{"id":118445,"date":"2018-02-21T09:00:49","date_gmt":"2018-02-21T14:00:49","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=118445"},"modified":"2020-09-17T10:33:02","modified_gmt":"2020-09-17T14:33:02","slug":"its-important-to-do-what-we-can","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2018\/its-important-to-do-what-we-can\/","title":{"rendered":"\u2018It\u2019s Important to Do What We Can\u2019"},"content":{"rendered":"<div class=\"banner-container banner-has-html\">\n<div class=\"videoWrapper\" style=\"position: relative;padding-bottom: 56.25%; \/* 16:9 *\/height: 0;\"><iframe loading=\"lazy\" width=\"855\" height=\"481\" src=\"http:\/\/www.bu.edu\/buniverse\/interface\/embed\/embed.html?v=2LCjnB0\" style=\"position: absolute;top: 0;left: 0;width: 100%;height: 100%;frameborder=\"0\" scrolling=\"no\" allowfullscreen> <\/iframe><\/div>\n<\/div>\n\n<p>\n<div class=\"wp-prepress-component-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">February 21, 2018<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t<\/div>\n\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<\/p>\n<div class=\"block-callout-large left\"><img src=\"\/sph\/files\/2018\/01\/ICW-Julia-Raifman-400x241.png\" \/><h2>Julia Raifman <span class=\"text-subtitle\">Assistant Professor of Health Law, Policy &amp; Management<\/span><\/h2><\/p>\n<p>Breakfast: Cinnamon Puffins cereal<\/p>\n<p>Hometown: Rochester, Minnesota (\u201cIt makes the Boston winter seem warm.\u201d)<\/p>\n<p>Extracurricular: Hiking (\u201cMy husband and my dog and I do a lot of hiking. This fall we got to go explore the fall foliage for the first time in New Hampshire in places like Hedgehog Mountain. Minnesota is very flat, so mountains are especially exciting to me.\u201d)<\/p>\n<p><\/div>\n<p class=\"p1\"><span class=\"s1\">Watch the video above for a preview of Raifman&#8217;s Think. Teach. Do. presentation.\u00a0 Read her &#8220;In Conversation With&#8221; below\u00a0 to learn more about her research here at SPH.\u00a0 Register today for <a href=\"http:\/\/bostonu.imodules.com\/s\/1759\/2-bu\/2col.aspx?sid=1759&amp;gid=2&amp;pgid=5803&amp;cid=10682&amp;ecid=10682\">Think. Teach. Do. Miami.<\/a><br \/>\n<b><br \/>\nYou joined SPH faculty in fall 2017. What led you here<\/b><\/span><b>? <\/b><\/p>\n<p>I really appreciate the social justice mission of SPH. It\u2019s a great place to be working on research on how policies and institutions shape health inequities. I also came here because when I interviewed, the students were remarkably happy, and that was a wonderful reflection of an institution that values everybody who\u2019s here.<\/p>\n<h5 class=\"p1\"><span class=\"s1\"><b>What led you to studying how policies shape LGBT health?<\/b><\/span><\/h5>\n<p class=\"p1\"><span class=\"s1\">When I initially worked on HIV globally, I was reading about HIV among men who have sex with men (MSM) and was curious about the HIV rate among MSM in the US. I knew that it was about half a percent in the general US population, and I figured it must be higher among MSM\u2014\u201cProbably 1.5 percent or something really high like that,\u201d I thought. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">When I looked it up, it was 18 percent. I thought it was a typo, that it was missing a decimal point. It was not. That\u2019s actually the proportion of MSM in the US who have HIV. MSM in the US have 80 times the lifetime risk of HIV of heterosexual men, and it\u2019s even worse for black MSM. One in two black men who have sex with men will get HIV in their lifetimes, relative to one in 11 white MSM. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">We have effective methods of addressing HIV. We have condoms, and we know that treatment helps prevent HIV. Now we also have pre-exposure prophylaxis\u2014PrEP. We have all these effective means of addressing HIV. There\u2019s no reason that so many MSM should have HIV. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">I thought there must be structural drivers of these disparities. In the US, LGBT populations have explicitly unequal rights, and I was interested in whether those drove the health inequities that I was seeing. Infectious diseases like HIV and STIs have a way of exposing these inequities, and hopefully addressing structural barriers and facilitators can help reduce unjust disparities.<\/span><\/p>\n<h5 class=\"p1\"><span class=\"s1\"><b>What led you to begin looking at LGBT health beyond HIV and other STIs, like <\/b><span class=\"s2\"><b>same-sex marriage legalization and adolescent suicide<\/b><\/span><b>? <\/b><\/span><\/h5>\n<p class=\"p1\"><span class=\"s1\">One reason was that we started to have data available indicating that LGBT populations experience a wide range of health disparities beyond HIV. The CDC had just started to include questions on whether adolescents were LGB\u2014they still don\u2019t collect information on T\u2014in the Youth Risk Behavioral Surveillance data, and they started to put out <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/65\/ss\/pdfs\/ss6509.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">studies<\/span><\/a> on the disparities that they were seeing. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2604258\" target=\"_blank\" rel=\"noopener noreferrer\">I focused<\/a> on suicide attempts because it was one of the largest disparities, and I thought that was a natural first place to look. LGB youth were about five times more likely than their peers to report attempting suicide in the past 12 months. That itself is really heartbreaking. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">I took advantage of this natural experiment created by geographic and temporal variation as states legalized same-sex marriage\u2014starting with Massachusetts in 2004 and with more and more states passing it until it became legal across the country in 2015\u2014to look at how changes in policies lead to changes in suicide attempts among youth. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">It\u2019s been really gratifying to contribute to the literature on LGBT health and how rights affect health outcomes. I hope to continue working on LGBT health disparities as well as to start looking at things like how criminal justice, housing, education, tax, and welfare policies affect racial and ethnic health disparities.<\/span><\/p>\n<h5 class=\"p1\"><span class=\"s1\"><b>You mentioned the CDC beginning to gather data on LGB youth, but not transgender youth. What is the state of LGBT data in the US now?<\/b><\/span><\/h5>\n<p class=\"p1\"><span class=\"s1\">Unfortunately, some of it has been rolled back, like with the <a href=\"https:\/\/www.nbcnews.com\/feature\/nbc-out\/lgbtq-americans-won-t-be-counted-2020-u-s-census-n739911\" target=\"_blank\" rel=\"noopener noreferrer\">Census<\/a> and the\u00a0<a href=\"https:\/\/aoasurvey.org\/default.asp\" target=\"_blank\" rel=\"noopener noreferrer\">National Survey of Older Americans Act Participants<\/a>. That really takes away a public good. It\u2019s an important thing to have those data and to make them accessible to researchers. It\u2019s something that would benefit all of us. <\/span><\/p>\n<p class=\"p1\"><span class=\"s2\"><a href=\"https:\/\/www.publichealthpost.org\/research\/lgbt-rights-adolescent-health\/\" target=\"_blank\" rel=\"noopener noreferrer\">I personally<\/a><\/span><span class=\"s1\"> have been frustrated by the lack of representative data on transgender populations. We have little representative data on who\u2019s transgender, but some states have started collecting transgender data through the <a href=\"https:\/\/www.cdc.gov\/brfss\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">Behavioral Risk Factor Surveillance System<\/a> beginning in 2014, and the Massachusetts Youth Risk Behavior Survey is starting to collect it as well.<\/span><span class=\"s3\"> <\/span><span class=\"s1\">With a small population, you really need data collection more broadly. I think that laws regulating restrooms, locker rooms, and military participation for transgender individuals<span class=\"Apple-converted-space\">\u00a0<\/span>are a top priority for study, but it\u2019s very hard to study without the data. Population surveys, like the <a href=\"http:\/\/www.ustranssurvey.org\/reports\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">2015 US Transgender Survey<\/span><\/a>, are important, but it really should be a top priority to get these questions into the representative data sets that the US government collects in all 50 states. I\u2019m doing what I can with the limited data available to study policies that affect LGBT populations right now. It\u2019s important to do what we can with the data available.<\/span><\/p>\n<h5 class=\"p1\"><span class=\"s1\"><b>In the face of limited data and new policies affecting minority groups, what are you hopeful about?<\/b><\/span><\/h5>\n<p class=\"p1\"><span class=\"s1\">I\u2019m hopeful for a lot of reasons. Especially in this moment, researchers are advancing rigorous research on how social policies affect people. There have been some great quasi-experimental studies on things like immigration raids and Deferred Action for Childhood Arrivals and how they affect the mental health of Hispanic populations.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">There are a lot of questions to answer right now, and on the other hand there are some questions we\u2019ve answered pretty well. We have a lot of evidence that Medicaid expansion has really benefited the health of populations who got Medicaid because of it, for example. What\u2019s hard is providing evidence that appeals to everyone and really demonstrates the case across the population.<\/span><\/p>\n<h5 class=\"p1\"><span class=\"s1\"><b>How do you make that jump from gathering evidence to convincing people?<\/b><\/span><\/h5>\n<p class=\"p1\"><span class=\"s1\">That\u2019s really important for public health researchers to be thinking about right now. In a polarized world, it\u2019s good to focus on where we do agree. With the paper on same-sex marriage and adolescent suicide, there\u2019s widespread agreement that we don\u2019t want adolescents taking their lives. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Thanks to SPH encouraging it, I\u2019ve also been prompted to do more work to translate my research into policy. Tomorrow I\u2019m talking to policy makers about PrEP and why we should include it in the Massachuetts sex ed bill under consideration by the House Ways and Means Committee, because my research\u00a0shows that <a href=\"https:\/\/www.bu.edu\/sph\/2018\/01\/17\/young-men-who-have-sex-with-men-receive-less-hiv-education\/\">young gay, bisexual, and other MSM are getting less HIV education than their peers<\/a>. They have low awareness of PrEP even though it\u2019s very effective for preventing HIV, and they deserve to know about it. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">I noticed the bill included a lot of great things like LGBTQ-inclusive education, which is wonderful and a really great indicator of how progressive this state is. I think it\u2019s natural to start including PrEP in sex education as well. <a href=\"http:\/\/www.ajpmonline.org\/article\/S0749-3797(16)30315-4\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">We know<\/a> many people <span class=\"s2\">aren\u2019t learning about PrEP<\/span> from their doctors, so school is a place to reach everyone. Everyone should learn how to protect their health, and PrEP is one approach to doing that. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">If there\u2019s a bill that\u2019s relevant to my work, then I should take the opportunity to go talk to policymakers about the insight that I have based on my research. It\u2019s been really great to be able to <a href=\"https:\/\/www.bu.edu\/sph\/2017\/10\/19\/in-the-classroom-translating-passion-into-action\/\"><span class=\"s2\">get advice from Dean [Harold] Cox<\/span><\/a> on going about this.\u00a0<\/span><span class=\"s1\">This is really what makes our work meaningful: translating it into change for people\u2019s lives. I\u2019m excited to be doing that here at SPH. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">\u2014<a href=\"mailto:msamu@bu.edu\" target=\"_blank\" rel=\"noopener noreferrer\"><i>Michelle Samuels<\/i><\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Julia Raifman on how policy affects health of LGBT populations, why US government needs to start counting transgender people, and translating research into action.<\/p>\n","protected":false},"author":10989,"featured_media":118469,"comment_status":"closed","ping_status":"open","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":""},"tags":[2439,2070,1711,2222,1816,2021,2283,1753],"bu-publication":[3516],"sphnews-article-category":[3519,3531,3535,3536,3543],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[2473],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/118445"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/10989"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=118445"}],"version-history":[{"count":15,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/118445\/revisions"}],"predecessor-version":[{"id":175250,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/118445\/revisions\/175250"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/118469"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=118445"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=118445"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=118445"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=118445"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=118445"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=118445"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=118445"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=118445"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}