Research Projects

• PI: Heather Corliss
• Funder: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

Type 2 diabetes (T2D) is a critical public health problem affecting the U.S. because it causes enormous morbidity, disability, premature mortality, and financial and social costs to society. Lesbian and bisexual (LB) women may be at elevated risk for developing T2D because they are more likely than heterosexual women to experience obesity and other risk factors linked with T2D such as cigarette smoking, violence victimization, and depressive distress. Nonetheless, knowledge of T2D and how it may disproportionately affect LB women is severely limited. Studies using longitudinal designs that have comprehensively examined how lifestyle, diet, and psychosocial risk factors for T2D may differ between LB and heterosexual women across the life course are virtually nonexistent. In addition, evidence to understand how risk for developing T2D may differ between LB and heterosexual women is inconclusive and limited to four cross-sectional health surveys. To our knowledge, no studies with longitudinal designs have investigated how incidence of T2D may differ between LB and heterosexual women. Furthermore, analytic epidemiological studies examining how sexual-orientation disparities in risk factors for T2D may contribute to LB women’s disparities in occurrence of T2D are nonexistent. Consequently, huge knowledge gaps exist in understanding the extent to which T2D and related risk factors may disproportionately affect LB women. According to the IOM report The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, LB women face large health disparities, and understanding these disparities and how to eliminate them is hampered by methodological complexities involving research with this population. To address these problems and gaps in the literature, SASH researchers are carrying out a rigorous quantitative study using prospectively collected data spanning more than 20 years (1989 through 2011) from nearly 100,000 women participating in the Nurses’ Health Study II. This study will compare incidence of developing T2D among LB women to that among heterosexual women, compare risk factors for T2D in multiple domains (e.g., diet, lifestyle, psychosocial) and over the life course (i.e., from childhood through age 65 years) among LB women to that among heterosexual women, and examine how lesbian and bisexual women’s disparities in risk factors for T2D prospectively explain their disparities in risk for developing T2D. Our study has high potential for public health impact because findings will increase understanding of: 1) the extent to which risk factors for T2D disproportionately affect LB women over a substantial portion of the life course, 2) the extent to which incidence of T2D disproportionately impacts LB women, and 3) potential social and behavioral factors that explain sexual-orientation-based disparities.

• PI: Heather Corliss
• Funder: National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH)
• see video – Identifying risk factors for substance use disparities with LGBT youth – Brigham & Women’s Hospital

Substance abuse and dependence are critical public health problems affecting the U.S. and they cause enormous financial and social burden, morbidity, and mortality. Sexual-minority populations (e.g., lesbian, gay, bisexual [LGB]) are disproportionately affected by substance use, substance use disorders, and co-occurring mental health problems. However, there are almost no empirical investigations among youth that would enable researchers and clinicians to: 1) understand patterns and causes of sexual-orientation disparities in risk for substance use disorders, and 2) elucidate sexual minorities’ barriers to receiving needed substance use treatment and their treatment experiences. Consequently, huge knowledge gaps exist in understanding which subpopulations of sexual-minority youths are most at risk for substance use disorders, their barriers to receiving needed treatment, and effective treatment approaches. The recent Institute of Medicine (IOM) report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, identifies large health disparities in the LGB population, extensive gaps in understanding LGB health, and methodological complexities in conducting LGB research. To address these problems, SASH researchers are carrying out a mixed methods study with the Growing Up Today Study, two ongoing longitudinal cohorts of 27,324 youth begun in 1996 and 2004. This project will focus on a range of substance disorders including alcohol abuse and dependence, drug abuse and dependence, and nicotine dependence. In order to develop targeted, effective, evidence-based preventive and treatment interventions for sexual-minority youth, it is necessary first to: 1) understand the extent to which substance disorders disproportionately impact this population, 2) identify subpopulations at greatest risk, 3) understand causal mechanisms contributing to sexual-orientation-based disparities, 4) identify specific barriers sexual minorities face receiving needed treatment, and 5) identify effective treatment strategies. Our study has high potential for public health impact, as we propose to contribute essential knowledge to all 5 of these critical areas, with a focus on the developmental periods of adolescence and emerging adulthood.

• Co-I: Heather Corliss
• Funder: National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
• see video – Identifying Multilevel Protective Factors for LGBT Youth in North America

A growing body of literature demonstrates dramatic disparities in health between lesbian, gay and bisexual (LGB) and heterosexual youth, including problem substance use, HIV risk behaviors and suicide. In 2011 the Institute of Medicine called for additional research with this population, prioritizing health disparities research as “essential for building solid evidence base” in LGB heath. The IOM report highlights the importance of multilevel social influences on the lives of LGB people, specifying the role of social structures such as families, schools, workplaces, religious institutions and community organizations as critical subjects of study to expand our understanding of the determinants of health in this population. This research directly addresses this need. The goal of this study is to broaden and deepen our understanding of the family, peer, school and community environments that protect young LGB people from involvement in high risk health behaviors, including substance use, HIV risk behaviors and suicide behaviors. This research aims to 1) develop a theoretically grounded approach to promoting health among LGB adolescents based on in-depth knowledge of their community and school environments, and 2) link environmental data, collected using the Inventory, with existing population-based student data to identify factors at the individual, family, peer, school and community levels that protect LGB youth from involvement in health risk behaviors. “Go-along” interviews with 72 youth in diverse locations will be used to elicit in-depth information on LGB adolescents’ perceptions of supportive elements in their schools and communities; this information, in conjunction with published literature, expert review, and psychometric testing, will be used to create an LGB Environment Inventory to characterize policies, programs, resources and other supports for LGB youth that exist in these settings. The Inventory will then be used to measure indicators of support in 120 communities in Minnesota, British Columbia and Massachusetts, using publicly available materials (e.g. websites) and brief contacts with key informants (Aim 1). These community-level data will then be linked with existing student survey data from approximately 3,600 LGB adolescents in these same communities, which will include information about family, peer and individual supports, as well as health behaviors and demographic information (Aim 2). The following hypotheses will be tested: a) higher LGB environment scores for the community and school will be protective against health risk behaviors among LGB youth; b) greater family connectedness and support and a more supportive peer environment will be protective against health risk behaviors among LGB youth, and c) family, peer and individual-level factors will moderate the associations between the LGB environment (community and school) and the health risk behaviors of interest.