Improving mortality data through postmortem measurement of sexual orientation and gender identity

项目摘要 健康风险文献表明，性少数和性别少数(SGM)人群更有可能 死于暴力死亡的人比他们的非SGM同龄人(例如，SGM人死于暴力死亡的可能性是他们的2-4倍 企图自杀)，但因为性取向和性别认同(SOGI) 在死亡时没有系统地收集数据，死亡率的差异不能 评估为预防和干预提供信息。这个提议的项目的目标是证明 暴力死亡后收集SOGI的可行性。因为我们一直与 法医死亡调查员、验尸官和法医开展死亡培训 调查人员在尸检后收集SOGI数据，我们的团队独一无二地准备实现拟议的 研究目标，符合R21机制的探索和发展目的。我们的目标是 对：(1)评估培训死亡调查人员进行死后测量的可行性 暴力死亡死者的SOGI，以及(2)检验死亡调查人员的测量忠诚度 SOGI在最初的SOGI培训之后。为了进行这项研究，我们将与洛杉矶 县验尸官部门和县卫生局法医办公室 犹他州盐湖城卫生局。对于目标1，我们将使用定量和定性 方法检查两个地点培训的可行性。使用每月的案例总结，我们 假设调查人员进行SOGI测量的案件比率将显著增加 从培训前一个月到培训后6个月。开始-6个月后 培训，我们将与死亡调查人员进行半结构化访谈，以探索促进者和 在动态的调查背景下衡量SOGI的障碍，并收集建议、指导、 以及他们的警告，以促进死亡调查中SOGI测量的最佳实践。 对于目标2，一个由4人组成的专家小组将使用文件分析来审查去脂类药物的随机样本 从6个类别(即，性少数群体、异性恋、性取向)确定案例叙述 未确定、变性人/非二元、顺性、性别认同未确定)，确定主题 关于案件类别内和类别之间文件的相似和不同之处。我们的建议 与RFA-MD-20-005的目标保持一致，该目标的目的是“研究 新的或现有措施的可接受性，但它采取了一种不同于典型SOGI的方法 体内的测量研究，因为我们解决了预防SOGI的主要差距 验尸后测量。由于这种独特的方法，拟议的研究回应了 直接向国家心理健康研究所的方案感兴趣“，以改善收集 自杀和/或其他暴力死亡后的SOGI数据。

Project Summary The health risk literature suggests that sexual and gender minority (SGM) people are more likely to die by violent death than their non-SGM peers (e.g., SGM people are over 2-4 times more likely to attempt suicide than non-SGM people), but because sexual orientation and gender identity (SOGI) data are not systematically collected at the time of the death, disparities in mortality cannot be assessed to inform prevention and intervention. The goal of this proposed project is to demonstrate the feasibility of collecting SOGI following a violent death. Because we have worked closely with medicolegal death investigators, coroners, and medical examiners to develop a training for death investigators to gather SOGI data postmortem, our team is uniquely poised to achieve the proposed study goal, which befits the exploratory and developmental purposes of the R21 mechanism. We aim to: (1) assess feasibility of training death investigators to implement postmortem measurement of SOGI among decedents of violent death, and (2) examine death investigators' fidelity of measuring SOGI after the initial SOGI training. To conduct this research, we will partner with the Los Angeles County Department of the Medical Examiner-Coroner and the Office of the Medical Examiner for the Utah Department of Health in Salt Lake City, UT. For Aim 1, we will use quantitative and qualitative methods to examine feasibility of training at both sites. Using monthly case summaries, we hypothesize that the rate of investigators' cases with SOGI measurement will significantly increase over time from one-month prior to training through 6 months after training. Beginning 6-months post training, we will conduct semi-structured interviews with death investigators to explore facilitators and barriers of measuring SOGI in the dynamic contexts of investigations and gather advice, guidance, and caveats from them to contribute to best practices for SOGI measurement in death investigation. For Aim 2, a 4-person expert panel will use document analysis to review random samples of de- identified case narratives from 6 categories (i.e., sexual minority, heterosexual, sexual orientation undetermined, transgender/non-binary, cisgender, gender identity undetermined), identifying themes of similarities and differences in documentation within and between categories of cases. Our proposal aligns with the RFA-MD-20-005 objective for “research that examines the performance, utility, and acceptability of new or existing measures,” but it takes an approach that is unique from typical SOGI measurement studies that are in vivo because we address major gaps preventing SOGI measurement postmortem. Because of this unique approach, the proposed research responds directly to the National Institute of Mental Health's programmatic interest “to improve the collection of SOGI data following a suicide and/or other violent death.”