Fish, Jessica N.

Tralka, Hannah

Turpin, Rodman E.

Williams, Natasha D.

English

Digital Repository at the University of Maryland

 UNIVERSITY OF MARYLAND PREVENTION RESEARCH CENTER (UMD-PRC) POLICY BRIEF | SEPT, 2020   HEALTHY PEOPLE 2030: NEW LGBT OBJECTIVES Natasha D. Williams, Hannah Tralka, Jessica N. Fish, Rodman E. Turpin INTRODUCTION In August 2020, Healthy People 2030 objectives were released, setting data-driven, population-level health goals to be met over the next decade.1 These national objectives fall into three categories (i.e., core, developmental, or research objectives) and are organized by topic (i.e., health conditions, health behaviors, populations, settings and systems, or social determinants of health).   The inclusion of LGBT people in these objectives is critically important. LGBT populations evidence elevated risk for myriad physical, mental, and behavioral health outcomes, in large part driven by social and structural factors.2–5 Population-based strategies to reduce these risks are limited, in part due to limited data collection about LGBT people and their health.2,6 Healthy People’s recognition of LGBT communities as uniquely vulnerable is an important step in improving the health and wellbeing of LGBT people across the United States.   WHAT’S NEW IN HEALTHY PEOPLE 2030? Table 1 (below) compares the LGBT-focused Healthy People 2020 objectives with those included in Healthy People 2030. There are several notable changes:  Data Collection The data collection objectives for Healthy People 2030 utilizes slightly different language compared to the previous decade’s objectives. Overall, the goal for 2030 is to increase the number of national surveys that collect data on LGBT people. Furthermore, the 2030 objectives retained objectives related to incorporating sexual orientation and gender identity questions in Behavioral Risk Factor Surveillance Survey (BRFSS)7 but dropped the analogous objective for the sexual orientation and gender identity module in Youth Risk Behavior Survey (YRBS).8  LGBT Youth Healthy People 2030 also added clear objectives related to improving the health and wellbeing of LGBT high-school students through reduced substance use, suicidal ideation, and bullying.    Sexual Health All Healthy People 2020 HIV objectives that specified “men who have sex with men (MSM)” have been removed. The objective to reduce syphilis transmission was modified to specify among MSM. KEY POINTS • LGBT data collection remains a priority.  • LGBT youth health is a new and urgent area of focus. • Transgender-related goals are developmental and reflect the importance of ongoing, systematic data collection. • Sexual health objectives related to MSM were largely removed. POLICY RECOMMENDATIONS • Mandate sexual orientation and gender identity data collection in all Health and Human Services data collection efforts.  • Invest in policies, programs, and practices that address LGBT youth substance use, suicidality, and bullying in schools. • Explicitly address MSM populations in policies promoting sexual health.   UNIVERSITY OF MARYLAND PREVENTION RESEARCH CENTER (UMD-PRC) POLICY BRIEF | SEPT, 2020   IMPLICATIONS It is critical that national surveys include sexual orientation and gender identity measures in their data collection. Researchers, policymakers, and other stakeholders cannot adequately prioritize and address health inequities without guidance from data.9 Although some national health surveys have been collecting sexual orientation and gender identity data since the mid-to-late 2000s, the sexual orientation and gender identity modules for the BRFSS and YRBS remain optional.7,8 There also are other national data sources have yet to incorporate these items.10 This leaves researchers and policymakers with an incomplete picture of how to intervene in ways that help to alleviate LGBT health inequities.    Disparities in substance use, suicidal ideation, and bullying for LGBT youth are evident in early adolescence.11 However, there are currently no national health surveys that universally collect sexual orientation and gender identity data among youth, particularly at younger ages.10 These data collection efforts are crucial for understanding and addressing the Healthy People 2030 goals of reducing substance use, suicidal ideation, and bullying among LGBT youth and the programs, policies, and practices that need to be implemented to achieve these goals.   Finally, by removing the MSM-specific language in sexual health-related objectives, general measures of progress in HIV and STI reduction may obscure disparities between LGBT people and their heterosexual and cisgender counterparts. This is especially relevant given the differential risk between these groups, and even within subgroups of the LGBT community.12 Losing this specificity may deter progress in both understanding and addressing persistent disparities in HIV/STI rates, impeding efforts towards LGBT health equity. This is particularly true for local, state, and federal-level policies related to HIV/STI reduction among MSM, which rely heavily on understanding the unique social and cultural context of MSM, including social and structural factors associated with HIV/STI risk (e.g. homophobia). “One size fits all” approaches to policies promoting sexual health inherently exclude MSM, and thus often contribute to disparities in adverse sexual health related outcomes among this population. Although there is a relative dearth of federal-level sexual health promotion policy specific to MSM, sexual health interventions specific to MSM have demonstrated notable success, such as the CDC MPowerment program.13 Policies to reduce sexual health disparities among MSM require a focus on this population, making sexual health objectives specific to this population critically necessary.  REFERENCES 1.  U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030.; 2020. https://health.gov/our-work/healthy-people-2030 2.  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. National Academies Press; 2011. 3.  James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi Ma. Executive Summary of the Report of the 2015 US Transgender Survey. National Center for Transgender Equality; 2016. 4.  Meyer IH. Minority stress and mental health in gay men. Journal of Health and Social Behavior. 1995;36(1):38-56. doi:10.2307/2137286 5.  U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health.; 2010. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health 6.  Sexual orientation data collection and progress toward Healthy People 2010. American Journal of Public Health. 2001;91(6):876-882. doi:10.2105/AJPH.91.6.876 7.  CDC. Behavioral Risk Factor Surveillance System: BRFSS Questionnaires. https://www.cdc. gov/brfss/questionnaires/index.htm 8.  CDC. Youth Risk Behavior Surveillance System. https://www.cdc.gov/healthyyouth/ data/yrbs/index.htm 9.  Cahill SR, Makadon HJ. If They Don’t Count Us, We Don’t Count: Trump Administration Rolls Back Sexual Orientation and Gender Identity Data Collection. LGBT Health. 2017;4(3):171-173. doi:10.1089/lgbt.2017.0073 10.  Human Rights Campaign. 2018 State Equality Index.; 2018. www.hrc.org/sei 11.  Fish, J. N. (in press). Future directions in understanding and addressing mental health among LGBTQ youth. The Journal of Clinical Child and Adolescent Psychology. Advanced online publication. https://doi.org/10.1080/15374416.2020.1815207 12.  CDC. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Updated).; 2020. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf 13.    CDC. Mpowerment: A Community-level HIV Prevention Intervention for Young Gay Men. https://www.cdc.gov/hiv/research/interventionresearch/rep/packages/mpowerment.html SUGGESTED CITATION Williams, N. D., Tralka, H., Fish, J. N., & Turpin, R. E. (2020). Healthy People 2030: New LGBT Objectives. University of Maryland Prevention Research Center. ACKNOWLEDGEMENTS Infrastructure and research support was provided by University of Maryland Prevention Research Center cooperative agreement #U48DP006382 from the Centers for Disease Control and Prevention (CDC). Any interpretations and opinions expressed herein are solely those of the authors and may not reflect those of the CDC.     The University of Maryland Prevention Research Center (UMD-PRC) at the University of Maryland School of Public Health is committed to research, service and training around issues of mental health among LGBTQ+ communities. Its mission is to eliminate existing health disparities and related social injustices experienced by LGBTQ+ persons. The Center is committed to bringing awareness to these inequities, as well as disseminating data, validated tools, and best practices to improve access to quality mental health and health care for these communities. To find out more, please visit sph.umd.edu/center/prc    Table 1. Healthy People 2020 and 2030 LGBT Objectives Crosswalk 2020 2030 Increase the number of population-based data systems used to monitor HP2020 objectives which collect data on (or for) lesbian, gay and bisexual populations Increase the number of national surveys that collect data on lesbian, gay, and bisexual populations  Increase the number of population-based data systems used to monitor HP2020 objectives which collect standardized data that identify lesbian, gay and bisexual populations -- Increase the number of population-based data systems used to monitor HP2020 objectives which collect data on (or for) transgender populations Increase the number of national surveys that collect data on transgender populations  Increase the number of population-based data systems used to monitor HP2020 objectives which collect standardized data that identify transgender populations -- Increase the number of states, territories and the District of Columbia that include questions on sexual orientation and gender identity in the BRFSS Increase the number of states, territories, and DC that include sexual orientation and gender identity questions in the BRFSS Increase the number of states, territories and the District of Columbia that use the provided module on sexual orientation and gender identity in the BRFSS Increase the number of states, territories, and DC that use the standard module on sexual orientation and gender identity in the BRFSS  Increase the number of states and territories that use the provided module on sexual orientation and gender identity in the YRBS -- -- Reduce bullying of lesbian, gay, or bisexual high school students -- Reduce bullying of transgender students (developmental) -- Reduce the proportion of lesbian, gay, or bisexual high school students who have used illicit drugs -- Reduce the proportion of transgender high school students who have used illicit drugs (developmental) -- Reduce suicidal thoughts in lesbian, gay, or bisexual high school students Increase the proportion of men who have sex with men (MSM) who report having been tested for HIV in the past 12 months -- Reduce the proportion of men who have sex with men (MSM) who reported unprotected anal intercourse with a partner of discordant or unknown status during their last sexual encounter -- Reduce new AIDS cases among adolescent and adult men who have sex with men -- Reduce the percentage of young gay and bisexual males in grades 9 through 12 who engage in HIV-risk behaviors -- Increase hepatitis B vaccine coverage among men who have sex with men -- Reduce new hepatitis B infections among high-risk populations—Men who have sex with men Reduce the rate of acute hepatitis B  Reduce domestic transmission of primary and secondary syphilis among males Reduce the syphilis rate in men who have sex with men 

Healthy People 2030: New LGBT Objectives

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Healthy People 2030: New LGBT Objectives

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