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

THE NATIONAL ACADEMIES PRESS
Washington, DC
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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
Digital Object Identifier: https://doi.org/10.17226/26383

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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.

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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

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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

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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.

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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

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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.

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

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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.

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

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.

Contents

1 INTRODUCTION

Background

Organization of the Proceedings

Opening Remarks

Key Concepts and Definitions

Research Landscape

Policy Landscape

Reflections

2 LGBTQ YOUTH OF COLOR

Lived Expertise

How Do You Define Health and Well-Being?

What Are Promising Solutions to Inequalities in Health and Well-Being That You Have Seen Work in Your Community?

What Are the Barriers to These Types of Solutions?

Who Are the Influential People in Your Community and How Can We Support Them?

If You Had a Magic Wand, What System Would You Change and How?

What Are Common Misconceptions About Youth?

How Does Your Racial or Ethnic Identity Shape the Way You Experience Your Sexual Orientation and/or Gender Identity?

How Do You Think COVID-19 Has Impacted LGBTQ Young People and the Community as a Whole?

Research Landscape

Exploring Racism and Sexual Identity During the COVID-19 Pandemic

Systems of Support

Reflections

3 PROMISING INTERVENTIONS IN PERSONAL, CARCERAL, AND CARE SYSTEMS

Landscape: Outcomes, Inequalities, and Known Interventions

Paths Forward in Research

Promising Interventions

Juvenile Carceral System Intervention: Youth Justice Agency Policies and Professional Development

Child Welfare System Intervention: The American Civil Liberties Union of Illinois and the Illinois Department of Children and Family Services

Child Welfare System Intervention: National Quality Improvement Center

Reflections

4 PROMISING INTERVENTIONS FOR FAMILIES AND COMMUNITIES

Research Landscape: Outcomes and Known Interventions

Promising Interventions

Family Interventions: Lead with Love and PATHS

Community Intervention: Community Centers and CenterLink

Community Intervention: Rainbow Pride Youth Alliance

Reflections

5 PROMISING INTERVENTIONS IN MENTAL, EMOTIONAL, AND PHYSICAL HEALTH

Landscape: Outcomes, Inequalities, and Known Interventions

Promising Interventions

Mental Health Intervention: EQuIP

Mental Health Intervention: AFFIRM

Mental Health Interventions: The Trevor Project

Physical Health Intervention: HIV Prevention

Reflections

6 PROMISING INTERVENTIONS IN EDUCATION

Landscape: Outcomes, Inequalities, and Known Interventions

Promising Interventions

School-Based Intervention: Broward County Public Schools’ LGBTQ+ Coordinator

School-Based Intervention: Comprehensive Sex Education

School-Based Intervention: GSA Clubs

Reflections

7 CLOSING REFLECTIONS

REFERENCES

APPENDIXES

A Workshop Agenda

B Biographical Sketches of Planning Committee Members and Workshop Speakers

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Acronyms and Abbreviations