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

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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.”