This Notice of Special Interest (NOSI) solicits research, research training, and research career development on the health and well-being of people who identify as bisexual or bisexual+. Bisexual or bi in this NOSI may describe those with the potential to be attracted, romantically and/or sexually, to people of more than one sex or gender, not necessarily at the same time, not necessarily in the same way, and not necessarily to the same degree. Bisexual+ or bi+ in this NOSI is an umbrella term that is intended to encompass non-monosexual identities, including but not limited to bisexual, pansexual, sexually fluid, and queer.

Background

Although in recent years there has been an overall increase in research and advances focused on the health and well-being of sexual and gender minorities (SGM; defined for the purposes of NIH-supported research in NOT-OD-19-139), not all populations that fall under the SGM umbrella have benefited equally. Notably, there are relatively fewer projects related to bisexual and bisexual+ (bi/bi+) health in the NIH SGM research portfolio despite bi/bi+ people accounting for the largest proportion of the population of lesbian, gay, bisexual, transgender, queer, intersex, and other SGM (LGBTQI+) individuals in the U.S. as of 2022 (LGBT Identification in U.S. Ticks Up to 7.1%, Gallup, 2022). NIH recognized the current paucity of work specific to bi/bi+ persons in the NIH FY 2021 2025 Strategic Plan to Advance Research on the Health and Well-being of Sexual & Gender Minorities and urged increased consideration and inclusion of bi/bi+ populations in research.

In September 2019, NIH held the Bisexual Health Research Workshop in an effort to better define the health needs and disparities of bi/bi+ people and identify research opportunities to help advance the health and well-being of members of the bi/bi+ community. The workshop focused on four key areas of bi/bi+ health:

• Life course perspective different challenges and knowledge gaps exist for bi/bi+ people at each stage of life and during the transitions between these stages
• Intersecting populations bi/bi+ individuals may have multiple intersecting minoritized identities, all of which can have important implications for health and optimal research approaches
• Key health inequalities members of the bi/bi+ community experience unique health-related disparities and may require tailored interventions or prevention-based approaches to help address them, as well as accompanying strategies to overcome barriers to their implementation
• Social determinants of bi/bi+ health social and structural determinants and drivers play a significant role in many facets of the health of bi/bi+ persons

Further information about the workshop can be found on the SGMRO website, including the summary document containing prioritized research opportunities for each of the aforementioned key areas.

Research Objectives

This NOSI is specifically intended to stimulate investigation into the biomedical, clinical, behavioral, and social processes that affect the health and welfare of bi/bi+ individuals, and the development of acceptable, appropriate, and relevant interventions, preventive strategies, and service delivery methods. Applicants are encouraged to address one or more of the key areas highlighted in the Bisexual Health Research Workshop in their submissions. Examples of research topics which are responsive to this Notice include, but are not limited to:

• Examining bi/bi+-relevant structural factors and the impact of policy on bi/bi+ health across the life course (e.g., increasing funding for research among gerontologists and pediatricians on bi/bi+ issues; economic and employment trajectories; availability of personally appropriate health care and support resources; how bi/bi+-relevant policies shape identity and health inequities over time)
• Utilizing the health equity promotion model, the minority stress model, the SGM Health Disparities Research Framework, and other relevant models and frameworks in studies on bi/bi+ health
• Determining the effects of protective factors on bi/bi+ health at different life stages (e.g., resiliency, positive assets, community connections, social support)
• Developing, adapting, and testing methods and measures specific to bi/bi+ communities and their health outcomes
  • Potentially relevant resources pertaining to bi/bi+-focused methods and measures may be found on the SGMRO’s methods and measurements website
• Investigating key health inequities experienced by members of the bi/bi+ community (e.g., violence and trauma and their resultant biological imprint and impact, substance use)
• Conducting intersectional research to better understand the health needs of bi/bi+ populations who are also members of groups that experience further health inequities and disparities (e.g., racial and ethnic minority populations, persons with a disability, individuals living in rural settings, people with low socioeconomic status, those at an advanced age)
• Developing and testing bi/bi+-tailored interventions that simultaneously address health needs associated with intersecting identities
• Evaluating the impact of structural and social determinants and drivers of bi/bi+ health and health disparities (e.g., incarceration, unemployment, pay inequality, historical contexts, access to health and other services) and where these fit into current models of health
• Creating novel interventions and evaluations related to structural and social determinants of health

Data Harmonization

The NIH encourages the usage of common data elements (CDEs) and other standardized measurement protocols whenever feasible in research studies to strengthen data consistency, usability, and interoperability. CDEs and protocols for capturing bi/bi+ identity and other identities, social determinants of health, and other relevant topics can be found, for example, in the All of Us Research Program data set and NIH CDE Repository. The SGMRO site features a webpage with examples of questions used in national surveys related to various dimensions of sexual orientation that may be helpful for harmonization with these data sets.

Of relevance, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a consensus report in 2022 entitled Measuring Sex, Gender Identity, and Sexual Orientation which presents evidence-based recommended measures to assess sexual orientation identity and associated research recommendations for consideration by applicants to this NOSI. The report also offers specific measures for gender identity (comprised of sex assigned at birth and current gender in a two-step question that allows for passive identification of transgender experience) and intersex characteristics/differences in sex development (DSDs), as well as associated research recommendations which may be pertinent to investigators interested in capturing and/or evaluating a broader range of aspects of SGM status and experience in addition to bi/bi+ identity.

IC-Specific Application and Submission Information

Applicants should select the most appropriate IC and Funding Opportunity Announcement (FOA) to which to submit their application using the IC-specific research interests and FOA listing provided in this section of the NOSI. Applications must fall within the mission of the IC and the requirements of the FOA selected for submission. DPCPSI Offices may consider co-funding meritorious applications depending on the alignment with Office-specific missions and priorities and the availability of funds.

IC Research Interests

Investigators are strongly encouraged to reach out to the relevant scientific contacts listed in the Inquiries section of this NOSI to determine whether their proposed research is suitable for the IC to which the proposal is submitted.

National Center for Complementary and Integrative Health (NCCIH)

NCCIH is interested in supporting research on the use of complementary and integrative health approaches, including natural products and mind and body interventions, to manage stress, chronic pain, mild anxiety, or depression among bisexual or bisexual+ populations. NCCIH is also interested in research studying mind and body approaches to improve adherence to treatment (e.g., Medication Assisted Treatment (MAT) for opioid misuse, Antiretroviral therapy (ART) for HIV) and prevention (e.g., Pre-exposure prophylaxis (PrEP) for HIV) regimens to promote health outcomes. Natural products include botanicals, pre/probiotics, and products marketed as dietary supplements. Mind and body approaches include various meditation approaches (e.g., mindfulness), hypnosis or guided imagery, meditative movement approaches (e.g., yoga, tai chi, qi-gong), body-based approaches (e.g., spinal manipulation, massage, mobilization, acupuncture), a combination of these approaches (e.g., meditation and yoga, such as in mindfulness-based stress reduction MBSR), or complex interventions including music and art therapy. NCCIH offers a range of funding opportunity announcements to support clinical trials of natural products and mind and body interventions. Applicants are strongly encouraged to consult with the NCCIH Scientific Research contact prior to developing and submitting an application. Please reference NOT-AT-20-001 for guidance on NCCIH Clinical Trials Policies.

National Institute on Aging (NIA)

NIA is interested in research that takes a life course approach to the study of bisexuality, studies that focus on and address health inequities and health disparities, and bi/bi+ research that is related to Alzheimer’s disease and related dementias.

• Applications submitted to NIA that focus on health disparities are expected to use the NIA Health Disparities Research Framework to guide the development of the proposed research. Applicants are strongly encouraged to propose studies that take a multidimensional life course approach and that focus on factors operating through multiple levels of analysis (i.e., environmental, sociocultural, behavioral, and biological).
• NIA directs researchers to NIA-supported publicly available datasets that include data collection on participants that self-identify as bi/bi+, including but not limited to the following: Health and Retirement Study (HRS) and HRS’s International Sister Studies, Midlife in the United States (MIDUS); National Social Life, Health, and Aging Project (NSHAP); National Longitudinal Study of Adolescent to Adult Health (Add Health); Study of Women's Health Across the Nation (SWAN); and the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), in addition to NIH’s All of Us Research Program and the CDC-initiated Behavioral Risk Factor Surveillance System (BRFSS).
• For applications proposing behavioral interventions, NIA will only accept applications proposing well-powered research in accordance with the NIH Stage Model for Behavioral Intervention Development and that specifies and examines the hypothesized essential components and/or the hypothesized underlying principle(s) or mechanism(s) of action of the intervention and strategies for measuring intervention fidelity.Applicants are encouraged to use the resources and tools developed through NIH’s Science of Behavior Change (SOBC) program.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

NIAAA seeks innovative applications in the areas of:

• Epidemiological research that examines patterns of risk, morbidity, and mortality related to alcohol use disorders (AUDs) in bi/bi+ populations, including studies of: 1) risk and protective factors for heavy (including binge) drinking and AUDs; 2) correlates of underage drinking and related problems among bi/bi+ populations; 3) factors that influence transitions into and out of problem drinking patterns across the lifespan among bi/bi+ populations; and 4) the consequences, for drinking and related problems, that may be attributable to the combination of racial/ethnic minority status in addition to bi/bi+ status.
• Etiological or mechanistic research including human laboratory-based research examining how biological, behavioral, social, and/or environmental factors contribute to drinking-related outcomes for bi/bi+ populations.
• Research leading to interventions to ameliorate drinking and related problems in bi/bi+ populations, including formative research to identify and develop appropriate intervention content, as well as pilot testing of interventions to establish feasibility, acceptability, and preliminary efficacy.
• Design, implementation, and evaluation of preventive and/or treatment interventions that address AUDs and related problems and that are appropriate to the needs of bi/bi+ populations. Such projects may extend to evaluations of screening, assessment, brief interventions, and referral to alcohol treatment; other individual-level preventive approaches, such as protective strategies; studies that assess drinking prevention approaches that enlist families or peers (online or offline); studies that focus on the effects of community/institutional-level alcohol policies for preventing drinking and related problems among bi/bi+ populations; and studies that look at alcohol treatment efficacy among bi/bi+ populations.

National Institute of Allergy and Infectious Diseases (NIAID)

Areas of programmatic interest to NIAID include, but are not limited to, the following:

• Research focused on understanding the prevalence of common infectious diseases, including upper respiratory infections (influenza and SARS-CoV-2), viral hepatitis, HIV, mycobacterial infections, community-acquired pneumonia, and enteric infections, among bi/bi+ individuals and any unique vulnerabilities or pathogenesis for these infections among this group
• Research to optimize participation of bi/bi+ people in studies of interventions for infectious diseases and/or organ transplantation, including studies of small molecule therapeutics and biologics, studies to eliminate HIV and HBV, and studies to characterize the effectiveness of these interventions in bi/bi+ populations compared to the general population
• Research to describe the risk of complications from infectious diseases in bi/bi+ individuals and identify any unique features in the epidemiology, pathogenesis, and treatment for this group
• Identification of contextual and structural factors that differentially influence risk for infection transmission in bi/bi+ individuals, particularly with regard to sexually transmitted infections
• Development of strategies to target unique barriers to access in prevention, diagnosis, and treatment of acute and chronic infectious diseases of bi/bi+ individuals
• Development of research training for the full spectrum of the research community concerning the unique issues and considerations in bi/bi+ health related research

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

The NICHD mission is to lead research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. The NICHD's broad and diverse research portfolio includes research related to conception and pregnancy; typical and atypical development in childhood; childhood trauma, injury, and critical illness; the transition from adolescence to adulthood; reproductive health; rehabilitation; intellectual, developmental, and physical disabilities; and population dynamics across the lifespan.

For this NOSI, NICHD seeks applications on bi/bi+ health that utilize a life course approach to investigate bi/bi+ youth and young adult development; bullying, violence, and pediatric and trauma-informed care among bi/bi+ youth; and the sexual, reproductive, and pregnancy-related health of bi/bi+ people. NICHD especially welcomes projects using population representative samples to examine disparities in development and reproductive health between bi/bi+ and heterosexual, gay, or lesbian people, and the intersectional impact of bi/bi+ identities with other identities in NIH-designated health disparities populations and/or among persons with disabilities. NICHD is also interested in research within NICHD’s scientific priorities that revisits past studies in which bi/bi+ individuals were grouped with lesbian or gay people. Broad areas of inquiry could include, but are not limited to:

• Service provision in pediatric primary care for bi/bi+ children and adolescents
• Impact of bullying and teen dating violence on the social, emotional, and psychological development of bi/bi+ youth
• Disparities in access to and utilization of trauma-informed care among bi/bi+ persons who have been exposed to violence
• Short- and long-term sequelae of adverse childhood experiences on the psychological and physical health and well-being of bi/bi+ persons
• Factors affecting behavioral health of bi/bi+ adolescents transitioning from and aging out of foster care
• Identification and etiology of clusters of health disparities between bi/bi+ and heterosexual, gay, or lesbian youth and young adults in areas within the scope of NICHD’s scientific priorities, including risk and protective factors that mediate or moderate those disparities
• Individual, relational, and structural factors related to disparities between bi/bi+ and heterosexual, gay, or lesbian people in reproductive health and pregnancy-related outcomes and care, including:
  • Pregnancy preferences, desires, and/or intentions
  • Access to, seeking, and provision of reproductive and pregnancy health services
  • Contraceptive acceptability, use, and non-use
  • Fertility, infertility, and perinatal needs and outcomes
  • STI (including HIV/AIDS) prevention and treatment, especially for bi/bi+ girls, women, or people assigned female at birth

• Relationships between the reproductive health of bi/bi+ persons and their socioeconomic status, race/ethnicity, age, and/or other social and demographic characteristics
• Design, implementation, and evaluation of bullying, dating violence, and reproductive health interventions for bi/bi+ youth and young adults
• Research to improve survey measurement of sexual fluidity or shifting sexual identities and methods for examining whether and how sexual fluidity relates to the reproductive health of bi/bi+ people
• Differences in family formation and dissolution for bi/bi+ people compared with gay men, lesbian women, and/or heterosexual people

National Institute on Drug Abuse (NIDA)

NIDA is interested in research aimed at the prevention and treatment of substance abuse disorders in all populations, including individuals who identify as bi/bi+. While members of LGBTQ communities face increased risk for substance abuse relative to their heterosexual counterparts, studies have shown that bi/bi+ individuals are at even greater risk when compared to gay individuals.

As a result, areas of programmatic interest to NIDA include, but are not limited to:

• Prevalence and severity of substance use and substance use disorder in the bi/bi+ community relative to their SGM and/or heterosexual counterparts
• Vulnerability to addiction in the bi/bi+ population
• Factors (social, environmental, behavioral and/or biological) that contribute to the development and maintenance of substance use in bi/bi+ populations
• Substance abuse treatment research (e.g., medications, cognitive/behavioral therapy) leading to interventions targeting the needs of bi/bi+ individuals
• Research evaluating novel substance use prevention strategies for bi/bi+ individuals
• Barriers to substance use disorder treatment that may lead bi/bi+ individuals and populations to avoid or delay seeking treatment

National Institute of Dental and Craniofacial Research (NIDCR)

Areas of programmatic interest to NIDCR include, but are not limited to:

• Observational studies identifying how social determinants of oral health contribute to or ameliorate oral health disparities in bi/bi+ individuals or populations. Examples of social determinants include minority stress, stigma and discrimination, lack of access to oral care, cross-cultural awareness, social networks, and social support.
• Observational studies exploring the relationship between intersectionality of bi/bi+ status with other health disparity population membership and oral health disparities.
• Epidemiologic research on the prevalence and unmet dental, oral, and/or craniofacial needs of bi/bi+ individuals (e.g., oropharyngeal cancers, oral complications of HIV/AIDS and other sexually transmitted diseases, orofacial trauma).
• Studies developing interventions to reduce oral health disparities for bi/bi+ individuals or populations, targeting individual, family, community, provider, health system, and/or policy levers of change.

National Institute of Mental Health (NIMH)

NIMH encourages research on bi/bi+ populations consistent with Institute priorities. Examples of projects of interest to NIMH by NIMH Division include, but are not limited to:

Division of Services and Intervention Research

• Development and testing of developmentally focused theory-based preventive interventions that reduce risk and increase protective factors in mental health disparities in bi/bi+ populations
• Development and testing of developmentally focused theory-based preventive interventions that address intersectionality of mental health disparities in bi/bi+ populations (e.g., racial/ethnic group, people with low SES, rural residents)
• Developing and testing evidence-based mental health practices designed to improve access, engagement, and coordination of services to meet the mental health needs of bi/bi+ persons
• Identifying mutable targets and mechanisms of action at the individual, family, provider, clinic, or system level that can be interrogated to improve mental health treatment and services for bi/bi+ persons
• Developing and testing of strategies to optimize the delivery of evidence-based suicide prevention, treatment, or services to bi/bi+ persons across the life course

Division of AIDS Research

• Improving visibility of bi/bi+ individuals in HIV-related research through approaches that include more effective community engagement with bi/bi+ communities and the purposeful inclusion of meaningful samples of bi/bi+ participants
• Statistical, mathematical, or computational approaches to understand how bi/bi+ individuals may be impacted by HIV or experience different outcomes in HIV-related interventions
• Research to support centering and strengthening bi/bi+ voices in HIV prevention and treatment messaging campaigns, especially those that aim to engage, empower, and elevate the needs of bi/bi+ individuals to improve HIV outcomes

National Institute on Minority Health and Health Disparities (NIMHD)

The mission of NIMHD is to lead scientific research to improve minority health and reduce health disparities. Populations that experience health disparities include African Americans/Blacks, Hispanics/Latinos, American Indians, Alaska Natives, Asians, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and SGM populations. In the context of this FOA, NIMHD is especially interested in approaches that utilize the NIMHD Research Framework to understand and examine health and healthcare access and utilization across multiple domains (i.e., biological, behavioral, environmental, systemic) and levels of influence (i.e., individual, community, societal) among bi/bi+ people.

Examples of potential topic areas include, but are not limited to:

• Studies that explore how social determinants (e.g., minority stress, stigma and discrimination, lack of access to culturally competent healthcare, social networks, social support), may cause, sustain, and/or ameliorate health disparities among bi/bi+ people.
• Studies that examine the relationship between intersectionality of bi/bi+ status with other health disparity population membership and health outcomes. In addition to SGM populations, NIH-designated populations that experience health disparities include racial/ethnic minorities, socioeconomically disadvantaged populations, and underserved rural populations.
• Studies that explore health disparities among bi/bi+ people relative to other SGM populations.
• Rigorous studies of community-based, multilevel interventions in community and healthcare settings to reduce health disparities among bi/bi+ people.

National Institute of Neurological Disorders and Stroke (NINDS)

NINDS is interested in mission-relevant applications. NINDS is interested in funding applications that enrich scientific understanding of how sexual orientation, gender identity, and/or being born with differences/disorders in sex development (DSDs) or intersex characteristics relate to health outcomes, health risks, health behaviors, perceptions and expectations about health, and access to health-related services or associated barriers as they pertain to the NINDS mission. The NINDS supports basic, clinical, translational, and implementation research focused on identifying, monitoring, and targeting biological, environmental, social, community, structural, and healthcare system factors that lead to or are associated with disparities (or inequities) in neurological diseases and care across the lifespan. Some priority disease areas include stroke and other cerebrovascular diseases, Alzheimer’s disease-related dementias (including frontotemporal neurodegeneration, Lewy body dementias, vascular contributions to cognitive impairment and dementia and mixed etiology dementia), epilepsy, migraine, nervous system infections, spinal cord injury, headache, Parkinson's disease, and other neurodegenerative disorders, brain trauma, neurodevelopmental disorders, and the neurological consequences of HIV/AIDS. Observational studies should be health equity theory-based to enable the future development of actionable, scalable, and evidence-based interventions. Applicants are encouraged to incorporate community-engaged research strategies into their study designs. Research activities outside of the NINDS mission, or traditionally supported by another NIH Institute or Center, will not be considered through this program. A letter of intent and communication with NINDS program staff prior to submission of an application is strongly encouraged.

Eligible FOAs

Investigators are strongly encouraged to reach out to the relevant contacts listed in the Inquiries section of this NOSI to determine whether the FOA and funding mechanism selected are appropriate for the proposed research. The following ICs accept applications to the FOAs below or their subsequent reissued equivalents:

Please note the following IC-specific information with regard to eligible FOAs.

NCCIH offers a range of FOAs to support clinical trials of natural products and mind and body interventions. Please reference NOT-AT-20-001 for guidance on NCCIH Clinical Trials Policies.

For information on NIMH clinical trial policies and the NIMH experimental therapeutics approach, see NOT-MH-20-105, NOT-MH-19-006, and the NIMH webpage on Support for Clinical Trials.

For applications through PA-20-183 to NINDS, only mechanistic clinical trials will be accepted in accordance with NOT-NS-18-011. Applicants wishing to propose other clinical trials (i.e., efficacy, effectiveness, feasibility, acceptability, and implementation) through separate FOAs should consider reviewing submission guidelines listed on the NINDS clinical trials website.