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I submitted the following abstract to the 2021 Gay and Lesbian Medical Association conference. It was accepted, and I presented it at the GLMA Nursing Summit. Additionally, the First Annual Bisexual+ Research Conference that year accepted it as a “lightning talk” followed by a breakout discussion.

Bi-Bi, Bi+ Health Gap:

Identifying and Implementing Evidence-based Interventions
to Reduce Bisexual Health Disparities

Bisexuals experience staggering rates of disability, sexual assault, depression, anxiety, suicidality, and poverty. Their rates in all of these areas are closest to those of the transgender community. Sometimes even higher.

There’s no doubt that this community needs support and advocacy from healthcare professionals of all kinds. Yet 39% of bisexual men and 33% of bisexual women report not disclosing their sexual orientation to any of their healthcare providers, compared to 13 % of gay men and 10% of lesbians. Worse, those who do have frequently had negative experiences.

But there is a light at the end of the tunnel. Bisexual researchers and bi+ allies have done extensive work towards identifying what is causing those health inequities and what improves these outcomes. We’ll explore the full range of recommendations in available research, then discuss what we can each do to implement the solutions that are appropriate to our own work.

After completing this workshop, you will be able to:

1. Describe the major factors influencing bisexual health disparities, and begin to identify which ones most impact your communities.

2. Identify evidence-based interventions to reduce those factors.

3. Discuss ways to implement specific interventions in a given practice, project, or organization.

Research

In Health Equity

Thanks in part to the efforts of the Gay and Lesbian Medical Association, health equity for gay people has greatly improved.

This has paid dividends in everything from mental health to overall income.

Unfortunately, most people don’t know that the bi community still faces outcomes as bad as those of the trans community.

I designed the infographics here to bring the healthcare community up to speed on decades of minority stress research all at once.

These graphics can also be split up and used separately to educate people on a specific topic, such as sexual violence or mental health.

Bi-Bi, Bi+ Health Gaps! Identifying and Implementing Evidence-Based Interventions to Reduce Bisexual Health Disparities.

What's Bi+? Bisexual, bi, or bi+ ("bi plus") is an umbrella term for anyone who can be attracted, in any way, to more than one gender, regardless of their label(s).

Who's Bi+? • About 2/3 of the trans community. • 5% of millennials. • 11.5% of Gen Z. • Not 11.5% of the queer community. 11.5% TOTAL. • Increase also driven by Black women: 23% identify as bi. The more that people encounter language for and acceptance of bisexuality, the more people come out.

What Are Bi+ Health Gaps? Sexual Violence. Abuse. Addiction. Trauma.

Percent of High School students who, anywhere, In 2019, experienced.... Below are four charts, each showing the percentages for straight, gay, and bi students. Sexual violence: 9% of straight students, 13.5% of gay students, 23.8% of bi students. Sexual dating violence: 6.7% of straight students, 7.2% of gay students, 18.8% of bi students. Injury, poisoning, or overdose, from a suicide attempt: 1.7% of straight students; 4.7% of gay students; 6.7% of bi students. Physical dating violence: 7.2% of straight students, 11% of gay students, 13.6% of bi students.

Barriers to Education: In 2015, the Association of American Universities surveyed more than 150,000 students nationwide about some of the challenges they might have been experiencing. These statistics are from their time in college and graduate school only. Sexual Harassment: Gay/Lesbian 60.4%, Bisexual 69.1%. Sexual Assault: Straight 5.2%; Gay/Lesbian 8.7%; Bisexual 14.4%. Stalking: Straight 3.7%; Gay/Lesbian 5.9%; Bisexual 9.9%. Rape: Straight 10.8%; Gay/Lesbian 13.7%; Bisexual 25.6%.

Sexual Violence: Includes experiences since age 14. Does not include child sexual abuse. cis hetero men 38%. cis gay men 62%. cis lesbians 63%. cis hetero ♀ 65%. cis bi+ men 74%. trans men 77%. trans women 77%. cis bi+ women 80%. these numbers are arranged around a solid red circle, with 0 and 100 at the bottom center. in the middle of the circle is a heart-shaped hole. in that hole are the words: Nonbinary Bi+ People 92.5%. Below all this are three more red hearts, each containing a number. The first says, "2: Resources, globally, for bi+ survivors." Next is "2x More likely to face violence in shelters than gay & straight peers." And finally, "0.089% of LGBTQ+ funding globally goes specifically to bi+ needs."

Even More Bi+ Health Gaps: Depression. Anxiety. Suicidality. Mental illness.

Percent of High School students who, during school, In 2019, were.... Hurt or threatened with a weapon: 6.4% of straight students; 10.4% of gay students; 15.5% of bi students. Depressed: 32% of straight students, 60% of gay students, 68% of bi students. Absent because they felt unsafe: 7.5% of straight students; 12% of gay students; 14% of bi students. Planning suicide: 12% of straight students; 32.5% of gay students; 42.5% of bi students.

What does this mean? The average bisexual is depressed and anxious. There is a gap between straight and gay health. There is an even larger gap between gay and bi health. [Below this header is the same chart again. Now it has neon blue boxes drawn from the mean straight anxiety score to the mean gay one, et cetera, to visibly show the gaps. A starburst of words to one side gives the sizes of each gap. Straight-Gay Gap: Anxiety: 1.35 Depression: 1.84 Gay-Bi Gap: Anxiety: 2.42 Depression: 1.90.]

To look at it another way, contrast the gaps between the straight and gay scores with the gaps between the straight and bi scores. Straight-Gay Gap: Anxiety: 1.35 Depression: 1.84 Straight-Bi Gap: Anxiety: 3.77 Depression: 3.74.

Pan falls under the bisexual umbrella. An increasing number of studies include both labels. Coincidentally, a lot of people also use both labels. Demographically, the main difference is that in studies, more trans people select "pan." Gay-Pan Gaps: Anxiety: 2.63 Depression: 3.54 Straight-Pan Gaps: Anxiety: 3.98 Depression: 5.38.

THIS IS A NEAR-BI HEALTH GAP. People on the asexual spectrum are treated much the same way as those under the bi umbrella -- with disbelief, disgust, or as sexual conquests -- and, across the board, have similar outcomes. Learn more in your resource packet! [Below this is the same chart again, but this time the starburst reads, "Straight-Ace Gaps: Anxiety: 3.09 Depression: 4.81 Straight-Demi Gaps: Anxiety: 5.41 Depression: 6.48." Gay-Ace and GAy-Demi gaps were left as an exercise to the reader, but: the gay-ace gaps are 2.74 anxiety, 3.03 depression. The gay-demi gaps are 4.06 anxiety, and 4.64 depression. The purpose of contrasting these is to challenge the widespread assumption that gay and lesbian are the orientations that most threaten the mainstream, and get the worst reactions and therefore the worst outcomes. According to this belief, this group would have the highest scores, and all others would be fairly close to the scores for heterosexuals. Instead, it turns out -- both here, and in minority stress studies in general - that the opposite is true.

Did you know? According to the CDC and the Trevor Project, bi+ cis youth attempt suicide at even higher rates than transgender youth. In the US alone, 25% of bi+ teens survived suicide attempts during 2018-2019. Cis hetero: 7%. Gay/Lesbian: 19%. Trans: 21%. Bi+: 25%.

Which Create More Bi+ Health Gaps: Teen pregnancy. Disability. Poverty. Isolation. Silence.

A screenshot of a June 2, 2021 tweet by Heron Greenesmith, Esq., @herong. It says, "We know the following things: 1) Most queer youth are bi. 2) WAY MOST queer girls are bi. 3) There is effectively $0 funding for bi-specific programming and services. 4) Thus, there are, lik, nearly NO bi-specific programming and services. 5) Bi womn and girls face INTENSE, and UNIQUE violence from family and intimate partners. 6) Let me underscore UNIQUE. This violence is BASED IN BIPHOBIA, not homophobia (though it is related). 7) Bi girls face SHIT at school." [The tweets appear on the image of a classroom blackboard. Below it is the text, Below the tweet is a link to an article calld "High Risk, Few Resources: Bisexual Kids Lack Help When They Need It." The preview text says, "Bisexual young people face intense bullying and harassment and report poorer mental health outcomes than gay, lesbian, or straight youth." The link is at rewirenewsgroup.com.

TEEN PREGNANCY IS A BI HEALTH GAP. [below this is a graphic of an open notebook, which says] A 2019 study using national data from the Youth Risk Behavior Survey found that bisexual-identified cis girls were [highlighted text] 72% more likely than their straight peers to have had a pregnancy.[end highlighted text] In researcher Heron Greenesmith's words: "It wasn't that the bi-identified girls had higher alcohol use. "They do, it's just not causative. " It wasn't that the bi-identified girls had more male partners than lesbian girls. "They do, it's just not causative. " IT'S LITERALLY JUST BEING BISEXUAL." [Below the notebook, smaller text continues, "The study points to other research showing that about half of the higher pregnancy rates among sexual minority girls is likely related to stigma and childhood victimization. It's unknown what else causes this gap. But perhaps it has to do with the elevated risk of sexual assault, which that study does not examine."]

Percent of High School students who... Ever tried smoking: 23% of straight students; 23% of gay students; 36% of bi students. Currently smoke: 1.7% of straight students; 4.7% of gay students; 6.7% of bi students. First drank before age 13: 7% of straight students; 14% of gay students; 21% of bi students. Had 10+ drinks in a row in the past month: 3% of straight students, 1% of gay students, 4% of bi students.

Bi+ The Numbers: The surprising truth: Cis bi+ outcomes are most similar to those of the trans community. ][Below this we again have four charts. This time, thy show cis straight, gay, and bi outcomes, and trans outcomes. Each one centers the cis bi+ outcome, and lists the other three alongside it. Disability rate: Cis bi, 33%. Trans, 35.5%. Gay/lesbian, 27%. Straight, 22%. (Please note, however, that these numbers are pre-pandemic.) Poverty rate: Cis bi+, 25%. Trans, 29%. Gay/lesbian, 14%. Straight, 14%. Youth Depression: Cis bi+, 66%. Trans, 53%. Gay/Lesbian: 49%. Straight: 27%. Food insecurity among college students: Cis bi+, 49%. Trans, 47%. Gay/Lesbian, 45%. Straight, 36%.

Everything here is connected. (below this is a sort of flow chart. At the top is Trauma, with arrows leading to Hypervigilance on the left, and Emotional Pain on the right. Below Hyperviligance is an arrow pointing down to Isolation: "Where's safe? Who's safe? What's safe? Is anything safe? How do I even put words to this, much less say them?" But another arrow points from Hypervigilance to the words below Emotional Pain. And arrows from Emotional Pain lead to the words below Hypervigilance, as wll as to these words below it: "Drains the emotional and mental resources needed to reason, make choices, and take actions. (Aka 'executive function.')" And below this is another thing Emotional Pain leads to: Self-harm. A way to convert the emotional pain into physical pain and/or numbness, which is a way to control it, which means it's a way to feel better. But another arrow leads from this back up to "drains the emotional and mental resourcs needed to function...." Below the whole mess, text explains, "All of it is a disability rights issue. We have to educate ourselves if we want to effectively fight it."

Giant glowing neon yellow letters ask, "SO, WHAT HELPS?"

EVIDENCE-BASED INTERVENTIONS: Three columns are labeled "Problem," "Solution," and "Details." Line by line, it says: Trauma/PTSD? CPT (Cognitive Processing Therapy). 12 structured individual or group sessions in which you undo the cognitive and emotional impact the trauma has had on you. Addiction: AA, Nicotine Anonymous, et al. Free peer-led groups where you can get support, have fun, and learn what has helped people like you stop wanting to use. Poverty: Medicare, SNAP, TANF, local support. (and in bold) This is not a solution. Our movement needs to fight for universal basic income. Teen pregnancy: Inclusive sex ed. Abortion care. Reproductive care. Condoms. We need to fight to provide free condoms in school, effective and supportive sex ed, and BE SUPPORTIVE of teens who are having sex. Sexual abuse and sexual betrayal: COSA, CPT. COSA is another 12-step organization, for those affected by cheating, sex addiction, or sexual violence.

But what can I do? HOMEWORK: Your packet is filled with fun ways to learn about bi culture and history, and so much more. read a little or a lot. Your packet is also filled with posters, flyers, and brochures about these gaps, these interventions, and bi pride. print them out and saturate your waiting room, hallways, front desk, exam rooms, staff room, etc. "Yes, I had a great time at the glma nursing summit! Is there a day when I can share what I learned in a staff meeting?" "Part of my homework from the nursing summit was to make everyone watch this video." Extra Credit: go to unicornmarch.org and hit "join," to stay connected to this movement. DOWNLOAD IT: powerfullyvulnerable.com/bi-health-gaps (or email) danicastone@gmail.com.

Case Study:
Teach Your Brand to Speak

This self-help brand, designed to teach people how to overcome imposter syndrome, sounded like a great idea to everyone who heard about it. The challenge was to avoid the trap of “many fans, no customers.”

I began by drawing up user personas and relatable brand voices, and tested them by approaching 75 target users.

The message architecture:
• casual language and vivid, relatable anecdotes;
• big pictures made up of bite-sized insights;
• optimistic, encouraging, and confident.

In this meme, this brand is definitely “the sisterfriend.”

[A screenshot of a Tumblr post with 238 thousand notes that says, "the momfriend (is very gentle and comforting, carefully and calmly helps you work out the root of the issue, gives you lots of space and the affection you need) the sisterfriend (pushes you over [and says]) alright nerd what do i need to beat up for you? a boy? your feelings? do you need me to punch your feelings?"

Thanks to researching and deeply understanding the prospective customer, I was able to hit very high engagement rates from the beginning, both paid and organic.

Successes:
• Bounce rate of only 23% on the landing page.
• 29% click rate in emails; 50% click-to-open-rate.
•16% reach engagement rate on blog posts (the ratio of users engaged to users reached; 2% is considered high).

Case Study:
the stradivarius of UI/UX

Musica Pacifica, a top-tier baroque ensemble, had a hard time tooting their own horn. Talking about themselves seemed like boasting, and their largely older fan base wasn’t engaging with them much online.

I simplified navigation by asking, “what are our target users looking for, and where do they look for it first?” Then, I made the site accessible for customers with vision challenges, especially focusing on alt text and mobile optimization.

The shop page was a particular focus of this redesign. I used plugins to simplify and pre-fill as much information as possible, and to keep customers on the site throughout the checkout process.

Then I added a ton of the details that classical fans crave, like instruments, reviews, samples, and track listings, and created short, detailed descriptions of what made each album special. Restructuring and redesigning their website to better showcase their music resulted in a 7x increase in sales year-over-year.

And crafting intriguing, well-researched content that resonated with their demographic resulted in an average newsletter open rate of 44%, in an industry with a 19% average.

“

The better you understand your audience, the more you help them.

The more you help them, the more you both thrive.

Copywriting and Design HIGHLIGHTS

One of the biggest challenges in this project was creating engaging new covers for 150-year-old pieces. This is one of my favorites.

Consistent 40-50% open rates overall for Musica Pacifica, in an industry that averages 19-26%, and at a list size that averages 32.4%.

Achieving a 14% average reach engagement rate early on, for a growing self-help brand.

"Tune Up Your Resume": A car-themed infographic, for case managers helping former auto workers switch careers. The goal: to condense the steps involved, providing achievable actions that anyone can follow. This also involved considerable research on best practices, at the time, in resume writing. The result: significantly better outcomes for the clients who went through this process.

A tri-fold brochure helping laid-off auto workers, many of whom hadn't searched for a job in decades, to present themselves well at career fairs. This and the previous piece were key in positioning the NUMMI Re-Employment Center as the premier career center in California.

The goal: create insightful, shareable images, educating people about recovery from imposter syndrome. This one, a Facebook post that says "When you can truly love the things about yourself that make you feel most vulnerable, you become invincible," achieved a 22% reach engagement rate organically.

The goal: follow best practices, maximizing the value of each piece of content by adapting it for different platforms. In this case, the previous Facebook post grows to become a blog post.

Design, layout, and content for a short workbook giving people the first few steps toward vanquishing imposter syndrome. This page introduces the problem, and helps the reader see how much deeper it truly goes.

Short, engaging descriptions of each week in a course on imposter syndrome. The goal: to set expectations, and give the reader hope that their problems can be solved.

A complete redesign of the welcome email for this ensemble's newsletter. This is the bulk of the email, which was followed by links to free tracks and to the brand's online presence. We wanted to communicate both the excitement and peace that listeners would find in their music.

The new description of the album "Francesco Mancini: Concerti da Camera." "Eighteenth-century Naples was the heart of the Italian Baroque. The variety and virtuosity of these pieces capture the excitement of that musical hotbed of innovation. In these pieces, Mancini draws freely from solo concerti, concerti grossi, opera, and church music, saluting past styles and anticipating future trends. His Sonata in B-Flat Major evokes the frothy, comic fun that his successor Pergosi would eventually become known for. His gracious, slow movements are reminiscent of Handel. The recorder is featured in several of the concerti. This is a wonderful choice for the powerful ensemble, putting Judith Linsenberg's lovely and lyrical performances front and center. Other performers come into their own power in Durante's concerto and Scarlatti's sinfonia. Each piece is powered by the rich and sonorous continuo of skilled instrumentation that ties the whole album together. As one fan remarks, "The Durante piece is reminiscent of Vivaldi in a harmonically wry mood." You'll find plenty of fun and beauty in these delightful adventures by the talented ensemble."

A sample Facebook post driving YouTube views, poised to be turned into a blog post.

Lit Up's monthly ebook box showcases writing from underrepresented groups. This catalog copy introduced customers to the idea while encouraging them toward the more expensive box.

What follows is a few graphic design examples: covers created for a few of the pieces in Lit Up's book boxes.

This cover was intended to draw readers to a spooky but intriguing short story by an anonymous author.

This cozy and comical mystery needed a cover that incorporated its SoCal setting and playful plot elements, and made readers want to learn more.

About Dani Aidan Stone

Ever since I taught myself to read at the age of 2, words have been the air I breathe. Ever since my dad got me my first email account, through his work, in 1990, the internet has been my home.

As a teenager, I worked as a community manager for AOL. After college, I worked in UX testing and digital branding for Ask.com.

Because I essentially grew up online, I have experience with every aspect of online spaces, from obscure niche message boards to Facebook ad optimization.

I’ve spent the past 15 years using these passions to help all of you share yours with more people. My focus is on innovative practices, highly tailored to each brand.

What challenges is your business facing? Where do you want to grow? Drop me a line for a free consultation over email.