To improve the health of the communities they serve, legislators, health care organizations and their community partners need data to implement evidence-based, equitable practices and policies that integrate targeted strategies with community preferences. In the absence of community-based data, invisible and preventable health disparities persist, and health care costs for all soar. And, while research funding has prioritized identifying and addressing health disparities documented across racial and ethnic minority groups for a few decades, much less is known about the health of lesbian, gay, bisexual, transgender, queer and other sexual and gender minorities (LGBTQ+).
The scientific evidence that does exist suggests that LGBTQ+ individuals are more likely to smoke, be overweight, have greater risk of certain cancers, attempt suicide, encounter discrimination, face social stigma, and be less likely to receive appropriate health care than straight and cisgender peers. However, little is known about the factors contributing to these health disparities, and published studies mostly rely on LGBTQ+ research samples living in large, urban areas in coastal states, with very few studies conducted in the Midwest and rural areas.
Elizabeth Baker, Ph.D., M.P.H., CPH, assistant professor of public health at DMU, is leading a research team working to address that lack of LGBTQ+ health data, specifically in Iowa. In June, during LGBTQ+ Pride Month, she and her research partners received a $25,000 grant from Delta Dental of Iowa Foundation to support this effort.
“The overall health of Iowans and health care costs cannot improve without identifying and strategically addressing the health disparities of Iowa’s most marginalized and invisible communities, including LGBTQ+ Iowans,” she says. “The significance and urgency of this work are amplified by Pride events across the country promoting LGBTQ+ visibility and health equity.”
The research will be conducted in the year ahead and will build on the largest statewide health assessment of LGBTQ+ Iowans, which Dr. Baker and her partners from the University of Iowa, the Iowa Cancer Consortium and One Iowa conducted in 2017. Their community report on assessment results may be found here.
In the new assessment cycle, the team will replicate that work with modifications, supported by the grant, to better illuminate oral, mental and vision health disparities among LGBTQ+ individuals. New questions will allow the team to compare disparities among Iowans living in rural and urban areas and assess COVID-19 vaccination uptake and hesitancy, identified by Iowa Governor Kim Reynolds as a critical public health issue.
“Before repeating the assessment, we hope to expand its reach and overall community impact by engaging other stakeholders in Iowa who have vision, mission or strategic goals related to addressing health disparities in the state,” Dr. Baker says. “To fully realize these goals, these stakeholders need access to LGBTQ+ health data to set benchmarks and monitor progress.”
This approach to the assessment is known as community-partnered participatory research (CPPR), which emphasizes authentic community-academic partnerships in all research phases, from study design to results dissemination.Later this summer, the team plans to issue an open call to community, academic and LGBTQ+ partners to join an advisory group that will guide the community health assessment.
“Our approach identifies LGBTQ+ individuals as critical partners in the assessment process, considers the LGBTQ+ community’s historic and current mistrust towards research institutions, adheres to an ethos of cultural humility, and prioritizes diversity in planning and among participants,” Dr. Baker says.
Results of the assessment will be publicly reported next fall. Findings from the 2017 assessment have been presented at local and state conferences and will be highlighted at this year’s annual American Public Health Association conference in Denver in October. Findings have also been published in peer-reviewed journals.
