Nurse Researchers’ Study Suggests that Microaggressions Can be Hazardous to Your Health

Nurse Researchers’ Study Suggests that Microaggressions Can be Hazardous to Your Health

Two recent papers by UIC College of Nursing faculty found that microaggressions – common, subtle indignities – can be just as harmful as a major discriminatory event, contributing to negative mental and physical health outcomes in bisexual women.

Two recent papers by UIC College of Nursing faculty found that microaggressions – common, subtle indignities – can be just as harmful as a major discriminatory event, contributing to negative mental and physical health outcomes in bisexual women. Associate professor Wendy Bostwick, PhD, MPH, and assistant professor Ariel U. Smith, PhD, RN, were co-authors on both papers, one published in the Journal of Bisexuality and the other in Psychology of Sexual Orientation Gender Diversity, a publication of the American Psychological Association. Both relied on findings from the Women’s Daily Experience Study of 112 ethnically and racially-diverse bisexual women. Bostwick is principal investigator on a National Institute on Minority Health and Health Disparities grant which funded the Women’s Daily Experience Study, one of the first ever to focus on bi-identified women and mental health. Participants completed a baseline survey, followed by 28 days of e-diaries to capture microaggressions that they may have experienced during the previous 24 hours. “The old saying goes, ‘sticks and stones may break your bones, but words can never hurt you,” Smith says. “But you look at the data and realize that’s simply not true. Microaggressions that someone has experienced over a lifetime are correlated with mental and physical ailments they experience even today.” The researchers looked at microaggressions related to sexual orientation, race and gender. Microaggressions could include denying a person’s bisexuality—suggesting it’s “just a phase”—or a rude or insulting comment about lesbian or gay individuals. A comment minimizing or denying the existence of racial discrimination is an example of a racial microaggression. Participants reported an average of eight microaggressions of any type in the previous month, with almost all women—97%—reporting at least one microaggression throughout the duration of the study. Gender-based microaggressions were reported the most frequently. Women reported being sexually objectified on more than 15% of the days recorded. The papers also found microaggressions were associated with poor mental health and binge drinking, smoking and marijuana use. The most consistent finding was an association between microaggressions and anxiety. “Our findings suggest that for bisexual women, the weight of denigrating comments about their sexual identity, gender and race can contribute to poor health outcomes—whether such comments happened last year or yesterday,” Bostwick says. “Of course, these comments are situated in a larger context of systemic inequities, which may render bisexual women with fewer resources to cope when confronted with dismissive and disparaging comments about core aspects of who they are and their own lived experiences.” Bisexual women of color were a majority in the study—57%—a group that is notably absent in the literature, the researchers say. Latina bisexual women reported worse health outcomes than Black and White bisexual women in their daily diaries. Smith says the impact of microaggressions on bisexual women of color is an area where further research is needed. “So often we focus on the large discriminatory events, like being denied housing or being fired from a job,” Smith says. “These subtle comments and slights can be just as harmful. That’s why it’s important to address it through education – understanding and recognizing what a microaggression is and then adapting policies to raise awareness.” Co-authors included UIC Nursing visiting research specialist Larisa Burke, MPH, Amy L. Hequembourg, Alecia Santuzzi and UIC Nursing professor emerita Tonda Hughes, PhD ’89, RN, FAAN.Associate professor Wendy Bostwick, PhD, MPH, and assistant professor Ariel U. Smith, PhD, RN, were co-authors on both papers, one published in the Journal of Bisexuality and the other in Psychology of Sexual Orientation Gender Diversity, a publication of the American Psychological Association. Both relied on findings from the Women’s Daily Experience Study of 112 ethnically and racially-diverse bisexual women.

Bostwick is principal investigator on a National Institute on Minority Health and Health Disparities grant which funded the Women’s Daily Experience Study, one of the first ever to focus on bi-identified women and mental health. Participants completed a baseline survey, followed by 28 days of e-diaries to capture microaggressions that they may have experienced during the previous 24 hours.

“The old saying goes, ‘sticks and stones may break your bones, but words can never hurt you,” Smith says. “But you look at the data and realize that’s simply not true. Microaggressions that someone has experienced over a lifetime are correlated with mental and physical ailments they experience even today.”

The researchers looked at microaggressions related to sexual orientation, race and gender. Microaggressions could include denying a person’s bisexuality—suggesting it’s “just a phase”—or a rude or insulting comment about lesbian or gay individuals. A comment minimizing or denying the existence of racial discrimination is an example of a racial microaggression.

Participants reported an average of eight microaggressions of any type in the previous month, with almost all women—97%—reporting at least one microaggression throughout the duration of the study.

Gender-based microaggressions were reported the most frequently. Women reported being sexually objectified on more than 15% of the days recorded.

The papers also found microaggressions were associated with poor mental health and binge drinking, smoking and marijuana use. The most consistent finding was an association between microaggressions and anxiety.

“Our findings suggest that for bisexual women, the weight of denigrating comments about their sexual identity, gender and race can contribute to poor health outcomes—whether such comments happened last year or yesterday,” Bostwick says. “Of course, these comments are situated in a larger context of systemic inequities, which may render bisexual women with fewer resources to cope when confronted with dismissive and disparaging comments about core aspects of who they are and their own lived experiences.”

Bisexual women of color were a majority in the study—57%—a group that is notably absent in the literature, the researchers say. Latina bisexual women reported worse health outcomes than Black and White bisexual women in their daily diaries. Smith says the impact of microaggressions on bisexual women of color is an area where further research is needed.

“So often we focus on the large discriminatory events, like being denied housing or being fired from a job,” Smith says. “These subtle comments and slights can be just as harmful. That’s why it’s important to address it through education – understanding and recognizing what a microaggression is and then adapting policies to raise awareness.”

Co-authors included UIC Nursing visiting research specialist Larisa Burke, MPH, Amy L. Hequembourg, Alecia Santuzzi and UIC Nursing professor emerita Tonda Hughes, PhD ’89, RN, FAAN.

Groundbreaking HIV Prevention Campaign Targets Latino Gay Community

Groundbreaking HIV Prevention Campaign Targets Latino Gay Community

Prevention Campaign Targets Latino Gay Community

The colorful, bilingual advertisements first began to appear on San Francisco mass-transit buses in June. The messages and images they contain are simple but bold. In one ad, a gay Latino man is shown affectionately hugging his partner, while the adjacent text reads: “I don’t want to hurt my family. That makes talking about the truth so hard.” Another ad urges the public to “see [gay and bisexual Latinos] for who [they are],” then speaks directly to gay readers: “You deserve to be accepted.” One of the most powerful ads in the series delivers a subtle but clear HIV/AIDS prevention message: “Because I love my friends and family I can’t risk my health.”

This pioneering public awareness campaign was created by AGUILAS, a San Francisco non-profit advocacy organization serving the city’s Latino Lesbian, Gay, Bisexual and Transgender (LGBT) community. AGUILAS, which stands for Asociacion Gay Unida Impactando Latinos/as A Superarse (Association of Gay Latinos/Latinas United to Empower Ourselves), provides its members with many support services, including El Ambiente, a highly successful HIV prevention program developed by and for gay and bisexual Latino men. El Ambiente has managed to reduce participants’ HIV risk behavior by an estimated 50% to 70% over the past four years.

Funded by the San Francisco Health Department’s AIDS Office, the advertising campaign is designed to make the general public aware of critical issues facing the Latino LGBT community, including isolation, the need for friends’ and families’ support, cultural connection/re-connection, discrimination, and risk factors for developing and spreading HIV/AIDS. According to AGUILAS Executive Director Eduardo Morales, PhD, “These ads have two purposes: first, to reduce the barriers to HIV prevention in gay men and secondly, to reduce the social stigma the Latino LGBT community faces. In fact, social stigmas in and of themselves create barriers to HIV prevention.”

Prevention Campaign Targets Latino Gay Community

To identify the key messages that needed to be communicated in the campaign, AGUILAS conducted focus groups of Latino gay and bisexual men. The images used in the ads are photos of real people living in the San Francisco Bay Area, along with pictures of their families. “Our members were involved in the creative process from the very beginning,” the AGUILAS Web site explains. “They contributed with ideas and personal photos that illustrated all the campaign ads. Their real concerns made us take into consideration the many barriers we face in order to reduce the risk of HIV.”

In addition to appearing on the exterior and interior of city buses, the ads are also being distributed in smaller, postcard-sized versions at cafes, bookstores and businesses throughout San Francisco. The campaign is particularly targeting the city’s Mission district, which has a large Spanish-speaking population, and the Castro district, which has a large gay population.

Nurses can find out more about this culturally and linguistically competent HIV prevention program at http://www.sfaguilas.org/.

Get All the Facts About the Gay and Lesbian Medical Association

The Gay and Lesbian Medical Association (GLMA) is a national nonprofit organization based in San Francisco. GLMA’s mission is to make the health care environment “a place of empathy, justice and equity.” The organization began in 1981 as the American Association of Physicians for Human Rights. It became the Gay and Lesbian Medical Association in 1994 to broaden its visibility, leadership, education and advocacy.

GLMA aims to increase the visibility of the specific health concerns of lesbian, gay, bisexual and transgender (LGBT) patients. Although HIV has been the focus of gay health care activism in the past, GLMA addresses a broad spectrum of health issues affecting the gay community, including disparities in treatment and growing difficulties in acquiring funding for research that addresses these issues. According to GLMA President Kenneth Haller, MD, health care providers often assume that their patients are straight, thus missing questions or considerations that might apply to gay patients. Meanwhile, the Bush administration’s prohibition of language referencing homosexuality in grant proposals has restricted the amount and quality of research being conducted on gay health issues.

GLMA says its members provide expertise and credibility in its policy advocacy efforts, which are especially dedicated to expand access to high-quality health care. GLMA members represent the interests of thousands of LGBT physicians, medical students, and increasingly other health care professionals, as well as millions of patients throughout North America who seek equality in health care access and delivery.

To accomplish its goals in these areas, GLMA holds conferences and seminars to provide continuing medical education to health providers, researchers, policy makers and students. The Lesbian Health Fund was established in 1992 to fund research in several areas specifically affecting lesbians, including what GLMA calls “dangerously indequate medical care,” high rates of suicide, increased incidence of stress-related chronic illnesses, and avoidance of preventative health services.

GLMA also mobilizes its membership on policy issues through its email alert system, called GLMA*PAN. The organization uses the listserv to encourage its membership to advocate for administrative and legislative changes to promote health and civil rights. Another tech tool offered by GLMA is its online health referral service, which helps patients find gay-friendly physicians and other health care professionals who are GLMA members. In an interview with DAHC, President Kenneth Haller talked about GLMA’s challenges as an organization, common problems faced by LGBT patients, and his hopes for the future.

How did GLMA evolve from an association for physicians to one that now includes other health care workers in its membership?

“GLMA has been in existence as a freestanding association dedicated to eliminating homophobia in health care for more than 20 years. During that time, no other health care profession has been able to create a similar freestanding LGBT organization for themselves. Over the years many people in other health care professions approached GLMA about broadening our scope to include professionals other than physicians. We did so two years ago, and we have been very gratified that membership in the non-physician category has grown steadily. We feel strongly that the more providers we have in our association, the more credibility we will have with government policy makers, and we feel we are beginning to see that come to fruition.”

What is the biggest challenge facing GLMA today?

“The climate in Washington has made it difficult for researchers to focus on LGBT health issues. Earlier this year, for example, there were reports from many researchers that their project directors were telling them to avoid words and phrases like ‘gay,’ ‘transgendered,’ ‘men who have sex with men,’ among others, when they submitted grantproposals to the National Institute for Health (NIH) or Center for Disease Control (CDC). This sort of censorship makes it difficult for researchers to communicate with one another and to communicate their work to health care providers taking care of patients. GLMA connected some of these researchers to the media, resulting in coverage in various outlets including The New York Times, and we created a sign-on letter at our Web site protesting these actions that was signed by 650 GLMA members. The letter was sent to the White House, the CDC, the NIH, and the Department of Health and Human Services, putting them on notice that we wouldn’t take this sort of treatment lying down.”

You’ve just been re-elected for a second one-year term as president of GLMA. Why do you believe this organization is worth such a high level of commitment?

“Two influences really. I did my residency in New York City in the early 1980s, so I came of age as a doctor in the midst of the AIDS crisis. I also grew up in a very liberal Catholic tradition of social justice and have always worked in underserved communities. As I, like so many others, saw how AIDS affected our community, I began to realize how invisible the gay and lesbian community had been to the medical community for years. It’s a matter of simple justice, and I feel that GLMA is best equipped to bring these issues to light and make a difference.”

How can students and young professionals participate in GLMA’s work?

“GLMA has reduced rates for student members, and students make up a significant portion of our volunteer base. Students can be a very important part of GLMA’s advocacy function by signing up for GLMA*PAN alerts, which are emails sent out to alert our members to pending legislation that will impact LGBT health. They can also serve on GLMA committees. Further information is available at our Web site at www.glma.org.

What are some examples of disparities in health care for gay and lesbian patients?

“Well, beyond HIV, there are differences in how gay men contract sexually transmitted diseases. Lesbian women have rates of breast and gynecological cancers that are very different from straight women. Both gay men and lesbians smoke at rates about twice that of their straight counterparts. Rates of substance abuse and risk behaviors seem to be higher among gay and lesbian youth than among the general adolescent population.

“Beyond that, though, is the very issue I touched on earlier—we often have only a vague idea of the particular health concerns of gay and lesbian persons because of how difficult it is to get funding for research into our health issues. This leads to a Catch-22: Without the evidence you don’t get the funding, but without the funding you don’t get the evidence. Obviously, this has got to stop, and GLMA is adamant about the need for increased funding to investigate the state of LGBT health.”

Why do you think it has taken so long for physicians to become aware of these issues? How is GLMA working to make this change?

“I don’t think most health care providers are actively homophobic; these sorts of issues have just never occurred to them. The problem is, when you don’t know to ask the right questions, you may not get the right diagnosis. For example, men who have sex with men and are sexually active may not know that they may have an elevated PSA level after anal sex. The PSA is a test done to see if the prostate is inflamed, and if you have an elevated level, the doctor will often recommend a prostate biopsy. If a patient isn’t comfortable telling his doctor that he’s gay, he may end up getting this procedure—which is painful, expensive, and does have some risk—for no reason.

“GLMA is working on education, not just of LGBT health care providers, but of all providers through materials such as our “Top Ten Health Concerns of Lesbians and Gay Men” and “Guidelines for Creating a Safe Clinical Environment for LGBTI Patients.” These and other instructional materials are available at our Web site at www.glma.org. We are also trying to get funding to distribute these materials more widely. In any case there’s still a lot to do. The need for GLMA is not going to disappear soon, and we intend to be here to keep doing that work.”

Is the Bush Administration Ignoring Gay/Lesbian Health Issues?

So far, the U.S. Department of Health and Human Services (HHS)’s Initiative to Eliminate Racial and Ethnic Disparities in Health–launched in 1998 as part of former President Bill Clinton’s Initiative on Race–seems to have survived the transition to a new Republican administration with its minority health advocacy agenda reasonably intact. But some health experts and policy makers are concerned that George W. Bush’s HHS is failing to address the health care needs of one the nation’s most important minority populations: lesbian, gay, bisexual and transgender (LGBT) Americans.

According to an article published last fall in the Washington Blade, a newspaper serving the District of Columbia’s gay community, a growing number of gay health activists say they are worried that the Bush administration may be systematically ignoring and marginalizing this population’s health concerns. “Gay and lesbian health issues were clearly on the agenda during the Clinton administration,” says Judy Bradford, a panelist on a landmark 1999 Institute of Medicine report on lesbian health. “Now, it’s as if they’ve vanished. They’re off the radar screen.”

The National Coalition for LGBT Health, the Gay and Lesbian Medical Association (GLMA) and other advocacy groups cite HHS’ last-minute decision to withdraw funding earmarked for the National Lesbian Health Conference 2002, and the lack of references to LGBT populations in the department’s 2003-2008 strategic plan, as examples of how the Bush administration is backpedaling on the commitment to gay health established during the tenure of Clinton-era HHS Secretary Donna Shalala. “The [Bush] administration has reneged on promised support, censored [LGBT] health information and pushed health programs that render gays and lesbians non-entities,” charges GLMA President Christopher E. Harris, MD.

Fortunately, the Blade reports, gay rights groups aren’t the only ones taking Bush’s HHS to task on this issue. In October 2002, Rep. Constance Morella (R-Md.), Rep. Henry Waxman (D-Calif.) and 17 other House members wrote a letter to HHS Secretary Tommy Thompson requesting that HHS “identify the actions that have been taken or will be taken across the department to ensure that health disparities due to sexual orientation and gender identity are being addressed and reduced.” Added Waxman, in a written statement, “The Bush administration has ignored many important gay and lesbian health issues.”
 

Out at Work: Diversity in the Pharmaceutical and Biotechnology Industries

The U.S. pharmaceutical industry has been in a five-year hiring frenzy. IMS Health, a leading source of market information for the pharmaceutical industry, forecasts that both pharmaceutical and biotechnology companies will continue to experience growth that outpaces that of the overall economy for the foreseeable future. This steep growth curve spells opportunity for new college graduates considering a career in pharmaceuticals. The industry has recognized the value of attracting and retaining a diverse workforce and is actively pursuing graduates from many different backgrounds. Within many organizations, the workforce diversity they embrace not only encompasses race, gender and disability status, but also has been expanded to include lesbian, gay, bisexual and transgender (LGBT) employees.

What do you do if you are a gay man or lesbian looking for a job in the pharmaceutical or biotechnology industry? How do you know which potential employers have a demonstrated commitment to diversity and especially to their LGBT employees? An excellent place to start is the Corporate Equality Index published annually by the Human Rights Campaign (HRC) Foundation. HRC is an organization that works to advance equality based on sexual orientation and gender expression and identity. In 2003 the index rated 250 employers that can be found on either the Fortune 500 list of the largest publicly traded companies or the Forbes 200 list of the largest privately held firms. An additional 112 employers with at least 500 employees were also included. Companies were surveyed and rated on a scale of 0% to 100% based on seven factors that demonstrate how the companies treat LGBT employees, consumers and investors. Nineteen pharmaceutical and biotechnology companies were rated in this year’s index. Sixteen had scores of 57% or higher, indicating positive responses on at least four of the seven factors, with Bausch & Lomb Inc. scoring a perfect 100%. (To see how other pharmaceutical and biotech employers scored, see the chart below.)

Gaining the Support of Your Employer

One of the seven factors on the HRC survey is whether the companies “officially recognize and support a gay, lesbian, bisexual and transgender employee resource group; or would support employees’ forming a LGBT employee resource group if some expressed interest by providing space and other resources; or have a firm-wide diversity council or working group whose mission specifically includes LGBT diversity.”

Employee resource groups (also known as affinity groups) are expanding in number as more and more companies focus on diversity for a competitive advantage. However, groups often develop at the grassroots level, before formal diversity initiatives are in place. As corporate sponsorship increases, the groups can help spread diversity messages to the rest of the company. Resource groups are usually formed around what are known as the “primary dimensions of diversity”: age, race, physical disability, gender, ethnicity and sexual orientation.

Genentech, a biotechnology leader headquartered in South San Francisco, Calif., is a strong supporter of employee resource groups and offers one that focuses on LGBT issues. (See sidebar “Genentech’s Out & Equal Diversity Network Association”.) Sandra Manning, co-chair of Genentech’s Out & Equal (GO&E), states that “at Genentech, it is truly believed that when an employee can arrive at work free of inhibitions or worries, then that person will contribute fully to their work and to the company’s goals. That is what is so great about a corporate culture that embraces diversity.”

Resource groups work to support their companies’ business in four common ways:

Education. An educational forum is one of the most useful benefits a resource group can provide to both its members and the company. For instance, busy employees may not know all of the details surrounding the domestic partnership benefits that the company offers. (Lobbying to get them is often the first goal of a LGBT resource group if they are not already available.) The same holds true for benefits available to registered domestic partners in the states where the company does business, and updating members on pending legislative issues such as the Employment Non-Discrimination Act (ENDA). More ambitious projects include educating and increasing the awareness of all employees about their gay and lesbian colleagues.

Educational programs need not, indeed should not, be limited to LGBT issues. A powerful way to align the resource group’s objectives with those of the company is to sponsor lectures open to all staff members on professional development and corporate issues. For example, invite a senior manager from research, manufacturing or sales to speak about what their departments do and what their greatest challenges are. Other educational offerings can include maintaining a library of current books and publications relevant to LGBT professional issues, and facilitating a book club that covers general business and leadership related topics from a LGBT perspective.
Networking. Social events provide an excellent opportunity to meet with people from across the organization, which is good for exchanging information and developing professional contacts. Networking is an informal way to learn how different parts of the company contribute to the organization’s overall goals. Such knowledge is useful if you want to make a lateral move within the company, and it also becomes increasingly valuable as your career advances.

Genentech’s Manning says, “Since GO&E meets monthly to plan activities throughout the year, people attending the meetings make an impact on each other simply by introducing themselves. We meet new members who are from various departments in the company, we learn a little about our different roles, and how we each contribute to the goals of Genentech.”

Meeting gay and lesbian colleagues at higher levels in the organization also fosters mentoring opportunities. In addition, resource groups often have sponsors who are high-ranking employees within the company that offer advice and guidance on group activities. Membership in a resource group, and especially holding a leadership position, can provide access and visibility that might not normally be available in your job.

Networking opportunities can expand well beyond the company. Community outreach activities allow members to interact with LGBT philanthropic organizations. Connecting with other corporate LGBT resource groups in the same city and across your industry can infuse your group with new ideas and energy. Two formal programs provide a structured way for gay and lesbian professionals to come together: The Out & Equal Workplace Summit is an annual three-day event culminating in the Outie Awards Gala and the LGBT Leadership Institute sponsored by the Anderson School at UCLA offers a week-long symposium covering a full range of gay and lesbian employment and career issues.
Recruitment and Retention. Finding talented and highly skilled employees is a constant challenge for pharmaceutical companies. Once they find the right employees, companies want to keep them. Manning adds, “Genentech’s GO&E group works to help accomplish the goals of the company and, in turn, Genentech supports GO&E in order to retain its highly valued human resources.”

The presence of an LGBT resource group is a strong indicator of the corporate culture’s attitude toward and acceptance of gay and lesbian employees. The groups foster a sense of community within the company, and make a gay or lesbian employee more likely to stay. Often, personnel who have been hired recently are not only new to the company, but also new to the city. A resource group provides an immediate social circle and can help smooth the transition to the new area—this reduces stress and makes a new employee more productive, faster.

As the workplace becomes more open for gay and lesbian employees, and candidates become more comfortable addressing GBLT issues before they are hired, the demand for information on diversity policies and corporate attitudes will increase. Resource groups can assist on this front in several ways. They can help the company identify talent pools by providing the human resources department with recruitment contacts for LGBT professional societies and college or university alumni associations. Group members can serve on panels for human resources during the interview process. A savvy candidate may request an informational interview with a gay or lesbian employee before accepting an offer. New hire orientation packets should include contact information for all corporate diversity groups along with listings of local organizations and community events.
Community Outreach. Resource groups can do good deeds while also building the company’s image through community outreach programs. Activities can take the form of directed giving, volunteerism and corporate sponsorship. Directed giving involves identifying worthwhile charitable organizations that the group can support by combining individual member contributions. Corporate foundations may offer matching funds in addition to employee contributions. Volunteerism can be as simple as forming a corporate team for an AIDS walk or as complex as staffing an entire fundraising event.

Pharmaceutical and biotechnology companies have a vested interest in building strong science skills in school-age children. Mentoring high school students or sponsoring a science fair develops both goodwill and future employees. Finally, corporate sponsorship of gay and lesbian events sends a strong message of support to the community. Both Amgen(a global biotechnology company headquartered in Southern California) and Genentech have sponsored their local LGBT Pride events.

Opportunities to contribute can come from a variety of sources. The Amgen Network for Gay & Lesbian Employees (ANGLE) recently had an unexpected, but welcome, request. “A local elementary school asked for donations of age-appropriate books from each of Amgen’s affinity groups for their school library. The experience made me realize that our group can help shape positive attitudes toward gays and lesbians not only within the company but also in the communities where we do business,” states Durk Hubel, president of ANGLE. (See sidebar “Amgen: Lessons Learned From a Start-up”.)

Your Next Step

The HRC’s Corporate Equality Index is a unique and helpful resource, but it surveys only the largest U.S.-based companies. Don’t let a potential employer’s absence from the index hold you back. Check out the company’s Web site; it may have information on their commitment to diversity. Also, try calling the human resources department. Ask if they have an active LGBT resource group, and if so, whether you can have the group’s contact information. Employment prospects in the new millennium for both the pharmaceutical industry and LGBT professionals are looking very bright indeed.

 

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