The Health of Lesbian, Gay, Bisexual, and Transgender People Building a Foundation for Better Understanding (2011) / Chapter Skim
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4 Childhood/Adolescence
4 Childhood/Adolescence
Pages 141-184
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From page 141... ...
Today's youth are able to use the Internet to retrieve online information about LGBT issues, providing social networking opportunities and access to knowledge in a way that was not available to older cohorts. At the same time, young LGBT people searching the Internet and interacting with their peers will be aware of the pervasive negative views of sexual and gender minorities.
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From page 142... ...
As mentioned in previous chapters, the disparities in both mental and physical health that are seen between LGBT and heterosexual and non-gender-variant youth are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity and throughout the life course. This chapter begins with a discussion of the development of sexual orientation and gender identity in LGBT youth.
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From page 143... ...
Investigators who conducted early work on the development of sexual orientation identity argued that coming out or self-identifying as lesbian or gay during adolescence may be a developmental process seen only in contemporary LGB youth -- one that may have unique consequences for later life-course development compared with lesbian and gay adults who did not come out during adolescence (Boxer and Cohler, 1989)
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More research is needed to understand the process of coming out for diverse populations of LGB youth. Similarly, little research has focused on sexual identity development among ethnically diverse LGB adolescents.
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From page 145... ...
Gender variance, as it relates to expressing and exploring gender identity and gender roles, is a part of normal development. A relatively small percentage of gender-variant children develop an adult transgender identity (Green, 1987; Wallien and Cohen-Kettenis, 2008; Zucker and Bradley, 1995)
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From page 146... ...
Although a small amount of the literature explores the process of sexual orientation and gender identity development among LGBT youth (see the preceding section) , a greater portion of the literature focuses on sexual-minority youth's risk for suicidality and depression; few studies examine the prevalence of mood, anxiety, or eating disorders in these populations.
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From page 147... ...
diagnoses compared with national data, the prevalence was similar to that among another sample of urban, ethnically diverse youth from the same geographic area. Depression and Suicidality Over the past decade, an increasing number of studies based on large probability samples have consistently found that LGB youth and youth who report same-sex romantic attraction are at increased risk for suicidal ideation and attempts, as well as depressive symptoms, in comparison with their heterosexual counterparts.
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From page 148... ...
. Many risk factors, both general and LGB-specific, have been implicated in the increased rates of suicidal behavior among LGB youth (see the detailed discussion of risk factors for the health of LGBT youth later in this chapter)
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. Similarly, a study of 224 selfidentified LGB youth aged 21–25 found that higher rates of family rejection were associated with increased rates of reports of attempted suicide, high levels of depression, and risk behaviors (Ryan et al., 2009)
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From page 150... ...
In addition, little research has examined suicidality by race/ethnicity. Eating Disorders/Body Image A large cohort study provides some evidence that eating disorders follow gender-specific patterns among LGB youth.
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. The literature on eating disorders among LGBT youth is based on large data sets, unlike most of the literature on these populations, which often relies on small convenience samples.
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SOURCE: DSM IV (American Psychiatric Association, 2000b)
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. PHYSICAL HEALTH STATUS As noted earlier, for most people, including LGBT youth, childhood and adolescence are times of good physical health.
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, most studies in this area have not included males. Although LGBT youth have indicated an interest in parenting (D'Augelli et al., 2006/2007)
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From page 155... ...
The authors also found differences in sexual risk behaviors. The bisexual young men were more likely to report having unprotected insertive anal intercourse during their last sexual encounter with a nonprimary male partner, as well as using drugs or alcohol during their last sexual encounter with either a primary or nonprimary male partner.
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From page 156... ...
found that among transgender women, the likelihood of HIV risk behaviors varied according to the nature of the relationship with their sexual partner (either main, casual, or commercial) (Wilson et al., 2010)
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Conversely, little research has been conducted on protective factors for these populations. Risk Factors Risk factors affecting the health of LGBT youth examined in the literature include harassment, victimization, and violence; substance use; homelessness; and childhood abuse.
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From page 158... ...
have found significantly higher rates of health problems among LGB youth compared with their heterosexual peers.) Concerns about their safety have consequences for the academic achievement of LGBT youth.
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From page 159... ...
The authors note that this greater likelihood of punishment is not explained by greater engagement in troublesome behaviors and suggest that LGB youth may be targeted for punishment or that mitigating factors such as self-defense may be overlooked. Although less research has focused on nonschool settings, LGBT youth experience victimization and violence in their homes, communities, and other institutions.
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From page 160... ...
A significantly increased risk for smoking was not found among women and men with same-sex partners only or men with both-sex partners. In addition to smoking, LGB youth may be at greater risk than their heterosexual peers for alcohol consumption.
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There also has been little research on interventions specifically targeting substance use in LGBT youth. Homelessness Lesbian, gay, and bisexual youth are disproportionately represented among the homeless youth population.
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. Likewise, although homeless or streetinvolved LGB youth appear to be more likely than homeless heterosexual youth to be tested for HIV and other STIs (Rew et al., 2005; Solorio et al., 2006; Van Leeuwen et al., 2006)
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. Therefore, it is apparent from the literature not only that LGB youth are at greater risk for homelessness than their heterosexual peers, but also that once homeless, LGB youth are more likely to experience multiple risk factors and significantly more negative outcomes.
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The systemic exposure to stigma that LGBT children and adolescents experience from early ages calls for studying protective factors that are unique to LGBT youth in addition to those that can be found among heterosexual youth (Russell, 2005)
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, those who experienced high levels of family acceptance reported significantly lower rates of depression, substance abuse, and suicidal ideation and attempts compared with those who reported no or low levels of family acceptance. Unique protective factors for LGBT youth warrant further study, particularly to inform services and approaches to caring for LGBT adolescents.
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From page 166... ...
However, not all LGB youth have access to such centers or health care professionals; most receive health care from providers in their own community who also provide care to non-LGB youth. Nationally, family physicians are the primary care providers for the majority of youth aged 15–24, and overall they are insufficiently trained to provide care to LGBT youth (IOM, 2009)
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From page 167... ...
with their providers; thus, it is incumbent on those who provide health services to youth to initiate such discussions. Studies of LGB youth (using small convenience samples)
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From page 168... ...
Familial Factors Although connections to family have been shown to be protective against major health risk behaviors, the literature on LGB youth and families has been very limited in scope and quantity, and has focused mainly on negative aspects of the relationships between LGB youth and their parents. Little research has examined the family experiences of transgender youth.
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From page 169... ...
Little research has focused on LGBT youth in custodial care -- foster care or juvenile justice -- although reports from providers have noted a high proportion of LGBT youth in these systems over many years. Researchers and providers have documented the experiences of LGBT individuals involved in these systems in a series of listening forums across the United States (Child Welfare League of America, 2006)
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From page 170... ...
• Potential risk factors for increased rates of suicidal ideation and suicide attempts specific to LGB youth include sexual-minority status, homophobic victimization and stress, and family rejection. • A few studies show that LGB youth may demonstrate higher rates of disordered eating than heterosexual youth.
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From page 171... ...
• The prevalence of childhood abuse may be higher among sexual minority youth compared with their heterosexual peers. • The few studies that have examined protective factors for LGBT youth suggest that family connectedness and school safety are two possible areas for intervention research.
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From page 172... ...
Health Services • LGBT youth may lack access to health care professionals who are able to provide appropriate care to LGBT patients. • Small studies suggest that many LGB youth have not disclosed their sexual orientation to their physician.
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From page 173... ...
and school and social life concomitants of LGBT identity and attraction, with special attention to protective factors at the individ ual, interactional (family, school, peers) , and systems levels; also pat terns and experiences of homelessness among LGBT youth, as well as intrafamily and domestic violence (e.g., sexual abuse, abuse by parents, intimate partner violence)
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From page 174... ...
2001. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay sensitive HIV instruction in schools.
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2003. Demo graphic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis.
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2009. Engaging young people with atypical gender identity development in thera peutic work: A developmental approach.
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2006. Overlooked, misunder stood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth.
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2010. Adolescent suicide and health risk behaviors: Rhode Island's 2007 Youth Risk Behavior Survey.
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for gender identity disorder in adolescents and adults. Archives of Sexual Behavior 39(2)
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2002. Gender identity disorder in young boys: A parent- and peer based treatment protocol.
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2002. Associa tions between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students.
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2004. Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys.
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2006. Serving LGBT youth in out-of-home care: Best practices guide.
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1995. Gender identity disorder and psychosexual problems in children and adolescents.
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