DATA SCAN: THE HEALTH OF THE LESBIAN, GAY, BISEXUAL, AND TRANSGENDER COMMUNITIES IN COLORADO
Indira Gujral, PhDColorado Department of Public Health and EnvironmentData Partner: ONE ColoradoSeptember 8, 2011
Table of Contents
Elevating LGBT health in the United States Overview of Survey Sampling Health of LGBQ Youth: data from the 2009 Boulder
County Youth Risk Behavior Survey Health of LGB Adults: data from the Colorado Behavioral
Risk Factor Surveillance System (2006 – 2009) HIV or AIDS: state surveillance Filling In the Gaps: Data from A Conversation with
Coloradans (One Colorado Education Fund’s Needs Assessment)
Contacts and Resources
ELEVATING LGBT HEALTH IN THE UNITED STATES
Elevating LGBT Health in the U.S.
In 2011, the U.S. Department of Health and Human Services recommended 14 actions to improve the health and well-being of the LGBT communities.
5 Examples of Recommended Actions: Healthy People 2020 The Affordable Care Act Anti-Bullying Efforts Improvements in Foster and Adoptive Care Runaway and Homeless Youth Services
Elevating LGBT Health in the U.S.
U.S. Department of Health and Human Services Recommended 6 Future Actions (2011).
Example of 2 Future Recommended Actions: LGBT Cultural Competency Curricula Increase the number of federally funded surveys
collecting data on Sexual Orientation and Gender Identity (starts 2013)
Lots to Celebrate, Still Work to Do
Goals and Objectives
The goal of this data scan is to provide a baseline of LGBT health in Colorado
To accomplish this goal, we have 2 Objectives1. Provide data from two population-based surveys
assessing youth and adults 2009 Boulder County Youth Risk Behavior Survey Behavioral Risk Factor Surveillance System
2. Provide data from convenience-sample survey of adultsOne Colorado Educational Fund’s Needs Assessment
OVERVIEW OF SURVEY SAMPLING
Overview: Population-based Sampling
Population-based sampling is a probability sampling method which selects a subset of individuals from within a population to yield some knowledge about the whole population.
Strengths of Population-based Sampling Cost: cheaper to sample group than whole population Time: data collection is faster Extrapolation: can generalize results to whole population Boulder County YRBS (generalize results about Boulder Youth) Colorado BRFSS (generalize results about Colorado adults)
Weakness of Population-based Sampling Accuracy: for small populations, need to aggregate years Story: does not tell a full story
Overview: Convenience Sampling
Convenience sampling is a type of non-probability sampling in which the sample is drawn from a population because the sample is readily available and convenient.
Strengths of Convenience Sampling Cost: cheaper than probability sampling Time: data collection is very fast Small and difficult to reach populations One Colorado Education Fund’s Needs Assessment (LGBT
community) Provides insight for new questions to be asked on population-based
surveys
Weaknesses of Convenience Sampling Extrapolation: can NOT generalize results to whole population
THE HEALTH OF LGBQ YOUTH IN BOULDER COUNTY, COLORADO
Youth Risk Behavior Survey Boulder County Health Public HealthNovember, 2009
Methods: 2009 Boulder County YRBS
2009 Boulder County Youth Risk Behavior Survey US Youth Risk Behaviors Survey
Purpose is to monitor health risk behaviors (not assets) Data collected from randomly sampled schools and
classrooms across the United States every other year Does NOT collect sexual orientation
Boulder County YRBS does collect sexual orientation (county adds the question)
Methods: 2009 Boulder County YRBS
Boulder County YRBS Administered in 18 high schools
9 high schools in Boulder County School District 9 high schools in St. Vrain Valley School District
108 questions (including sexual orientation) 2,491 high school students Sexual Orientation Status
Lesbian, Gay, Bisexual and Questioning (LGBQ)
Excludes Gender Identity
Results: 2009 Boulder County YRBS
Results by Topic Area Demographics Family and Community Service Injury Safety and Harassment School Safety Sexual Assault and Dating Violence Depression Suicide Tobacco, Alcohol, and Marijuana Weight Issues Behaviors Influencing Weight Physical Activity
Results: Demographics
9.3
90.7
Sexual Orientation
LGBQ Heterosexual
Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Family and Community
78%
64%
38%
86%
77%
43%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Parents have behavior standards
4 or more meals with family per week
Engaged in Community Service
LBGQ Heterosexual
*
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Injury
67.1%
7.7%
31.6%
68.8%
5.0%
22.4%
75.2%
7.6%
24.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Never/rarely wear bicycle helmet
Never/rarely wear seat belt
Rode with Driver who drank alcohol
LGBQ Heterosexual Colorado
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Safety and Harassment
78.4%
29.8% 26.8%
90.8%
12.9%
3.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Felt Safe in Neighborhood
Electronically Bullied Harassed because someone thought you
were LGB
LGBQ Heterosexual
*
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: School Safety
13.4% 14.9% 20.8%
4.0% 5.9%
14.1%
5.1% 8.0%
16.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Did not go to school because felt unsafe
Threatened or injured on school
property
Carried a weapon
LGBQ Heterosexual Colorado * *
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Dating and Sexual Assault
13.8% 20.8%
10.7% 6.4% 4.4% 2.4%
9.1% 7.7% 4.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Hurt by girlfriend/boyfriend
Forced to have sexual intercourse
First sex < age 13
LGBQ Heterosexual Colorado
* *
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Depression
52.2%
72.9%
29.3% 22.3%
81.6%
51.6%
25.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Felt sad/hopeless Has someone to talk Gets help when sad
LGBQ Heterosexual Colorado *
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Suicide
35.3% 28.9%
20.3%
11.1% 9.2% 4.2%
13.7% 11.0% 7.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Seriously considered Planned suicide Attempted suicide
LGBQ Heterosexual Colorado
*
* *
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Tobacco, Alcohol, Marijuana
39.0%
52.3%
20.3% 24.3%
41.8%
4.2%
24.9%
40.8%
7.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Current tobacco use Current alcohol use Current marijuana use
LGBQ Heterosexual Colorado
*
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Weight Issues
11.8%
47.7%
58.9%
5.1%
37.8%
73.9%
7.1%
38.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Obese Trying to lose Vigorous physical activity
LGBQ Heterosexual Colorado
*
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
Results: Behaviors Influencing Weight
10.1%
30.1% 23.1%
3.0%
40.7%
19.8%
3.6%
25.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Vomited/Laxatives Sleep ≥ 8 hours ≥ 3 hours tv/comp
LGBQ Heterosexual Colorado
*
*
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2009, Boulder County Youth Risk Behavior Survey; Boulder County Health Department.
THE HEALTH OF LGB ADULTS IN COLORADO
Behavioral Risk Factor Surveillance SystemColorado Department of Public Health and Environment2006 – 2009
Background
According to the Williams Institute at UCLA School of Law, it is estimated that more than 186,000 LGBT individuals live in Colorado, including 12,000 transgender people.
Background: LGBT Health
Very few federal and state health surveillance surveys include measures of respondents’ sexual orientation
Research from non-population-based surveys provides evidence of health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations
Healthy People 2020, the US Department of Health and Human Services, the Institute of Medicine, and others call for increased efforts to study and to improve LGBT health
Colorado Behavioral Risk Factor Surveillance System (2006 – 2009)
Background: Sexual Orientation and the BRFSS
Few states have added sexual orientation to the Behavioral Risk Factor Surveillance Survey (BRFSS)
Recently published results from Massachusetts and Washington provide evidence of LGBT health disparities Conron et al., AJPH, October 2010 Dilley et al., AJPH, March 2010
Colorado added sexual orientation to its BRFSS in 2006
Colorado Behavioral Risk Factor Surveillance System (2006 – 2009)
Methods: Colorado’s BRFSS Question
“Research has shown that some sexual minority community members have important health risk factors. We are collecting information about sexual orientation to learn whether this is true in Colorado.
Do You consider yourself to be: Heterosexual, that is, straight; Homosexual, that is, gay or lesbian; Bisexual, or something else?
Survey Does NOT measure Gender Identity
Colorado Behavioral Risk Factor Surveillance System (2006 – 2009)
Results: Demographics of BRFSS Respondents
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
1.3%
97.7%
0.9% 0.1%
Sexual Orientation
Homosexual Heterosexual Bisexual Other
Demographics of Respondents: Age
63.2%
12.5%
24.3%
79.3%
4.4%
16.4%
52.8%
9.8%
37.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
18-34 35-49 50+
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Urban/Rural
65.1%
24.6%
10.4%
63.2%
22.8%
13.7%
51.5%
30.2%
18.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Denver Metro Other Urban Rural
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Race/Ethnicity
76.0%
3.3%
13.6%
3.4% 3.7%
70.2%
1.2%
19.5%
5.0% 4.0%
75.0%
2.5%
17.8%
3.4% 1.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
White Black Hispanic Other Multiracial
Homosexual
Bisexual
Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Educational Attainment
4.0%
21.7%
74.3%
11.6%
29.1%
59.3%
8.7%
24.0%
67.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Did not complete High School
High School Graduate
Some College
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Poverty
26.9%
73.1%
45.4%
54.6%
25.9%
74.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Below 200% FPL Above 200% FPL
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Marital Status
8.6% 10.8%
46.2%
34.4% 29.2%
13.4%
47.7%
9.7%
65.3%
14.6% 16.0%
4.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Married Formerly Married
Never Married Unmarried Couple
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Demographics of Respondents: Children in Household
17.1%
82.9%
47.9% 52.1%
45.9%
54.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Yes No
Homosexual Bisexual Heterosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Demographic Summary
Variable Significant Not Significant
Age X
Rural Residency X
Race/Ethnicity X
Education X
Poverty X
Marital Status X
Children in Household X
*Statistically Significant Difference between LGBQ and Heterosexual (p<0.05) Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
What is the prevalence of health conditions and behaviors among Colorado’s LGB population?
Results: General Health
57.20%
20.9%
9.6%
71.40%
30.1%
14.4%
50.10%
17.8%
12.0%
Don't Always Get Needed Emotional Support
Some Physical Disability
Fair or Poor General Health
Heterosexual Bisexual Homosexual
*Statistically Significant Difference compared to Heterosexual (p<0.05) Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
*
Results: Health Services and Screenings
74.3%
60.2%
29.7%
24.5%
14.2%
78.4%
71.6%
37.4%
26.0%
31.3%
76.7%
60.2%
61.8%
20.7%
16.6%
Did Not Get Pneumonia Vaccine
Did Not Get Flu Shot
Never had an HIV test
No Regular Primary Care Provider
No Health Insurance
Heterosexual Bisexual Homosexual *
*
*
*Statistically Significant Difference compared to Heterosexual (p<0.05) Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Risk Behaviors
75.5%
34.1%
25.0%
12.4%
8.80%
73.1%
35.4%
28.2%
20.2%
5.80%
74.9%
17.3%
16.4%
17.2%
6.70%
Insufficient Fruits and Vegetables
Current Smokers
Binge Drink
Physically Inactive
Don't Always Use a Seatbelt
Heterosexual Bisexual Homosexual
* *
* *
*
*Statistically Significant Difference compared to Heterosexual (p<0.05) Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Chronic Disease
48.90%
32.3%
22.3%
14.3%
3.4%
2.5%
50.50%
34.5%
20.8%
13.8%
3.2%
4.5%
55.90%
21.3%
Overweight or Obese
High Cholesterol
Diagnosed Hypertension
Current Asthma
Diagnosed with Diabetes
Diagnosed Heart Disease or Angina
Heterosexual Bisexual Homosexual
*
*Statistically Significant Difference compared to Heterosexual (p<0.05) Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Homosexual Respondents
75.5%
74.3%
60.2%
57.20%
48.90%
34.1%
32.3%
29.7%
25.0%
24.5%
22.3%
20.9%
14.3%
14.2%
12.4%
9.80%
9.6%
8.80%
3.4%
2.5%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%
Insufficient Fruits and Vegetables Did Not Get Pneumonia Vaccine
Did Not Get Flu Shot Don't Always Get Needed Emotional Support
Overweight or Obese Current Smokers High Cholesterol
Never had an HIV test Binge Drink
No Regular Primary Care Provider Diagnosed Hypertension Some Physical Disability
Current Asthma No Health Insurance
Physically Inactive Drinking and Driving
Fair or Poor General Health Don't Always Use a Seatbelt
Diagnosed with Diabetes Diagnosed Heart Disease or Angina
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Bisexual Respondents
73.1%
78.4%
71.6%
71.40%
50.50%
35.4%
34.5%
37.4%
28.2%
26.0%
20.8%
30.1%
13.8%
31.3%
20.2%
2.10%
14.4%
5.80%
3.2%
4.5%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
Insufficient Fruits and Vegetables Did Not Get Pneumonia Vaccine
Did Not Get Flu Shot Don't Always Get Needed Emotional Support
Overweight or Obese Current Smokers High Cholesterol
Never had an HIV test Binge Drink
No Regular Primary Care Provider Diagnosed Hypertension Some Physical Disability
Current Asthma No Health Insurance
Physically Inactive Drinking and Driving
Fair or Poor General Health Don't Always Use a Seatbelt
Diagnosed with Diabetes Diagnosed Heart Disease or Angina
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Heterosexual Respondents
74.9%
76.7%
60.2%
50.10%
55.90%
17.3%
34.3%
61.8%
16.4%
20.7%
21.3%
17.8%
7.9%
16.6%
17.2%
4.10%
12.0%
6.70%
5.5%
2.7%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
Insufficient Fruits and Vegetables Did Not Get Pneumonia Vaccine
Did Not Get Flu Shot Don't Always Get Needed Emotional Support
Overweight or Obese Current Smokers High Cholesterol
Never had an HIV test Binge Drink
No Regular Primary Care Provider Diagnosed Hypertension Some Physical Disability
Current Asthma No Health Insurance
Physically Inactive Drinking and Driving
Fair or Poor General Health Don't Always Use a Seatbelt
Diagnosed with Diabetes Diagnosed Heart Disease or Angina
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Results: Summary
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
Insufficient Fruits and Vegetables Did Not Get Pneumonia Vaccine
Did Not Get Flu Shot Don't Always Get Needed …
Overweight or Obese Current Smokers High Cholesterol
Never had an HIV test Binge Drink
No Regular Primary Care … Diagnosed Hypertension Some Physical Disability
Current Asthma No Health Insurance
Physically Inactive Drinking and Driving
Fair or Poor General Health Don't Always Use a Seatbelt
Diagnosed with Diabetes Diagnosed Heart Disease or …
Heterosexual
Bisexual
Homosexual
Source: 2006 – 2009, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, Colorado Department of Public Health & Environment.
Conclusions
Disparities in health behaviors and health conditions do exist between Colorado’s heterosexual and LGB populations
LGB populations are not homogenous The prevalence of health behaviors and health
outcomes varies within the LGB population
Limitations and Future Opportunities
No data on transgender Coloradans No statewide data on LGBT youth Insufficient sample size to conduct analysis of
rotating core and state added BRFSS questions by sexual orientation
HIV OR AIDS
Colorado HIV Surveillance Report Colorado Department of Public Health and Environment 4th Quarter, 2010
Background: HIV or AIDS
In Colorado, physicians, health care providers, hospitals, or any other person providing testing and/or counseling or treatment to a person with HIV infection are required by law to report HIV and AIDS related information to the Colorado Department of Public Health and Environment, or local health department.
Laboratories must report tests that indicate HIV
infection.
Overview: HIV or AIDS in Colorado
The first case of Acquired Immune Deficiency Syndrome (AIDS) was diagnosed in 1982.
Between 1982 and 2010, nearly 16,600 people have been diagnosed with HIV disease in Colorado.
Between 2006 and 2010, new HIV diagnoses averaged 430 per year.
Between 2006 and 2010, HIV/AIDS deaths averaged 103 per year.
Since highly active antiretroviral therapy (HAART) became widely available in 1996, both AIDS diagnoses and HIV/AIDS related deaths have declined significantly.
New Cases of HIV by year, Colorado
279 256
302
249 249
72 76 52 48
64
0
50
100
150
200
250
300
350
2006 2007 2008 2009 2010
Num
ber o
f N
ew H
IV C
ases
Year
Male-male sex Heterosexual contact
Source: 4th Quarter, 2010, Colorado HIV Surveillance Report; Colorado Department of Public Health & Environment.
Racial/ethnic categories of individuals living with HIV due to male-male sex exposure, December 31, 2010
73.0%
9.0%
16.0%
0.7% 0.5%
0.7%
Percent
White
Black
Hispanic
Asian/Pacific Islander
American Indian/Alaska Native Multiple/Unknown
Source: 4th Quarter, 2010, Colorado HIV Surveillance Report; Colorado Department of Public Health & Environment.
FILLING IN THE DATA GAPS: THE HEALTH OF LGBT ADULTS IN COLORADO
One Colorado Education Fund’s Needs AssessmentONE Colorado2010
Methods: 2010 Conversation with Coloradans
One Colorado Education Fund’s Needs Assessment (AKA Needs Assessment)Purpose: start a dialogue about issues affecting
LGBT people in Colorado Online or print survey of over 4,600 respondentsStrength: sample size and inclusion of
transgender peopleWeakness: not population-based; cannot
generalize to the entire state
Results: 2010 Conversation with Coloradans
Results by Topic AreaDemographicsHousing DiscriminationEmployment DiscriminationSpiritualityPhilanthropyTop 5 Most Important Social Services
One Colorado Education Fund’s Needs Assessment
Health EquityHealth Begins Where You Live, Learn, Work and Play
NATIONAL INFLUENCESGOVERNMENT POLICIES
U.S. CULTURE & CULTURAL NORMS
PREGNANCY
EARLY CHILDHOOD
CHILDHOOD
ADOLESCENCE
ADULTHOOD
OLDER ADULTS
LIFE COURSE HEALTH FACTORS =
QUALITY OF LIFE
MORBIDITY
MORTALITY
LIFE EXPECTANCY
POPULATIONOUTCOMES
SOCIAL DETERMINANTS OF HEALTH
ECONOMIC OPPORTUNITY
PHYSICAL ENVIRONMENT
SOCIAL FACTORS
• Income• Employment• Education• Housing
Built Environment•Recreation•Food •Transportation
Environmental quality•Housing•Water•Air
Safety
• Participation• Social support
• Leadership• Political influence
• Organizational networks
• Violence• Racism
+
HEALTHBEHAVIORS & CONDITIONS
MENTAL HEALTH
ACCESS , UTILIZATION
& QUALITYCARE
• Nutrition• Physical activity
• Tobacco use• Skin Cancer• Injury• Oral health• Sexual health
• Obesity• Cholesterol• High Blood Pressure
• Mental health status
• Stress• Substance abuse
• Functional status
• Health insurance coverage
• Received needed care
• Provider availability
• Preventive care
Public Health’s Role in Addressing the Social Determinants of Health•Advocating for and defining public policy to achieve health equity
•Coordinated interagency efforts
•Creating organizational environments that enable change
•Data collection, monitoring and surveillance
•Population based interventions to address health factors
•Community engagement and capacity building
Colorado Department of Public Health - Social Determinants of Health Workgroup
Demographics: Sexual Orientation
9%
29%
54%
5%
2% 1%
Respondents
Bisexual Lesbian Gay Queer Chose not to label Self-Identify
Source: 2010, Needs Assessment; One Colorado.
Demographics: Gender Identity
39%
57%
3% 1%
Respondents
Female Male Transgender/Transsexual Self-Identify
Source: 2010, Needs Assessment; One Colorado.
Demographics: Gender Identity
26%
61%
13%
Transgender People
Female to Male Male to Female Self-Identify
Source: 2010, Needs Assessment; One Colorado.
Demographics: Age
15%
25% 24% 22%
12%
3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18-24 25-34 35-44 45-54 55-64 65 or older
Age Group
Source: 2010, Needs Assessment; One Colorado.
Housing Discrimination
87%
5% 4% 2% 7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
No one Attorney Colorado Civil Rights
Commission
Police Other
Report Being Denied Housing
Six (6) percent of respondents reported being denied housing due to sexual orientation or sexual identity
Source: 2010, Needs Assessment; One Colorado.
Employment Discrimination
72%
22%
7% 3% 0% 3%
9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
No one Human Resources
Attorney Colorado Civil Rights Commission
Police School Official
Other
Report Employment Discrimination
Twenty-seven (27) percent of respondents experienced employment discrimination due to sexual orientation or sexual identity
Source: 2010, Needs Assessment; One Colorado.
Spirituality: Attending religious service
9% 12%
23%
15%
41%
17% 14%
23%
15%
31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 or more times/wk
1-3 times/mth
Few times/yr 1 time/yr Never
LGBT Transgender Only
Source: 2010, Needs Assessment; One Colorado.
Philanthropy: Contributing to Charity
10%
58%
14% 15%
4%
16%
62%
10% 8% 3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
$0 $1-499 $500-999 $1,000-4,999 $5,000
LGBT Transgender Only
Source: 2010, Needs Assessment; One Colorado.
Top 5 Most Important Social Services
34%
10% 9% 8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ensuring school safety for LGBT youth
Access to LGBT-welcoming health care
Increasing services for people living w/ HIV/AIDS
Ensuring parents have information for supporting LGBT youth
LGBT
Source: 2010, Needs Assessment; One Colorado.
DATA CONTACTS & RESOURCES
Data Contacts
Indira Gujral, MS PhD, Epidemiologist, CDPHE [email protected]
Kyle Legleiter, MPH, Program Director, CDPHE [email protected]
Fran Simon, Simon Analytics [email protected]
Kieu Vu, MSPH, BRFSS Coordinator, CDPHE [email protected]
Resources
The Affordable Care Act and the LGBT Community: http://lgbthealth.webolutionary.com/sites/default/files/ACA%20final.pdf
The Affordable Care Act and LGBT Americans:http://www.healthcare.gov/news/factsheets/new_options_for_lgbt_americans.html
Boulder County Youth Risk Behavior Survey: http://www.bouldercounty.org/help/health/lgbtiq/pages/yrbsresultslinks.aspx
Bullying: www.StopBullying.gov Colorado HIV Surveillance Report:
http://www.cdphe.state.co.us/dc/HIVandSTD/HIV_STDSurv/HIV.AIDS.Surv.rpt.4thQuarter.2010.pdf
One Colorado Needs Assessment: http://www.one-colorado.org/issues/2010-needs-assessment/
Sexual Identity, Sex of Sexual Contacts and Health-Risk Behaviors Among Students in Grades 9 – 12 – Youth Risk Behavior Surveillance, Selected Sites, United States, 2001 – 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6007a1.htm
Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data from the 2006 – 2008 National Survey of Family Growth: http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf
U.S. Health and Human Services: http://minorityhealth.hhs.gov/lgbt/