A new R01 grant from the NIH’s National Heart, Lung, and Blood Institute (NHLBI) was awarded to Lauren Beach, Ph.D., J.D., faculty member at Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) and in the Department of Medical Social Sciences at Feinberg School of Medicine. Beach also serves as Associate Director of the Evaluation, Data Integration, and Technical Assistance (EDIT) Program at ISGMH. Beach’s research focuses on understanding and reducing chronic condition health disparities affecting sexual and gender minority (SGM) populations, particularly bisexual and other non-monosexual populations. This is Beach’s first R01 as a Principal Investigator (PI); Beach’s grant application received a first percentile score, the highest score possible for a NIH grant submission.
We sat down with Beach to discuss her new R01 grant, the benefits of high-quality cohort data, and chronic health challenges facing SGM people today.
What is the new “CHAMBERS” R01 grant about?
Cardiovascular Health Associations with Minority Stress: Biobehavioral Evaluations and Self-Reported Sociopsychological Outcomes by SOGI Status—or “CHAMBERS” for short—is an ancillary study to the CARDIA Cohort, which has been running for 35 years. Cohorts are an important and high-quality source of data for cardiovascular health and the epidemiology of cardiovascular health, and it’s important to evaluate this data to understand the big picture. Historically, none of the NIH-funded cardiovascular cohorts have included measurement of sexual orientation, sex at birth, or gender identity. I saw this gap in the field, which led me to reach out to CARDIA to see if they could add these measures to their study in the upcoming Year 35 exam. In the big picture, CHAMBERS proposes to study cardiovascular risk factors and cardiovascular health among SGM populations at the intersections of race, sex, and socio-economic status. In addition, to leverage the full power of the cohort, CHAMBERS asks SGM participants about the age they came out, the age they were first aware of their gender, and the age they first engaged in same-sex behaviors or attraction, whether sexual or romantic. CHAMBERS also will harmonize sexual orientation and gender identity (SOGI) data collection between CARDIA and another large cardiovascular cohort—the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). NHLBI funded both my R01 as well as another R01 that was led by Dr. Tonia Poteat and Dr. Krista Perreira of the University of North Carolina at Chapel Hill and that adds SOGI measures to that cohort, so we teamed up with Dr. Poteat and Dr. Perreira to pool data sets. We’re asking the same SOGI questions to be able to do that work together and increase diverse representation.
This study will generate data that will inform what cardiovascular disease prevention and the promotion of cardiovascular health and health equity looks like for SGM people. Embedded in the study are also questions about mechanisms. I included measures along the HCHS/SOL study to consider the effect of stigma and resilience on cardiovascular health. We hypothesize that more stigma will associate with more cardiovascular disease and worse outcomes, and that more resilience will have the power to counteract stigma and promote better outcomes.
We look at this not just at the individual and inter-personal level, but also the structural level. I don’t think you can do this work if you don’t consider the structural context in which health is being shaped. An innovative aspect of the study is the geospatial component, which will look at how neighborhood-level factors are associated with cardiovascular health outcomes of SGM populations. By merging the CARDIA data and census data, and using geo-coding to identify where individuals live, we can get more information about a neighborhood’s socio-economic status. Another thing I’ve written into the grant is to look and see how the presence of community resources may also associate with cardiovascular outcomes by SGM status. I’m also looking at hate groups and anti-LGBT community organizations and what the effect of those might be. Our goal is to think holistically about mechanisms, variation, stigma, and resilience at the individual, interpersonal, and structural levels to determine how those factors associate with cardiovascular and SGM health.
What are some of the chronic health challenges SGM people face? How will this study address those challenges?
We know from cross-sectional studies that were led in federal epidemiologic surveillance data sets like the Behavioral Risk Factor Surveillance System or National Health Interview Survey that SGM populations have a higher burden of self-reported diabetes and other various cardiovascular conditions like stroke and heart attack. Because SGM people are more likely to be uninsured and to not have a primary care provider, they often aren’t aware of potential cardiovascular-related diagnoses or risk factors that they may have. CHAMBERS will allow us to detect both diagnosed and undiagnosed cardiovascular risk factors and conditions among CARDIA participants across sexual orientation and gender identity. There are some other large federal studies, like the National Health and Nutrition Examination Survey, that are considered gold standards of data collection that allow researchers to see snapshots of a person’s health, but cannot show or trace changes to a person’s health over time like cohort studies can. What CHAMBERS will do is trace objective measures of cardiovascular disease risk factors and health events over a 35-year history in CARDIA and a 15-year history in HCHS/SOL. Taken together, CHAMBERS represents a step forward for the entire field of SGM health.
How can studies like this be more accessible to the communities most impacted?
CHAMBERS will give us answers that we’ve never been able to find before about what cardiovascular health and cardiovascular disease looks like in SGM populations at intersections of race, ethnicity, and socio-economic status using objective measures. The NIH’s investment in this study represents something important—that SGM health matters. I want to share with the community that this work exists because, for a long time, there’s been this awareness that if you’re following these issues in the media, we just don’t have data to answer questions about SGM public health. Now we’re starting to move in a direction where we will have that data, and I think the public deserves to know.
It makes me feel better knowing that when I go to the doctor’s office years from now, my doctor will have had the opportunity to read studies that published results about cardiovascular health of people like me and not just extrapolated or ignored from other types of data sets. There will actually be work done by and for people like me about my health. That matters.
The last reason I want to make this study known is for public health and data advocates in the community. When they read our research, they’ll be able to engage with it and know what’s going on in SGM populations. They will have the opportunity to reach out to share the findings and get input from advocates and community members about how to approach the work itself. I think you can never underestimate the importance putting the seeds out there because people aware of what’s going on will generate ideas and connect with each other. The point of this work is to improve the health of SGM populations; you can’t do that if you don’t work across the board. Academia can often act as an echo chamber, and that approach is not going to be effective in creating the public health change that we so desperately need to improve the health, lives, and wellbeing of SGM people.
What would you like to see in SGM health research moving forward?
I would like to see cardiovascular health prevention being highlighted within SGM communities, and I also would like to see more cohort studies include questions to identify SGM populations. As we learn more about the mechanisms and pathways that contribute not only to health disparities but health equity in SGM populations, evidence-informed, community-engaged interventions to improve the overall cardiovascular health and wellbeing of SGM people should be funded and evaluated. SGM cardiovascular health is an emerging field, and there are so many potential lines of research that still remain to be explored.
Who are the co-investigators and contributors supporting you in this work?
None of this happens in a vacuum. I have to give tremendous thanks to the CARDIA executive committee and the participants of CARDIA, because without both the leadership of the study and the people showing up to be in it, none of this work is possible. CARDIA is a multi-site study, so there are four data collection sites involved (Birmingham, AL; Chicago, IL; Minneapolis, MN; and the Bay Area, CA). The people involved in the field sites, principal investigators, and centers really helped me because their staff has a lot of expertise on how participants will react. They’ve been talking to CARDIA participants for 35 years, and some of the people in the grant have been there since the beginning. This grant was truly a collaborative effort, and I was really pleased that the CARDIA group that has been doing this work together for so long was willing to welcome me, a new investigator, to talk about a topic that a lot of people might initially consider sensitive. Now is the time to do this work together, and they really showed up and mentored me on how to work with an existing cohort. You have to thank the people who came before you and who help you move along your path.
I want to give additional thanks to Pam Schreiner, James Shikany, Beth Lewis, Steve Sidney, Mercedes Carnethon, Kiarri Kershaw, Diana Chirinos-Medina, Pat Janulis, Gregory Phillips II, Tonia Poteat, Krista Perreira, and HCHS/SOL leadership and study participants.