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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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REDUCING
INEQUALITIES

Between Lesbian, Gay, Bisexual, Transgender,
and Queer Adolescents and Cisgender,
Heterosexual Adolescents

PROCEEDINGS OF A WORKSHOP

Erin Hammers Forstag, Rapporteur

Board on Children, Youth, and Families

Division of Behavioral and Social Sciences and Education

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and William T. Grant Foundation (189982), and the National Academy of Sciences President’s Committee (unnumbered). Additional support was provided by the National Academy of Sciences W. K. Kellogg Foundation Fund. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-27298-8
International Standard Book Number-10: 0-309-27298-X
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. (2022). Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26383.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

PLANNING COMMITTEE ON REDUCING INEQUALITIES BETWEEN LGBTQ ADOLESCENTS AND CISGENDER, HETEROSEXUAL ADOLESCENTS: A WORKSHOP

STEPHEN T. RUSSELL (Chair), University of Texas, Austin

AISHA CANFIELD-ALLEN, Ceres Policy Research

DAVID CHAE, Tulane University

NAT DURAN, Illinois Safe Schools Alliance

ERROL L. FIELDS, Johns Hopkins School of Medicine

JESSICA N. FISH, University of Maryland

AMORIE ROBINSON, Ruth Ellis Center

JAMA SHELTON, Hunter College

Staff

AMANDA GRIGG, Program Officer

MARISSA GLOVER, Senior Program Assistant

NATACHA BLAIN, Board Director

EMILY BACKES, Senior Program Officer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

BOARD ON CHILDREN, YOUTH, AND FAMILIES

DAVID V.B. BRITT (Chair), Retired, Sesame Workshop

HAROLYN BELCHER, Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, Professor of Pediatrics, Johns Hopkins University School of Medicine

RICHARD F. CATALANO, School of Social Work, University of Washington, Co-founder, Social Development Research Group

TAMMY CHANG, Department of Family Medicine, University of Michigan

DIMITRI CHRISTAKIS, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, University of Washington

GREG DUNCAN, School of Education, University of California, Irvine

NANCY E. HILL, Harvard University, Graduate School of Education

STEPHANIE J. MONROE, President, The Wrenwood Group, LLC

JAMES M. PERRIN, Harvard Medical School, MassGeneral Hospital for Children

NISHA SACHDEV, Center for Health and Health Care in Schools, George Washington University Milken Institute of Public Health

MARTIN H. TEICHER, Developmental Biopsychiatry Research Program, McLean, Harvard Medical School

JONATHAN TODRES, Georgia State University College of Law

JOANNA LEE WILLIAMS, Rutgers University, Graduate School of Applied and Professional Psychology

NATACHA BLAIN, Director

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

Acknowledgments

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of these proceedings: Jessica N. Fish, Department of Family Science, School of Public Health, University of Maryland. We also thank staff member Tom Arrison for reading and providing helpful comments on the manuscript. Although the reviewers provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release.

The review of these proceedings was overseen by Karina L. Walters, School of Social Work, University of Washington. She was responsible for making certain that an independent examination of these proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

Preface

We are pleased to introduce these proceedings of the National Academies of Sciences, Engineering, and Medicine workshop on Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents. The broadest goal of the workshop was to explore effective programs, policies, and practices for reducing inequalities in the areas of mental, emotional, behavioral, and physical health of U.S. lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth ages 13–25.1 The workshop addressed the interpersonal, institutional, and structural factors associated with the inequities that exist and are widening for LGBTQ youth compared to cisgender, heterosexual youth. In particular, the planning committee made a commitment to focus on the experiences of LGBTQ youth of color, strategies for supporting them, and lessons to be learned from their experiences.

The workshop was informed by prior work at the National Academies, including two important recent consensus studies: The Promise of Adolescence: Realizing Opportunity for All Youth (2019), and Understanding the WellBeing of LGBTQI+ Populations (2020). The Promise of Adolescence explores the neurobiological and social-behavioral processes that characterize the developmental period, and that lay the foundation for trajectories for the rest of the life course. The report synthesized the dramatic advances

___________________

1 A recent study (National Academies of Sciences, Engineering, and Medicine, 2019) refers to the period of adolescence as encompassing four periods, from early adolescence to young adulthood. The focus of this workshop will be on middle adolescence (starting at age 13) through young adulthood (ages 19–25). The term “youth” in these proceedings encompasses adolescents ages 13–25.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

in understandings of adolescent brain development and plasticity, and the dynamics between that development and the physical, psychological, interpersonal, social, institutional, and cultural influences that shape adolescents’ lives. A key focus was on inequity, including substantial attention to the lives and well-being of LGBTQ adolescents.2 The report illuminates the promise and possibility of development during the adolescent years, and focuses on the implications for social systems that shape adolescence—their families and communities, systems of care, schools, and health.

One year later, Understanding the Status and WellBeing of Sexual and Gender Diverse Populations assessed the state of knowledge about the status and well-being of sexual- and gender-diverse people. The report was the first by the National Academies to take a truly broad approach to understanding well-being—extending beyond physical and mental health3 to include family and community well-being, as well as the cultural, legal, educational, economic, and religious institutions that shape the lives and well-being of sexual- and gender-diverse people.

Our workshop built on the foundations in those National Academies reports, with the goal of examining inequalities in mental, emotional, behavioral, and physical health among LGBTQ youth, what is known about strategies for supporting them, lessons to be learned from these strategies, and how to reduce inequities through programs, practices, and policies. The planning committee sought expertise from researchers to summarize the state of the evidence, although the committee was aware that efforts focused on actually reducing inequality (rather than simply measuring it) have rarely been empirically tested. The committee was particularly motivated to seek input from professionals and practitioners whose daily and lived experience is in the service of LGBTQ adolescents, and to hear from LGBTQ youth of color about their perspectives, lives, and recommendations.

We are grateful to the extraordinary planning committee, composed of experts in fields of research, practice, and policy in the service of LGBTQ youth. Through their vision and networks, we assembled an amazing group of workshop sessions and speakers, focusing first on key concepts and definitions, research on what is known about reducing inequalities through prevention and intervention, and perspectives from youths. We then focused on four domains or contexts that shape the lives of LGBTQ youth: their families and communities; systems of care, including child welfare and carceral systems; education; and health. For each domain we invited experts

___________________

2 A recent report (Akhmadikina, Saba, and Russell, 2021) reviews inclusion of LGBTQ youth in The Promise of Adolescence.

3 A prior report (Institute of Medicine, 2011) was transformational in the field of physical and mental health science and policy.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

in research to synthesize existing evidence, followed by panel discussions that included researchers, practitioners, and policy advocates working with LGBTQ youth in each of those domains. Across all sessions and panels, we asked all participants to keep the following principles in mind:

  • That the focus be on solutions or reductions in equality that can impact the long-term well-being of LGBTQ youth;
  • That the domains we highlight are intertwined and cannot be understood in isolation;
  • That youth and their experiences are intersectional in terms of race, ethnicity, cultural and religious background, and other identities, including intersex youth, youth with differences in sexual development, and youth who are not out; and
  • That while we are compelled to focus on vulnerabilities and inequalities, most LGBTQ youth thrive and contribute to their own well-being and to their communities.

We acknowledged the ever-evolving language of LGBTQ, recognizing the importance, meaning, and limitations of language, as well as the ways that our words and labels may shape both the way youth see and feel about themselves as well as public opinion about them. We further acknowledged the urgent need to center the experiences of Black, Brown, and Indigenous people of color, while acknowledging that naming may not resonate with all youth who are marginalized or minoritized. Ultimately, we acknowledged the goal of affirming language that can recognize the multidimensional nature of identity.

During the period of three half-days on August 25, 26, and 27, 2021, the workshop was conducted virtually, and reached over 600 participants. Although originally intended to be held in person, the experience illuminated the significant interest and motivation by people from across the U.S. and around the world to learn from the workshop program and engage with the goals of reducing inequalities for LGBTQ adolescents.

These proceedings illuminate the rich and growing body of evidence on the lives and well-being of LGBTQ adolescents, but also point to the limits of existing evidence for truly identifying the programs, practices, and policies that may reduce inequalities, particularly for LGBTQ youth of color. Yet the perspectives of the practice, policy, and youth experts pointed to promising strategies that are clearly making a difference in communities and for youth every day. Illuminating these strategies was the fundamental goal of the workshop and, in doing so, we hope to have sparked the next generation of research, practice, and policy that will support the well-being of LGBTQ adolescents, particularly LGBTQ youth of color.

Finally, we are grateful to the William T. Grant Foundation and the

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×

National Academies W.K. Kellogg Foundation Fund for the funding to make the workshop possible. Our hope is that this workshop will stimulate further interest in understanding the evidence base for reducing inequality among LGBTQ adolescents, including studies that could further explore the evidence base in depth and provide clear and actionable recommendations for researchers, practitioners, educators, policy makers, youth, and their families.

Stephen T. Russell, Chair
Planning Committee on Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents

REFERENCES

Akhmadikina, N., Saba, V., and Russell, S.T. 2021. The Promise of Adolescence: Highlighting the Experiences of LGBTQ Youth. The Stories and Numbers Project. Available: https://storiesandnumbers.org/wp-content/uploads/2021/09/The-Promise-of-Adolescence-Brief.pdf.

Institute of Medicine of the National Academies. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. Available: https://www.ncbi.nlm.nih.gov/books/NBK64806/.

National Academies of Sciences, Engineering, and Medicine. 2019. The Promise of Adolescence: Realizing Opportunity for All Youth. Washington, DC: The National Academies Press. Available: https://doi.org/10.17226/25388.

National Academies of Sciences, Engineering, and Medicine. 2020. Understanding the WellBeing of LGBTQI+ Populations. Washington, DC: The National Academies Press. Available: https://doi.org/10.17226/25877.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Acronyms and Abbreviations

BIPOC Black, Indigenous, people of color
CBPR Community-based, participatory research
CBT Cognitive behavioral therapy
CSE Comprehensive sexual education
EQuIP Empowering Queer Identities in Psychotherapy
GSA Clubs formerly known as Gay-Straight Alliances; now referred to either as Genders & Sexualities Alliances or simply GSAs.
LGB Lesbian, gay, and bisexual
LGBT Lesbian, gay, bisexual, and transgender
LGBTQ Lesbian, gay, bisexual, transgender, and queer/questioning
LGBTQ+ Lesbian, gay, bisexual, transgender, queer/questioning, and others
LGBTQ2S Lesbian, gay, bisexual, transgender, queer/questioning, and two spirit
LGBTQI Lesbian, gay, bisexual, transgender, queer/questioning, and intersex
MEB Mental, emotional, behavioral
MSM Men who have sex with men
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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PATHS Parents and Adolescents Talking about Healthy Sexuality
PUSH Providing Unique Support for Health
RCT Randomized controlled trial
RPYA Rainbow Pride Youth Alliance
SGD Sexual- and gender-diverse
SGM Sexual and gender minority
SIECUS Sexuality Information and Education Council of the U.S.
SOGIE Sexual orientation and gender identity and expression
STI Sexually transmitted infection
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reducing Inequalities Between Lesbian, Gay, Bisexual, Transgender, and Queer Adolescents and Cisgender, Heterosexual Adolescents: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26383.
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To better understand the inequalities facing lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and the promising interventions being used to address these inequalities, the National Academies of Sciences, Engineering, and Medicine's Board on Children, Youth, and Families hosted a virtual public workshop titled Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents, which convened on August 25–27, 2021. The workshop was developed by a planning committee composed of experts from the fields of sociology, medicine, public health, psychology, social work, policy, and direct-service provision. This Proceedings of a Workshop summarizes the presentations and discussions from that workshop.

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