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June 2007, Vol 97, No. 6 | American Journal of Public Health 1023-1027
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.086157

RESEARCH AND PRACTICE

Research, Curricula, and Resources Related to Lesbian, Gay, Bisexual, and Transgender Health in US Schools of Public Health

Heather L. Corliss, PhD, MPH, Michael D. Shankle, MPH and Matthew B. Moyer, MPH

At the time of the study, Heather L. Corliss was with the Department of Epidemiology, School of Public Health, University of California, Los Angeles. Michael D. Shankle and Matthew B. Moyer were with the Department of Infectious Diseases and Microbiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pa.

Correspondence: Requests for reprints should be sent to Heather L. Corliss, PhD, MPH, Division of Adolescent/Young Adult Medicine, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 (e-mail: heather.corliss{at}tch.harvard.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

To assess the extent to which public health schools conduct research, offer planned curricula, and provide resources related to lesbian, gay, bisexual, and transgender health, we mailed a self-administered questionnaire to individual department chairpersons at each school. Survey results suggested that departmental lesbian, gay, bisexual, and transgender research and curricular activities extending beyond HIV and AIDS were uncommon in most public health school programs. Expanding lesbian, gay, bisexual, and transgender health research and curricula may help health professionals improve their response to lesbian, gay, bisexual, and transgender health disparities.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
The mission of public health is to ensure societal conditions in which people can be healthy.1 Health services and programs tailored to the cultural characteristics of diverse populations (e.g., racial/ethnic minorities and elderly, lesbian, gay, bisexual, and transgender people) are more effective in addressing health disparities.2–12 Thus, the establishment of culturally competent health care systems (i.e., the integration of knowledge, attitudes, behaviors, practices, and policies that enable effective, quality health services in cross-cultural situations) has been identified as fundamental for achieving the public health mission.13

A growing body of research14–17 identifies some health disparities of the lesbian, gay, bisexual, and transgender population. For example, lesbian, gay, bisexual, and transgender people are at increased risk for experiencing mental health problems,18–31 engaging in substance use and abuse,32–49 and contending with discrimination and violence.50–60 Lesbian, gay, bisexual, and transgender people also encounter unique barriers to accessing and using appropriate health services.18,38,61–68 Consequently, factors associated with sexual orientation and gender identity are increasingly recognized as important to consider in public health practice and research.7,69

In light of the increasing recognition of the health disparities of the lesbian, gay, bisexual, and transgender population, we conducted a survey to examine the extent to which US schools of public health focus on lesbian, gay, bisexual, and transgender health through research and planned curricula. Our 3 primary objectives were (1) to assess overall climate indicators (e.g., sexual orientation nondiscrimination policy, same-sex domestic partner health insurance benefits) for lesbian, gay, bisexual, and transgender people affiliated with public health schools; (2) to measure the prevalence of lesbian, gay, bisexual, and transgender research and curricula; and (3) to establish a baseline to gauge the efforts of public health education to address the health needs of the lesbian, gay, bisexual, and transgender community.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
We designed and piloted a self-administered questionnaire that was mailed (May 2002) to department or division chairpersons (N = 184) of 35 schools of public health in the United States and Puerto Rico. The questionnaire covered 3 main domains: (1) overall climate for lesbian, gay, bisexual, and transgender faculty, staff, and students; (2) lesbian, gay, bisexual, and transgender faculty and student research activities; and (3) planned lesbian, gay, bisexual, and transgender health curricula. Schools and chairpersons were identified through Web sites of the Association of Schools of Public Health and the individual schools.

Nonresponders were targeted for follow-up (September 2002 and April 2003); 102 usable questionnaires were produced from departments and divisions, all schools contacted were represented, and a response rate of 55.4% was generated. Chi-square analysis found that nonresponders did not differ from responders with respect to region of location (P = .19), public or private affiliation (P = .96), or department type (i.e., epidemiology or biostatistics, behavioral or community health, health services or policy, environmental or occupational health, maternal child or international health, or other; P = .51).


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Climate Indicators for Faculty, Staff, and Students
Most schools included sexual orientation in their nondiscrimination policy, although fewer than 50% offered domestic partner health insurance benefits to same-sex partners of faculty, staff, and students (Table 1Go). About one third of the departments indicated the presence of a faculty member known to be lesbian, gay, bisexual, or transgender ("out").


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  		TABLE 1—— School- and Department-Level Lesbian, Gay, Bisexual, and Transgender Climate Indicators: US Schools of Public Health, 2002–2003
 
Indicators of Health Research and Curricula
Overall, 41% of the departments of US schools of public health reported the presence of a faculty member who was conducting any lesbian, gay, bisexual, or transgender health research. However, most of this research was related to HIV and AIDS (Table 2Go). Few respondents (10%) reported that a student in their department had ever completed a doctoral dissertation on lesbian, gay, bisexual, or transgender health. Fewer than 9% of the departments had offered a course in the past 2 years that covered lesbian, gay, bisexual, or transgender health topics extending beyond HIV and AIDS.


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  		TABLE 2—— Prevalence of Faculty and Student Lesbian, Gay, Bisexual, and Transgender Research and Health Curricula in Departments: US Schools of Public Health, 2002–2003
 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
The Institute of Medicine recommends that educational opportunities be expanded to increase public health practitioners’ knowledge of minority health issues.70 The American Public Health Association has adopted policy statements (9819 and 9933) urging educational, research, and funding institutions to improve their capacity to respond to the health disparities of the lesbian, gay, bisexual, and transgender population. Similarly, other health professional organizations formally recognize lesbian, gay, bisexual, and transgender health disparities.71–73 For example, in 2005, the American Medical Association adopted a policy statement (H-295.878) aimed at eliminating lesbian, gay, bisexual, and transgender health disparities through promoting lesbian, gay, bisexual, and transgender health topics in medical education.

The results of this study indicate that, contrary to official American Public Health Association policy, public health schools seldom offer planned curricula that address comprehensive lesbian, gay, bisexual, and transgender health. The unique and varied concerns of the lesbian, gay, bisexual, and transgender population may not be fully recognized within public health educational programs. Lack of knowledge of the full range of lesbian, gay, bisexual, and transgender health needs can lead to suboptimal health services and programs for this population.74 Although HIV continues to be an important concern for the lesbian, gay, bisexual, and transgender community, the public health landscape for lesbian, gay, bisexual, and transgender people is much broader and more complex than matters related solely to sexually transmitted infections. Achieving optimal health will require the public health community to move beyond standard practice and knowledge and to incorporate a perspective that considers the full range of health disparities as well as the multiple dimensions that influence the lesbian, gay, bisexual, and transgender community and its health.75

Limitations of this study included a moderate response rate (although similar to that in other analogous surveys)76,77 and possible changes in departmental characteristics over the 1-year data collection period that may have limited the generalizability of the findings. A lack of detailed information on the nature of reported research and planned curricula also precluded our ability to assess the quality, quantity, and perceived adequacy of lesbian-, gay-, bisexual-, and transgender-related activities within responding departments. The research has, however, established a baseline for future assessment of lesbian, gay, bisexual, and transgender school policies and activities.

Schools of public health may be able to improve their response to the health disparities of the lesbian, gay, bisexual, and transgender population by

These actions may have the potential to improve public health strategies to address the specific health concerns of lesbian, gay, bisexual, and transgender people. Public health schools are strategically positioned to become leaders in the fight to eliminate health disparities in this population. Future investigation to determine whether additional research and training of public health practitioners will contribute to improving the health of this population is warranted.


Figure 1
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  		A man from Nagpur in the west Indian state of Maharashtra, reacts as his photograph is taken during a cultural festival of sexual minorities in Bangalore, India. Source. Photograph by Gautam Singh. Printed with permission of AP Photo.

 

   Acknowledgments
 
We extend our deepest gratitude to Susan D. Cochran at the University of California, Los Angeles, and Anthony J. Silvestre at the University of Pittsburgh for their unwavering support of this project and their assistance with the design of the study and the questionnaire. We also thank the Lesbian, Gay, Bisexual, and Transgender Caucus of Public Health Workers, in official relations with the American Public Health Association, for their dedication to their members and continued support to lesbian, gay, bisexual, and transgender student researchers and professionals.

Human Participant Protection
The study was approved by the institutional review boards of the University of Pittsburgh and the University of California, Los Angeles.


   Footnotes
 
Peer Reviewed

Contributors
Each author contributed to all aspects of the study, including survey design and administration, questionnaire development, participant recruitment, data management and analysis, interpretation of findings, and article preparation.

Accepted for publication May 16, 2006.


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