large Language Models (LLMs) for Novel Approaches to Text Analysis

By the end of this webinar, participants will have a comprehensive understanding of AI's current and potential future roles in healthcare, practical insights from real-world applications, and knowledge of the governance frameworks essential for ethical AI implementation.

Laura Marcial, PhD, FAMIA

Laura Marcial is a Health Informaticist who has been working with AMIA for ~21 years. Laura is the Senior Director for the Center for Informatics at RTI International. The center has ~50 staff and includes researchers in Bioinformatics, Environmental informatics, and Health informatics.

Jamie Pina , PhD, MSPH

Jamie Pina is a public health informatician with 20 years of experience in the development, implementation, and evaluation of information systems to support public health practice and research. Jamie is the Scientific Director of Public Health Technology at RTI International.

Daniel Brannock, M.S.

Daniel Brannock is a research data scientist in the Center for Data Science and AI at RTI International, which uses modern data science techniques to progress RTI’s mission to improve the human condition. He has experience leveraging machine learning, Bayesian modeling, clustering, optimization, forecasting, and simulation across a broad array of industries and applications. His research focus is in applying data science in health care data and applications.

Emily Hadley, M.S.

Emily Hadley is a research data scientist at RTI International focusing specifically on responsible AI. In her work, Emily collaborates with subject matter experts to solve complex problems in health, education, and criminal justice using AI, data science, and statistical approaches. Emily’s main research interests are exploring technical and policy approaches to addressing bias, equity, and ethics in data science and AI. Emily leads RTI’s contributions to the NIST AI Safety Institute Consortium. She has presented at numerous conferences, including IEEE Big Data; ACM Fairness, Accountability, and Transparency (FAccT); and the Joint Statistical Meetings (JSM). She has several data science publications and has been quoted about data science research in Scientific American and the New York Times. Emily holds a BS in Statistical Sciences with a second major in Public Policy from Duke University and a MS in Analytics from North Carolina State University.

Dates and Times: Sep 18, 2024 | 1:00 pm - 2:00 pm EDT Type: Webinar Course Format(s): Live Virtual Price: Free Register now Share