July 2020: Brian Mustanski, PhD
Director, Northwestern Institute for Sexual and Gender Minority Health and Wellbeing

Brian Mustanski, Ph.D. is the founding Director of the Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, which has grown to be the largest LGBTQ health research institute in the US. He is a tenured Professor of Medical Social Sciences and Co-Director of the NIH Third Coast Center for AIDS Research (CFAR).  His research focuses on the health and development of LGBTQ youth and the application of new media and technology to sexual health promotion and HIV prevention. He has been a Principal Investigator of nearly $60 million in federal (NIDA, NIMH, NIMHD, NIAID, NCI) and foundation grants and has published over 265 journal articles.  He is a frequent advisor to federal agencies and other organizations on LGBTQ health and HIV prevention, including serving as an appointed member of the National Advisory Council on Minority Health and Health Disparities. Some recognitions for his work include being named a William T Grant Scholar and NBC News selecting him in 2017 from 1,600 nominees to their inaugural list of 30 changemakers and innovators making a positive difference in the LGBTQ community.

Dr. Mustanski was the inaugural speaker for the SGMRO Scientific Webinar Series. To see his talk on "Creating Health Equity for Young SGM People," click here!

Q: What are your current research interests?

A: The majority of my research focuses on the health and development of sexual and gender minority youth and the application of new media and technology to sexual health promotion and HIV prevention with young men who have sex with men (MSM). My current projects span the translational spectrum and include longitudinal cohort studies focused on developmental trajectories and risk/protective mechanisms, the development and testing of HIV interventions, and implementation science. In the epidemiological area, I lead the NIDA-funded RADAR cohort study of 1,200+ young MSM and transgender women, some of whom have been followed longitudinally for over 13 years and will be studied for another five years thanks to a recent renewal of project funding. RADAR focuses on multilevel influences on HIV and substance use and integrates biological, psychological, network, relationship, geospatial, and developmental science. This cohort study has directly informed intervention development. I have been the PI of a series of projects testing the Keep It Up! online intervention (R34MH079714; R01DA035145; R01MH118113), which was designated by the CDC as a “Best Evidence” HIV prevention intervention in their compendium of effective programs. We are now studying strategies to implement this effective program in 44 US counties. I am also currently serving as the PI of a NIMHD U01 hybrid effectiveness-implementation trial of an eHealth stepped care HIV prevention package for adolescent MSM (U01MD011281).

In addition to the project I lead, I am also really fortunate to get to collaborate with a great group of researchers within ISGMH and beyond. I collaborate with Dr. Michael Newcomb on his NIDA- and NIAAA-funded trials of the 2GETHER couples-based relationship program for young MSM couples, with Nanette Benbow on an NIAID-funded Implementation Science Coordinating Center for the NIH Ending the Epidemic program through the Centers for AIDS Research, with Dr. Sarah Whitton on the NICHD-funded FAB 400 cohort study of intimate partner violence among young LGBTQ people assigned female at birth, with Dr. Mary Gerend on a text messaging program to increase HPV vaccinations among young MSM, and with Dr. Kathryn Macapagal on a number of projects studying SGM teen app use. I also get to mentor some amazing early-career scientists studying the health of bisexual teens, including K awardees Drs. Brian Feinstein and Christina Dyar.
 

Q: Tell us about your career path – how did you end up where you are now?

A: I am one of those professors who knew from a young age that they wanted to be a scientist.  When I was in high school, I studied plant genetics at a University of Minnesota summer program. I liked the laboratory research, but I found plants less engaging than people. I have always been interested in the interplay of biological and psychological factors in health. When I entered the Clinical Psychology program at Indiana University, I worked on a project studying gene-environment interplay in substance use problems during the development from adolescence into adulthood. At the same time, I also was training in the treatment and prevention of sexual health problems at the Kinsey Institute. Across these two departments, I received great training in multilevel and developmental perspectives on behavioral and sexual health, which I have continued to draw from in my ongoing work. I also have always been an early adopter of technology and enjoy exploring new technological tools. So as the internet emerged as a growing force in social connection, I was well poised to first study how people used the internet in regards to their sexual health, and then later to use it as a tool for education and intervention. I matched for my psychology internship at the University of Illinois at Chicago Institute for Juvenile Research, where I learned a lot about community-engaged research, again lessons that I continue to draw from today. In 2011, I was recruited to a new department at Northwestern University’s Feinberg School of Medicine focused on the applications of social science methods to studying health. As my lab grew with new faculty and research projects spanning multiple SGM populations and health domains, I began a discussion with the university about the potential for an institute that could amplify and expand the community-engaged SGM health research we were doing by supporting excellent researchers who hadn’t yet applied their work to the SGM population. The model has worked incredibly well. Over the past five years, the Institute for Sexual and Gender Minority Health and Wellbeing has grown to 13 core faculty, 35 affiliate faculty, and nearly 70 full-time staff. I am incredibly proud of the diversity of our staff along so many dimensions, including the many health domains we study, and the diverse disciplines and methods being engaged.
 

Q: What organizational challenges have you faced?

A: Early in my career, reports were coming out from the CDC about very high prevalence of HIV among adolescent and young adult MSM. Because young MSM represented the majority of infections among young people, I assumed they would be the major focus of youth-oriented HIV research. When I started working on a study in this area and attended a conference focused on HIV among young people, I was surprised to see I was one of the only presenters focused on HIV among young MSM. Some conference attendees disputed the CDC data on the large number of cases of HIV among young MSM and said that young gay/bisexual men were not the “face of the youth epidemic.” There was a sense that you couldn’t conduct research with teen MSM because you couldn’t work with parents and IRBs wouldn’t approve waivers of parental permission. And while the CDC compendium of evidence-based HIV prevention programs for other groups grew and grew, there were none for teen MSM. And the epidemic raged on. As a gay man trained in adolescent health research and sexual health, I felt a moral obligation to make this population the focus of my work and every day that commitment guides how I spend my time and energy.

I will admit it has been a challenge to do this work. At my previous institution, my first grant was funded for two years, and I spent 10 months getting IRB approval. All along the way, it was clear the interest was in reducing institutional liability rather than supporting science that could advance the health and wellbeing of a group so heavily impacted by the HIV epidemic. Over the years, I have answered every imaginable question from IRBs and heard how my colleagues have been outright blocked from studying SGM adolescents. As a scientist, I decided to turn to the tool of science to help address these challenges. I began studying the attitudes and perspectives of teens, parents, and IRBs on SGM teen participation in HIV research. My first article on this issue includes my favorite sentence I ever wrote in a journal article: “Lesbian, gay, bisexual, and transgender people do not emerge fully formed at age 18 like the Roman goddess Venus from the sea and it is not scientifically sound to begin all studies of LGBT populations at age 18.” Later I wrote a grant with my colleague Celia Fisher to study the ethical and regulatory issues in involving SGM teens in health research, which was funded by NIMHD. Recently the American Psychological Association issued a resolution supporting mature minors’ right to participate in research without parental permission that drew extensively from the work we had done. Based on these experiences, I like to tell my mentees, “turn your challenges into strengths…or even better turn them into grants.”
 

Q: What advice do you have for trainees and researchers who want to work in this area or are interested in applying for NIH funding? 

A: I often tell my mentees that grant writing is a defensive sport. It is about having a good idea and then justifying every decision and possible concern with sufficient evidence so that reviewers see how you made each decision. I always have my grants reviewed by colleagues outside my team before I submit them and ask those colleagues to be brutally honest with me about what concerns they have. It is better to hear those concerns from a colleague before submission so you can address those concerns before your grant application is in front of a reviewer. I also would say you get zero percent of the grants you don’t submit, so it is worth taking measured risks with innovative ideas you have spent time workshopping and refining. Most grants, need to be resubmitted—sometimes several times—before they are funded. So prepare yourself to work through criticism and rejection. It is worth it when you get to address unanswered questions that can help advance the health of our community.  
 

Q: Do you have any specific advice for working with and involving SGM populations in research?
A: I think it is important to recognize that there are different kinds of expertise you need to do strong minority health research. There is expertise in scientific theories and methods, and there is lived experience. I think the best minority health research benefits from and respects the value of both kinds of knowledge. For me that means my research teams need both scientific collaborators and community members. I strongly believe in community-engaged research—recognizing that community engagement is a spectrum and you can calibrate the right type of partnership for your particular project.
 

Q: Who inspires you?
A: I’m inspired by the brave researchers who blazed a path to a career in SGM health research, which was not always a viable career option. Those researchers include people like Magnus Hirshfeld, who was an outspoken advocate for SGM rights; Evelyn Hooker, whose NIMH-funded research in the 1950s laid the foundation for the removal of homosexuality from the DSM; and Alfred Kinsey, whose studies of sexual behavior helped the world recognize the extent of sexual diversity. There are many others who broke down barriers to studying LGBTQ adolescents whom I have tremendous respect for (e.g. Ritch Savin-Williams, the CDC investigator who led the Young Men’s Survey Study, Emery Hetrick and Damien Martin, Anthony D’Augelli, Mary Jane Rotheram). Without their contributions, I wouldn’t be able to do this work myself.
 

Q: Any final words of wisdom?

A: When you belong to a stigmatized minority community, it can also be hard to study it. I continue to receive hateful messages and my staff is regularly exposed to vile statements posted on our study advertisements. Even if you have a thick skin, this kind of hate can get to you and bring up memories of earlier life adversities. It’s important to think about self-care and communal coping when doing this work. On the flip side, it is incredibly fulfilling to do work that advances the health and wellbeing of your own community and supports the career development of the next generation of scholars that will continue to move us closer to health equity. Every note of thanks or praise we get from a young person participating in one of our programs outshines a hundred nasty messages.