Hello and welcome to Listen Up People, a podcast
of the USC Suzanne Dworak-Peck School of Social
Work. I'm Dr. Eric Rice, professor and associate
dean for research. My guests today are two prolific
researchers who are dedicated to advancing the
health and wellbeing of the LGBT population.
Overall, LGBT individuals experience significantly
higher rates of health, mental health, and behavioral
health problems than their heterosexual peers.
Yet research on these disparities is under -researched
and lacking. The current political climate has
raised questions around there being an even less
welcoming environment for research around these
issues. But my guests today have a vision of
a world that promotes the physical, emotional,
and social well -being of all people, regardless
of their sexual orientation or gender identity.
So let me introduce my two colleagues, Associate
Professor Dr. John Blosnich, whose expertise
focuses on health disparities related to sexual
orientation and gender identity, and Assistant
Professor Dr. Gabriel Robles, who focuses his
research on healthcare access and wellbeing of
sexual and gender minorities. Welcome both of
you. Thanks. Thank you. Glad you could spend
some time with me here today and with our listeners.
I want to start with something a little more
perhaps personal, rather than just jumping right
into your research, which is something that I've
been trying to ask folks in these podcasts, which
is What got you interested in doing this kind
of research? Did you have a moment in your life
or an experience that made you think I have to
work on, you know, with this population on these
issues? Maybe we'll turn to to John first. Was
there was there a white light moment for you
in this in this world of research? You know,
I think for me, it's clearly a personal thing,
too. But for me, it came when I was doing my
training in public health and how I kind of found
my way to public health. You know, I knew I always
want to be an advocate, but I knew I was not
the person to be standing in front of any sort
of decision making group to try to make a plea.
I'm more of a behind the scenes advocate. So
I was like. you know, to the more polished people
who speak real well, I was like, tell me what
you need to know, and I will find the data, find
the studies for it, or I will do them to give
you that information to take forward. So, you
know, I kind of found a place to hone my advocacy
and in research. Yeah, and that's kind of how
that's great. That's great. Gabriel, how about
you? Was there was there a moment that you said,
oh, this is what I want to do with my career?
Yeah, so it started just I had just graduated
from undergrad. So I was in Long Beach and I
was working at the Y. I was working with kids
and the kids, you know, at certain times of the
afternoon, I mean, after school hours, they go
out and have structured kind of recess. And so
I stayed behind and I cleaned up. the office.
There's a bunch of toys everywhere. One of the
white staff brings in a kid saying, oh, he's
not feeling well. Can he, you know, sitting here?
Well, they have recess. So I said, yes, but I'm
going to be cleaning. If that's okay, you can
help me. And he said, oh, I'll just watch. And
so I was cleaning up. I had a bunch of toys.
I put on, you know, a fake crown and like some
beads just because I wanted to, you know, carry
it all at once. And the kid comes up to me and
asks, you like to play princess? Can we do that?
And I said, oh, yeah, I like to play princess.
It doesn't matter as long as, you know, I'm having
fun. That's all I care about. And that's when
I knew that there was something happening, like
with well -being and like these kids. So I wanted
to kind of explore that a little more. How old
is this kid? I believe he was in either kindergarten
or first grade. I don't exactly remember. Yeah,
that's great. Can I play princess? Well. Speaking
of well -being, I know both of you are really
invested in this. I mean, John, you have been
doing some really, I guess it's nice to start
with a story about a kid who's making Gabriel
smile because I think your stories tend to get
a bit darker, a bit faster. But I know that you're
doing some really groundbreaking work on... sexual
orientation and gender identity that is buried
within mortality surveillance data. So I mean,
not to be a downer, but you're doing some really
groundbreaking work. You want to talk to us a
little bit about how you got into that and what
sort of work you're doing in that space? Yeah,
absolutely. I don't mind dimming a room. I seem
to do that every time I walk into one. So what
happens when we don't have well -being in a community?
is that we know that it doesn't bode well to
thriving or survival. And so we have a lot of
research that focuses on the increased risk profiles
that happen for people who are sexual and gender
minorities. Increased rates of smoking, substance
use, suicidal ideation, suicide attempts, a lot
of health risks there, but we don't know a lot
about the ultimate outcome. in public health,
which is mortality. So one of the best ways to
keep populations alive is to learn about what's
killing them. It lets you focus your energies
and your interventions on, you know, what are
the priorities that are actually limiting people's
lives. We don't have that for LGBT populations
because we don't have that information about
mortality in terms of sexual orientation and
gender identity. You know, you could look up
and know what are the top 10 leading causes of
death for someone based on race, race, ethnicity,
based on sex. I mean, hell, even where they live,
we could generate top 10 leading causes based
on zip code. But we don't have that for sexual
orientation, gender identity. And for those of
us working in the suicide prevention space, it's
a problem. If we don't have this ultimate outcome,
we don't know how to really quantify the burden
of disease, which is one of the key things that
epidemiologists do. But we also cannot do the
second thing, which is, you know, how do we hatch
prevention? And how do we evaluate that it's
actually working? If you don't have a benchmark,
you can't tell if the program you launch has
made a dent in that because you don't know it's
gone up or gone down. You don't have a rate of
death. So you don't you can't evaluate your solution.
So we started from from scratch and from scratch
in a very dark place, which is where do these
mortality data originate? And that is with medical
examiner and coroner's offices. Suicide deaths,
specifically what I focus on my research on,
they all go through coroner and medical examiner
systems. And that's where we learn about the
circumstances of how someone you know, died.
They don't routinely gather information about
sexual orientation and gender identity. So we
hatched a plan to develop and test a training
for death, specifically medical legal death investigators,
and how to gather this information in the course
of their investigations. So that's what we, we
spent a couple of years doing that on a study
that was funded from 2020 to 2022. We train death
investigators in LA County and in the state of
Utah. and along the way learned about how to,
from these investigators, how do we edit this
training, what information was left out that
they need to know, what elements of their job
need to be represented to increase the credibility
of this kind of a training. So it was a really
fascinating education. in how I became partially
a workforce trainer when I never thought I would
be because I always envisioned myself as a kind
of a data jockey analyst kind of person. Yeah,
that's that project. That's an interesting change
of change of career paths to go from being somebody
who runs statistical models to somebody who's
training people to do death investigations. You
know, I would certainly not think of those as
one leading to the other in a linear path. Five
years earlier, if the fortune teller had told
me I would have been there, I would have demanded
my money back. And it came true. It sounds like
a really exciting thing to do, though. I mean,
before I ask Gabriel a question, I want to just
have one quick follow -up question with you about
this, which is, how was this received, especially
I'm thinking about in Utah, where I think of
that as a much more conservative state than California
and death investigators in Los Angeles, and just
thinking about what was it like to work with
people asking them to now be probing about people's
sexual and gender identity when they had not
been doing that before? Yeah, for sure. I think
the main thing about this was this was not political
work. This was about the work of getting data
that's important to a public health end. The
death investigators, their jobs, they have one
of the hardest jobs on earth. I shadowed death
investigators here in LA County. They go to scenes
that are grisly and grim, to put it nicely. Sometimes
these scenes are literally unstable. And their
job is to, you know, recover and process the
body, document evidence at the scene and talk
to next of kin. This is not a job for the light
hearted, but this is where these public health
data start. And not enough of us understand.
I think a lot of us don't have appreciation for
it because we just didn't know. And so their
jobs are hard and they ask people very personal
questions. Next of kin, sometimes really personal
things that sometimes next of kin didn't know.
And they're delivering this to a person who just
may have just found out that they this investigator
is the one who's alerting them that their loved
one has passed away. So in that regard, there's
really no question that's off the table for them.
They're already delivering the worst news possible.
There's very little they can say to somebody
that is going to be worse than the news they
just delivered. The challenge was their conversation.
They are not. data collectors in a traditional
epic sense of I have a survey and I'm going to
run through these questions. Sure, sure. They
have to stoke a conversation. So it's, you know,
running through this with them to identify ways
that this can be brought into the conversation
extremely naturally. It's just they need to know
about the concepts and how to introduce them.
So I think once we talked about that with them
and ran through it with them and established
that they are crucial to public health, I think
that got people on a at a place where they understood
the importance of the work and they understood
that it was feasible and that this was not about
anyone singular person's beliefs about what they
thought about gay people, what they thought about
trans people. It was rooted in we have a health
problem and we need these data to inform that.
You are in a very unique space to do that. They're
tough questions, but that's the name of your
gig is tough questions and tough news. So yeah.
It was very cool. I imagine it was actually something
fairly empowering for them in some regards as
well, given the way you've described it. Gabriel,
let me, as promised, maybe we can lighten things
a little bit. But I know that you also deal with
some very serious stuff, though, too. I don't
mean to make light of, in any way, what you do.
I know that you're very much interested in community
cohesion. social support and how it is that people
are accessing health care kind of born out of
this experience of what's happening for folks
and how do we create well -being in these communities.
Can you talk about what you've been working on
recently? Yeah, so one of the things that I like
to talk about is, of course, you know, as a field,
we are, to some extent, we're well -versed in
kind of intersectionality. And as Kimberly Crenshaw
describes it, like, these intersecting roads
of oppression, or the systemic forces that kind
of interact and like reinforce each other. But
with that, or along those lines, I also want
to look at kind of how people belong to multiple
communities. They're likely drawing from various
strengths from each of each of the communities
they belong to. I do a lot of my work with racialized
minorities who are in the LGBTQ community, specifically
Latino, you know, gay, bisexual, and other queer
men. And so we're often kind of embedded and
I say we because I identify as part of that community.
We're often embedded in, you know, at least the
Latino community. And so that community comes
with lots of sources of strengths and, you know,
things that can help us be resilient in our daily
lives. And some of us are also kind of connected
to the LGBTQ kind of broadly speaking. And those
in that community kind of has this, you know,
history of advocacy, this history of kind of,
you know, you know, being out there and in the
front lines trying to, you know, fight for what's
right. And so you know, at people who belong
to both communities, I think that we can kind
of draw upon, you know, various strengths and
kind of build one kind of cohesive, you know,
life or one cohesive community where we can kind
of all, you know, work together collectively.
Sure. I mean, are there other challenges though
there as well? I mean, I would imagine that there's
some ways in which the I don't know, the idealized,
the archetypical Latino man and the stereotypes
in the gay community. I mean, those things don't
necessarily go as easily as the mutual strengths
you were just talking about, right? Right. Exactly.
So for example, I've done some work on machismo.
So, you know, people just report that, oh, if
I'm going to be a part of the Latino community,
I might not be as accepted as I would be if I
were kind of interacting with people in the LGBTQ
space. And so that kind of leads us to like,
where is the work and where do we need to do
the work? Is it that we need to really make spaces
that are, you know, historically Latino? more
inclusive of LGBTQ individuals? Or is it the
inverse in which we're making LGBTQ spaces more
inclusive of racialized minorities? My answer
is always like, we need to be doing the work.
you know, in tandem together at the same time,
because we can't kind of prioritize one experience
over the other. Because it may be that today,
you know, on this specific day, I'm interacting
with the Latino community, but it may be later
on tonight, I'm interacting with the LGBTQ community.
So there really isn't this, you know, separate
or the separation that we kind of find in research
or in these data sets. It's very complex and
it's kind of together. Yeah, yeah. I mean, it's
interesting you say the separation in these data
sets, right? I think, I mean, maybe even in the
data, there's not necessarily the separation.
We just like to have these very separate concepts
in research dialogues. And at least in my experience,
I don't think that that necessarily, as you suggest,
jives with people's reality, right? I mean, people's
reality is much more nuanced, complex. It's fluid.
It moves, you know, changes from moment to moment
during the day sometimes. And I think that doesn't
necessarily lend itself to statistical models
in the easiest of ways, but it certainly is the
reality of our lives. So John had mentioned his
focus being on suicide and suicide prevention.
What are some of the issues for this population
of Latino, you know, LGBTQ men that you're interested
in working on? So I primarily, you know, as we're
talking about research, you know, researchers
often ask, well, what's the outcome of interest?
And my outcome of interest is kind of accessing
health care services. OK, there's a history in
the LGBTQ space that, you know, when we look
at health care access, we look at sexual health
care access. And I do think that's very important.
That's extremely important. It's, you know, it's
a salient need and we need that. I also think
that we can think broader than that. We can start
to think about how we can start to access preventative
services, primary care services, and how can
we kind of integrate this idea of being inclusive
to both Latino and LGBTQ people in one space.
And I think the clinic could be a space where
we can do that or we can begin that work and
ultimately, you know, make communities, I guess,
healthier again, I know, right? I think that
focus, I've certainly done some research on within
the work that I've done with homeless young adults
around some of the issues that face LGBT communities
within that space. And you're right. I mean,
oftentimes some of the research and even advocacy
work was around sexual health. And that's only
part of people's lives. And honestly, when I
do work in those communities, those young people
are much more concerned about their You know,
there's their safety for the night or they're
concerned about where they can get some of the
e there Maybe if they've got a health concern,
it's more about, you know, their mental health
maybe or even the fact that they've got an infection
They're there, you know, and by infection. I
don't mean like a sexually transmitted infection
I mean, you know, they they like cut themselves
and now they've got a big, you know infected
boil on their on their leg and they're not really
in sexual health is is an important thing which
I think maybe easily tracks on to those communities,
but people are so much more than that. That's
one of the things I love about your research,
and John's too, is that it's a much more holistic
vision of people. It's not just trying to pigeonhole
sexual and gender minority folks around their
sex lives. I mean, I think that that's so limiting
in some respects. And thinking about why do people
live healthy, thriving lives, or why do people
end their lives when they're not having health
and thriving is really fascinating. I want to
touch on the way in which some of the recent
federal decisions around research initiatives
have impacted research and I know that John,
you had a grant that was focused on parents who
had a child who was a sexual minority that had
come out and about how they were coping with
that experience that was defunded and then perhaps
reinstated. And I'm kind of wondering if you
can share with folks a little bit about what
that research was about, why you thought it was
important, and also maybe some of your thoughts
about the future of that kind of work. Yeah,
absolutely. So the grant was focused on like
you said, parents who had a child come out to
them about sexual orientation. This project did
not involve gender identity. It was terminated
by the NIH citing that it was focused on gender
identity, which was patently false. That was
not part of the grant at all. But the impetus
for the grant was really taking an upstream approach
to suicide prevention for sexual minority youth,
who we know have very high rates of suicidal
ideation and attempts. But because when I talked
about our other project, we don't have any idea
if suicide deaths are greater in this group.
But we know enough to know that ideation and
attempt are massive problems for youth who identify
as sexual minority. But we wanted to take a family
systems approach because research consistently
demonstrates that family rejection is a major
predictor of mental distress among sexual and
gender or sexual minority youth. You know, naturally
we're like, it's really, we want to know more
about parents. You know, so when a kid comes
out, you know, parents are a cornerstone of a
family unit and parents need to figure out how
they sort of guide and manage their families.
And when a kid comes out, that's a family system
change for sure. but we don't know what parents
need or how they navigate that family system
change. The lore is kind of, you know, well,
if a parent doesn't automatically sign up to
be the marshal of the pride parade, they're awful,
right? Parents just love their kids unconditionally.
And many parents do. But parents are afraid for
their children for, ironically, the very reasons
why our grant was terminated. A kid who comes
out for a parent who's not a sexual minority,
they Their understanding is their kid's going
to have a very different time in life, which
frankly is going to be a tougher time in life
than if their kid was straight. And a lot of
parents react poorly because they're just afraid
for their child. But ultimately, the literature
does not know where parents go for help, what
they consult. Do they just Google what to do?
Do they go visit clergy, religious leaders, medical
professionals? Do they not talk about it at all?
And what do they need to get through this? Because
most families will get through this. But that's
what we wanted to focus on was surveying and
interviewing parents. And this is not an easy
group to find. Right? Folks who are going to,
you know, who are parents of the person who identifies
as a section of the minority person, right? So
this research really digging into how do we find
them? And when we find them, you know, we have
a lot of questions we need to ask both in a survey
and then getting more detailed information from
them from folks who would agree to do an interview
with us. So that grant was terminated. It was
reinstated in July. We've been working on it,
resuming work on it as best we can with that
kind of a disruption to it. Sure. But yeah, so
that's where that project currently stands. I
want to get really nerdy with you for just a
second here. Forgive me for this, but I can't
help myself. You know, you said, how do we find
these parents? It makes me think that I guess
my assumption would be that the two places you
might find parents are in some space where they're
being a very loud positive advocate for their
child that's come out, or perhaps they're being
a very loud decryer of their child's coming out.
And I wonder you know, what you're how you're
trying to deal with, not just trying to find
the extreme cases. Right. Because I mean, I think
that those are the the visible folks, the people
that are very upset about it or the people that
are very welcoming or proud of it. And I would
imagine there's a lot there's a lot in between.
Right. Maybe there is. And we really want the
between. Right. You don't want the outliers necessarily.
I mean, they'll be there. But our main component
is, you know, and this is sort of survey recruitment
nightmare slash experiment 101 was being able
to target large enough samples where we could
find the baseline inclusion criteria is, are
you a parent? The stepwise thing of, are you
a parent? And then, you know, do you have a child
who identifies or is coming? So it's sort of,
we're starting at that umbrella level, trying
to find them. So we're using very large level
recruitment avenues. So research match is a resource
developed by NIH of individuals who have opted
in to basically volunteering for research projects.
The inclusion criteria is not that you want to
do this because of any number of things in your
characteristics that make you who you are. It's
just you have an interest in being in research
and then you get this kind of newsletter that
shows you all these different opportunities and
you can opt into it. Gabriel, I'm wondering if
you wanted to talk a little bit about some of
the sampling or some of the research strategies
that you've been employing recently, because
I think it's really interesting to hear from
John about the death investigators and about
trying to reach these samples. But I mean, where
have you been targeting the actual time that
you spend in the day working with these folks
recently? So one of the things that I want to,
I guess, be clear and give credit to is that
I work with a group of kind of men, like gay,
bisexual, and other queer men, kind of throughout
the United States. When I first started here
at USC, I was trying to create some type of community
group or advisory group. And so I kind of recruited
on social media. Is anybody willing to work with
me? We can work on projects together. And so
several men did. They signed up, they emailed
me and they were like, oh, yeah, I'm interested
in like, you know, giving I'll give you some
of my thoughts and like where we can go as kind
of as a field. And so one thing that I I personally
implemented first was this social media kind
of recruitment. Let's recruit, you know, Latino
gay men on social media. And things became a
little complex once the election happened. and
nobody was kind of signing up. And then it was
like, I don't want to give up or let you know
what some of my demographic information is. And
so I went back to the community advisory group
that we formed and they were like, yeah, we are
literally, this is happening in our communities.
This is happening at our clinics, at our CBOs.
Nobody wants to come. come in for any service.
Nobody wants to come in and fill out any intake
form. Wow. And so one of the things that they
recommended and you know, I'm really grateful
that they did is that I work with community organizations
directly because each community organization
is kind of finding out is tailoring the recruitment
methods that is good and appropriate for their
own community. And so that's kind of how I've
been working with these participants of the studies
is let me connect with organizations throughout
the United States. One of the things that we
saw was, you know, depending on which community
you're in, you know, some Latino gay men are
receiving all the services. But if you're you
happen to be in a community that is not, you
know, where health is and kind of at the forefront
of their community, they may not be receiving
services at all. I mean, it just depends on what
the priorities are. Are these community organizations
mostly health organizations, or are they mostly
organizations for gay, bisexual, queer men? So
they're for gay, bisexual, and queer men. They're
specifically ones that are working with the Latino
communities. Oh, OK. And so often, these organizations,
they fill the gaps. that the broader health care
system is not meeting. And so what it means is
that they integrate services. It's mental health
services. It's, you know, primary care services.
As we mentioned, it's sexual health services.
Often, they're just providing a space for kind
of social well -being. No, that's great. And
I think the way that you just mentioned this
community advisory board helping you think through
the future of research, this is... I think how
I wanna lead us out of this conversation, which
is to ask both of you what you are envisioning
over the next few years as being important avenues
for research to work with the health and wellbeing
of the communities that you each are a part of.
So maybe I'll turn to you, John, first and then
end with you, Gabriel, about what you think is
an important direction for the research to move
in in the next few years. Yeah, I think for me,
I'm still in the space of vital statistics, especially
around mortality data, to really understand the,
from my perspective, the toll of inequity on
populations. And these mortality data are key.
I think we see this happening. Well, I mean,
the case in point, what's happening with maternal
mortality in the country now, in a post -Dobbs
decision, America, where states that have banned
abortion care are seeing increases in rates of
maternal mortality. And that's only known to
us because we count, we collect this information
and we count this information at the time of
death. And that is absolutely crucial to knowing
again where interventions should be placed, but
also holding people and policymakers accountable
for decisions that they made. So I am all about
finding ways to enhance our mortality. information
because I just think that's the that is a bedrock
of our our public health and it's if we don't
have it inclusive of our communities we're not
understanding the full toll of what's going on.
So well put. Gabriel? Along the lines with inclusive
inclusivity I think that the future of research
in this area is how can we make every healthcare
setting kind of inclusive to people so that the
burden isn't on the community member, on the
queer man to figure out, okay, if I need primary
care services, let me see if I can find someone
who can provide services that is specifically
tailored to me. But if I want to go to a place,
doesn't matter where it is, I should be able
to do so. and make sure that the staff and the
health care providers are providing services
that are not only scientifically sound, but that
are socially and culturally appropriate. So I
think that that's kind of where we're headed,
something that's a little more integrated. That's
great. That's great. certainly hope that both
of your agendas are things which we pursue in
the near future. I think they're both absolutely
needed. I just want to thank you, John and Gabriel,
both for such a great discussion. So I hope that
you will be willing to come back and share more
with me in the future. I also want to commend
the two of you on being in the center of research
that is requiring people to be brave. And I really
appreciate your bravery of doing work that you
believe is important to and scientifically relevant,
and I wholeheartedly support you and believe
in its importance and scientific relevance. So
in the meantime, if listeners are interested,
they can check out more on our school's website
where we have a lot of information about ongoing
research. So you can go to dworakpeck .usc .edu
to learn more about all the work that's going
on. at our school around these topics. And if
you have questions for our guests or for me about
the show and you want to support the transformative
research of our program, you can email us at
listenuppeople at usc .edu. So that's L -I -S
-T -E -N -U -P -P -E -O -P -L -E at usc .edu.
And just one more time, John and Gabriel, thank
you so much for spending your time with me and
I hope our listeners enjoyed it as much as I
did. you