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Let’s Discuss – LGBTQ Health Disparities: Gains We’ve Made and Challenges We Face – R2R January 2017 Cyber Seminar

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This discussion is a follow up to our January cyber seminar, “LGBTQ Health Disparities: Gains We’ve Made and Challenges We Face” which focuses on recent challenges and opportunities in understanding LGBTQ disparities and healthcare needs. Now we want to invite you to join in the discussion and give your perspective!


  • Do you have any questions for our presenters, Karen Parker from the National Institutes of Health and Mandi Pratt-Chapman from the George Washington University Cancer Center?
  • Are you involved with the LGBTQ community in your own work? Do you have any “lessons learned” or best practices to share?
  • What are some of the challenges and opportunities you see in understanding LGBTQ health disparities and healthcare needs? How can we address these issues?


We look forward to reading your responses and continuing the conversation!



from the R2R team


Thank you so much to everyone

Thank you so much to everyone who participated in today’s cyber-seminar! We had a fantastic turnout, with over 260 participants worldwide! Thank you so much for distributing the announcement throughout your networks, and for attending.

As promised, I will post the discussion questions here that Karen and Mandi didn’t have time to answer. Please feel free to post additional questions or share your own experiences!


  • Kelly Selwyn brought up, “My program works with mostly rural providers and I am developing a training for them on collecting SOGI demographics from their patients, including intake forms and conversations. Do you have any suggestions on how to encourage providers who are new to collecting this information, specifically how to encourage them to use this training?”


  • Richard Cancio asked, “Do you all not ask the genders of their sexual partners?"


  • Cathryn Burby would like to know, “If a healthcare provider indicated that they would not give a routine clinical breast exam to a transgender woman or pap for a transgender man, could it be for any reason other than discrimination?”


  • Irene Tami asked, “We at MD Anderson Cancer Center are about to start a feasibility trial for evaluating a phone-based intervention for tobacco cessation among sexual and gender minority groups in Houston, Texas. Are you aware any similar efforts in US?”


  • Regina Washington wanted to know, “­What is the plan to work with CenterLink (LGBT HealthLink) and/or local LGBT community centers to reach LGBT people for research projects as a best practice approach?­”


  • Related to the question about how to most sensitively ask patients about their sexual orientation, Nicole Witherell asks, “What is the general idea on how physicians and other sources of data collection can properly screen patients for more complete data? And how can collection sources ensure more safety and security to the LGBTQ community in order to gain the trust of LGBTQ patients required to collect accurate and honest information? Many of these patients are likely fearful of the repercussions of their honesty, and therefore are more likely to withhold information. What kinds of sensitivity trainings are available to physicians and data providers who are willing to learn?”


  • Jackie Baras posed the question, “Do you encounter issues with regards to billing the insurance/Medicare claims particularly surgical services?”


  • Heather Sebero said, “­We are concerned about the political climate and wonder how, when working in a state govt agency (that is federally funded) we navigate this. Many concerns that things are going to get quite a bit more difficult...­”


  • Emma Richardson said, “­I am currently a Physician Assistant student at the University of Colorado. Although I graduate this May, I am interesting in helping my program to better build their transgender health curriculum, so I'd love to connect!­ Also, for now, any specific suggestions for how I can assist my university to make changes to the curriculum?”



  • Jill Price asked, “I'd like to write into our grant a breast screening program for our Trans population in Ohio.  Can we set up a call to see what kind of suggestions you may have?­”


  • Andy Tan suggested, “­One suggestion if not already available - would it be helpful for us to set up a listserv for researchers working on SGM health? Objective is to share valuable resources, link up people who have specific domain interests (e.g., cancer prevention)­”


Dear Kelly and Emma, Here are

Dear Kelly and Emma, 
Here are some resources to help you think about your curriculum and trainings: 

Keep in mind that the GW Cancer Center will be offering training in the year ahead and we are committed to advancing research, including education research in this space.





I don't know of an LGBT-specific telephone-based tobacco intervention elsewhere, but Truth Initiative - - or the CDC Quitline - - may be more in the know.


Hi Irene,

Hi Irene,

I've read your paper on the pilot to assess tobacco use among SGM in Houston, TX. It is nice to meet you.

Check out these two sources below that are reviewed in this systematic review (J. G. M. Lee, A. K.; McCullen, C. A.; Melvin, C. L.  Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: a systematic review.Am J Prev Med 2014;47(6) 823-31)

Burns EK, Deaton EA, Levinson AH. Rates and reasons: disparities in
low intentions to use a state smoking cessation quitline. Am J Health
Promot 2011;25(5S):S59–S65.

Senseman S.E. Making Minnesota’s quitlines accessible to LGBTQ
communities: lessons learned. [Conference Presentation.] Bridging the
Gap: 8th National LGBTQ Health Equity Summit, August 14, 2012,
Kansas City MO.

Also, the chapter by Jack Burkhalter in "Cancer and the LGBT Community" of tobacco cessation cites preliminary work by Gary Humfleet:

Humfleet G, Hall SM. Using telephone-based and internet-based smoking treatments with
LGBT smokers: preliminary findings. Society for Research on Nicotine and Tobacco 18th
Annual Meeting; Hilton Americas Houston Hotel, Houston, Texas: Paper Session PA7-3;
March 13–16, 2012. p. 26.

I hope these are helpful!


Thanks Katy. I will check

Thanks Katy. Nice to meet you too!!! I will check these references out. By any chance do you have a pdf of Burkhalter's chapter?

Thanks, Mandi! I will check

Thanks, Mandi! I will check the links you suggested.




We connected offline, but yes! Partnership is CRUCIAL. Our PCORI Pipeline project is working with several community based organizations along with patient representatives - they are already galvanizing beyond GW to build a citywide coalition. HealthLink does crucial work and I'm excited to join efforts to advance research, technical assistance and clinical care for LGBTQ persons.




Check out Fenway Health's white paper: Asking Patients Questions about Sexual Orientation and Gender Identity in Clinical Settings:

Also, check out their National LGBT Health Education Center which houses webinars and video training, including a session called: "Do Ask, Do Tell! Collecting Data on Sexual Orientation and Gender Identity in Health Centers."

Also, I was remiss in not mentioning the Human Rights Campaign's Healthcare Equality Index - this is an annual survey that is voluntary. Institutions can take the survey to indicate how/whether they are meeting LGBTQ promising practices:

Here is more info on the HEI: and here is a resource guide with examples of exemplar practices:


Andy, check out Karen's

Andy, check out Karen's listserv - I think she is best positioned to weigh in on that...

Hi everyone, 

Hi everyone, 

Someone asked about the citation for the explicit/implicit bias of med students study. My apologies that I ommitted that! Here is the source article and abstract from PubMed:

Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study.



A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers' treatment of sexual minorities. This study examined both explicit bias and implicit bias against lesbian women and gay men among first-year medical students, focusing on two predictors of such bias, contact and empathy.


This study included the 4,441 heterosexual first-year medical students who participated in the baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study, which employed a stratified random sample of 49 U.S. medical schools in fall 2010. The researchers measured explicit attitudes toward gay and lesbian people using feeling thermometer self-assessments, implicit attitudes using the Implicit Association Test, amount and favorability of contact using self-report items, and empathy using subscales of the Interpersonal Reactivity Index.


Nearly half (45.79%; 956/2,088) of respondents with complete data on both bias measures expressed at least some explicit bias, and most (81.51%; 1,702/2,088) exhibited at least some implicit bias against gay and lesbian individuals. Both amount and favorability of contact predicted positive implicit and explicit attitudes. Both cognitive and emotional empathy predicted positive explicit attitudes, but not implicit attitudes.


The prevalence of negative attitudes presents an important challenge for medical education, highlighting the need for more research on possible causes of bias. Findings on contact and empathy point to possible curriculum-based interventions aimed at ensuring high-quality care for sexual minorities.


ALSO: Here is a link to the Burkhalter et al. (2016) white paper - I can't seem to attach the pdf: