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  • Striving Towards Health Equity: Understanding the Impact of Discrimination on LGBTQ+ Communities

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    Updated June 27, 2022

    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    For Pride Month, learn how NIMHD is working to understand health disparities that impact SGM populations

    Sexual and gender minority (SGM) populations, including those who are lesbian, gay, bisexual, transgender, or queer (LGBTQ+)1, experience health disparities and face barriers to accessing health care. SGM populations have higher burdens of certain diseases, such as depression, certain cancers, and tobacco-related conditions. But the extent and causes of health disparities are not fully known, mechanisms remain unclear, and more research on how to close these gaps is needed.

    Stigmatization, hate-related violence, and discrimination are still major barriers to the health and well-being of SGM populations. Research shows that sexual and gender minorities who live in communities with high levels of anti-SGM prejudice die sooner—12 years on average—than those living in more accepting communities.

    SGM individuals who are also from racial, ethnic, and/or immigrant minority communities may be even more vulnerable because they face similar barriers, discrimination, and health challenges that are unique to those experienced by all minority populations.

    The National Institute on Minority Health and Health Disparities (NIMHD) is dedicated to understanding the effects of these complex and dynamic intersections and supports research on the role discrimination plays in SGM health disparities. For example, in a recently published study, NIMHD researchers examined whether race and ethnicity influenced any associations that may exist between sexual minority status and substance use (tobacco, cannabis, and alcohol) disorders. Overall, sexual minority adults showed a higher prevalence of substance use and disorders. Racial and ethnic minority individuals who were bisexual showed an even stronger association than heterosexuals. In addition, African American or Black bisexual persons were more than twice as likely to be using tobacco. These results underscore the importance of studying the intersectionality of race and ethnicity with sexual orientation, and the need for increased screening and treatment of substance use disorders among sexual minority adults, especially those from racial and ethnic minority groups.

    While NIMHD continues to delve into the factors of health disparities experienced by SGM populations, large gaps in the understanding of SGM health continue to persist, in part, due to the lack of adequate, consistent, and standardized data collection of sex, sexual orientation, gender identity, and sexual behavior in research studies, administrative records, surveillance databases, and clinical settings.

    The “Don’t Ask, Don’t Know” approach to SGM populations has been a challenge in health care and clinical research. In recent years standardized sexual orientation and gender identity questions have been increasingly incorporated into epidemiological surveys and in electronic health records, so that the era of hidden from sight is ending for SGM populations in clinical and public health studies.

    In addition, the National Institutes of Health Sexual & Gender Minority Research Office, NIMHD, and 17 other components of the agency commissioned a recently published study, “Measuring Sex, Gender Identity, and Sexual Orientation.” This report serves as an important cornerstone for the scientific community to enhance its data collection and improve measurements to fully reflect community experiences and recognize the diversity of the SGM population.

    With enhanced sexual orientation and gender identity (SOGI) data collection, researchers can better track health outcomes and develop tailored prevention strategies, interventions, and treatments to ultimately improve the health and well-being of SGM individuals across the nation. We now ask and will learn to reduce disparities in the SGM community.

    NIMHD envisions an America in which all populations will have an equal opportunity to live long, healthy, and productive lives. By understanding biological, behavioral, environmental, cultural, and structural components that affect SGM health, as well as the role clinical care can play, we can best address health disparities and identify interventions that improve the overall health of the SGM community.


    1 Sexual and gender minority (SGM) populations include, but are not limited to, individuals who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex. Individuals with same-sex or -gender attractions or behaviors and those with a difference in sex development are also included. These populations also encompass those who do not self-identify with one of these terms but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary constructs of sexual orientation, gender, and/or sex. [This study was retracted in March 2018. Details ]

  • Boost Your Community: NIMHD’s Role in Increasing COVID-19 Vaccine Uptake and Community Interventions

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    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    Dr. Eliseo J. Pérez-Stable reflects on National Minority Health Month and how NIMHD supports research projects that increase vaccine uptake.

    April is National Minority Health Month (NMHM), and this year we are joining the U.S. Department of Health and Human Services Office of Minority Health to highlight the key role individuals and organizations can play in helping to reduce health disparities and improve the health of people who are disadvantaged by social and economic conditions, geographic location, or the environment in which they live.

    This year’s theme, “Give Your Community a Boost!,” focuses on the continued importance of COVID-19 vaccination, including COVID-19 boosters, and sharing credible information as important tools to end the COVID-19 pandemic that has disproportionately affected communities already dealing with long-standing social and health inequities. Ongoing vaccination against COVID-19 is the single most important way to blunt the effects of severe disease, the consequences of stress on the health care system, and excess deaths of the most vulnerable people.

    The mission and work of NIMHD has never been more visible and crucial than it is now. NIMHD has been on the frontlines raising awareness about the connection of social determinants of health to the disproportionate impact of COVID-19 on communities experiencing health disparities. Through its mission to lead scientific research to improve minority health and reduce health disparities, NIMHD has established scientific programs to respond to many COVID-19 issues, such as evaluating interventions to promote testing through the Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) initiative, and conducting community-based research and outreach to provide trustworthy, science-based information through the Community Engagement Alliance (CEAL) Against COVID-19 Disparities. In addition, NIMHD has also supported research projects that are working to directly address misinformation, increase vaccine uptake, and evaluate interventions aimed to improve the health of communities experiencing COVID-19 health disparities across the nation.

    Impact of COVID-19 Outbreak on Minority Health and Health Disparities

    In spring 2020, shortly after the World Health Organization declared the COVID-19 outbreak a global pandemic, NIMHD announced a notice of special interest inviting researchers to apply for funding supplements to evaluate community-level interventions aimed to address the impact of the pandemic on populations that experience health disparities. A few of these supplements included:

    However, it has also become evident that the impact of the COVID-19 pandemic and the mitigation strategies implemented in response that led to closing of businesses have had significant psychosocial, behavioral, socioeconomic, and health impacts, which are exacerbated in populations that experience health disparities and in other vulnerable groups.

    To respond to this, NIMHD is supporting 6 projects through the “Community Interventions to Address the Consequences of the COVID-19 Pandemic among Health Disparity and Vulnerable Populations” funding opportunity announcement (PAR 20-237). These studies are investigating the effects of locally mandated and community-based interventions among American Indian communities, Latino/Hispanic families and day laborers, and vulnerable populations such as people who are incarcerated or homeless. A few examples of these include evaluating:

    • A point of care COVID-19 testing and education program provided by community health workers for justice-involved individuals recently released from incarceration.
    • The impact of COVID-19 mitigation strategies on non-COVID-19 health care utilization for American Indians.
    • A promotores-led intervention to increase COVID-19 mitigation practices such as physical distancing, handwashing, and use of personal protective equipment for Latino day laborers.

    Vaccine Uptake Initiative

    Responding to public health experts’ recommendation on the importance of getting a COVID-19 vaccine, NIMHD has taken a leading role in supporting research to determine which interventions are effective in increasing vaccination rates. In June 2021, NIMHD launched a vaccine uptake initiative, which funds research studies to evaluate interventions designed to promote vaccine uptake and facilitate vaccine access for populations that experience health disparities. The first set of research projects supported are evaluating interventions for African American/Black, Latino/Hispanic, and low-income populations. Using community-engaged research approaches, investigators are working with community leaders, local organizations, and trusted messengers to understand the barriers to and facilitators of receiving a COVID-19 vaccine and to address misinformation, distrust, structural barriers, and vaccine hesitancy. A few of these studies include:

    • A digital health intervention, Tough Talks COVID, for African American young adults (AA-YA) in the South that uses choose your own adventure journeys and digital storytelling to help with vaccine decision making.
    • A smartphone-based embodied conversational agent intervention for African Americans that addresses misinformation using culturally tailored messages developed in collaboration with a Black church alliance in Boston.
    • An intervention providing primary care physicians (PCP) at Federally Qualified Health Centers with educational resources, including an online library of videos, evidence-based text messaging, and concise educational materials to support PCP conversations with patients about the COVID-19 vaccine.

    The consequences of the pandemic will be felt for a very long time, and it is important that we persist and take direct and deliberate action to alleviate the effects of the pandemic. We must continue to encourage access to credible information from trusted sources and develop sustainable and effective interventions to reduce health disparities. As the Director of the Institute, I can confidently confirm NIMHD’s unwavering commitment and support to improve the health of all communities, especially those that have been disadvantaged for far too long.

  • NIH FIRST: Strengthening Inclusive Excellence in Biomedical Research

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    Co-authored by
    Norman E. Sharpless, M.D., Former Director, National Cancer Institute
    Eliseo J. Pérez-Stable, M.D., Director, National Institute on Minority Health and Health Disparities

    NIMHD Director Eliseo J. Pérez-Stable, M.D., and National Cancer Institute Director Norman E. “Ned” Sharpless, M.D., discuss the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) initiative. This NIH Common Fund program aims to enhance and maintain culture of inclusive excellence in the biomedical research community. Drs. Pérez-Stable and Sharpless share information about NIH’s commitment to this program, the first set of awards, and the final request for applications

    Year after year, the number of students from historically underrepresented groups that participate in biomedical research training has slowly increased. Yet today, individuals from underrepresented groups still remain much less likely to be hired as independently funded faculty researchers. This gap is untenable if science is to thrive in the future. NIH is committed to supporting institutions and programs to change this trajectory.

    In September 2021, NIH announced the initial set of awards in the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) program. FIRST funds and supports institutions to recruit diverse cohorts of new faculty and implement and sustain cultures of inclusive excellence where these faculty can thrive, excel, and become independently funded investigators. NIH expects to announce a second set of FIRST awards this summer.

    FIRST has a target budget of $241 million over 9 years, subject to the availability of funds. The NIH Common Fund leads in managing this NIH-wide program, but there is also robust engagement by others across NIH. The NIH Scientific Workforce Diversity Office, the National Cancer Institute (NCI), the National Institute on Minority Health and Health Disparities (NIMHD), the National Heart, Lung, and Blood Institute, and the National Institute of Neurological Disorders and Stroke all collaborate in managing FIRST.

    Our institutes, NCI and NIMHD, are proud to administer the program. NCI is managing the FIRST Faculty Cohort awards and NIMHD is managing the FIRST Coordination and Evaluation Center.

    We spoke to the inaugural class of awardees during a kickoff meeting in October 2021. This was a rewarding moment that reinforced what we consistently have seen, heard, and felt from the start—a deep commitment to this program from all involved. Issuing these awards was momentous, not only for the institutions that received the highly competitive awards, but also for many at NIH who have worked tirelessly to design and develop the program over the past few years.

    Researchers representing the institutions that received the six cohort awards and the Coordination and Evaluation Center award attended the kickoff meeting. Initially, we planned to issue only four cohort awards. But, in response to the many compelling applications we received, the NIH Common Fund and a dozen NIH institutes and centers agreed to contribute additional funds, which allowed us to expand the FIRST Cohort. This was no small feat, and it signals the tremendous commitment to this program across NIH.

    At NIMHD and NCI, we fully support the purpose, goals, and objectives of the FIRST program. These align with

    • NIMHD’s mission and the NIMHD director’s vision to advance the science of minority health and health disparities, which includes strengthening the diversity of the research workforce and building capacity in Minority Serving Institutions
    • NCI programs, such as its flagship diversity training program—the Continuing Umbrella of Research Experiences (CURE)—and new efforts through the NCI Equity and Inclusion Program
    • The NIH UNITE Initiative, which seeks to establish an equitable and civil culture within the biomedical research enterprise and reduce barriers to racial equity in the biomedical research workforce

    We are genuinely pleased with the extramural community’s fervor for FIRST, which has continued to build since the program’s launch in December 2020. Strong interest in FIRST yielded a highly competitive set of applications. It was impressive to see such an array of biomedical research areas represented in the applications and in the programs that received cohort awards.

    The institutions receiving awards plan to hire faculty in areas from cardiovascular disease to environmental studies, infection biology to cancer, mental health to health disparities, and more. This breadth demonstrates the commitment of extramural biomedical research institutions to build a workforce that genuinely reflects our nation and that cultivates inclusiveness so faculty can excel.

    The FIRST program recently issued its third and final cohort funding announcement, RFA-RM-22-008, with applications due July 12, 2022. We strongly encourage the research community to apply and to sustain the enthusiasm you have shown for FIRST.

    This is vitally important work. It is critical that we diversify the biomedical workforce and strengthen inclusiveness at our institutions.

    Our experience launching FIRST gives us a deep optimism for the transformation this program will foster at institutions receiving awards and throughout the extramural research community. Our continued commitment, and the commitment of so many others at NIH to FIRST, is full and unequivocal.