For example, in a community-based sample of sexual-minority youth aged 14—21, Rosario and colleagues found racial and ethnic differences in the timing of the coming out process. Similarly, a recent retrospective study of a community-based sample of LGBT young adults on family acceptance during their adolescence found an association between family acceptance and parental job status, with highly accepting families having higher parental job status Ryan et al.
The same study also explored religion as a factor in family acceptance and found that participants who reported a religious affiliation in childhood also reported lower family acceptance compared with participants with no childhood religious affiliation Ryan et al. Drawing on population-based data obtained from students in 7th through 12th grades in British Columbia, Poon and Saewyc compared adolescents from rural and urban areas.
They found differences between the groups on some health outcomes for example, rural sexual-minority youth were more likely than their urban peers to binge drink and further noted that the interaction between gender and location produced different outcomes. Rural boys were more likely to have considered or attempted suicide in the past year than rural girls or urban boys, and rural girls were more likely than urban girls or rural boys to have been physically assaulted at school.
More community-based and population-based research on the lives of LGBT adolescents is needed to document the role of sociodemographic factors and their impact on health. Community-based research can help inform the questions in this area for population-based surveys. 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. Exceptions include research conducted by Grossman and colleagues Grossman and D'Augelli, ; Grossman et al. Family-related research has been based on reports of LGBT youth themselves and rarely on reports of parents or other family members, especially among ethnically diverse groups. Research has continued to document fear of coming out to parents D'Augelli et al. Other research has measured parental rejection and support among LGBT adolescents and young adults in several ways.
The number of perceived rejecting reactions was found to predict substance use. Although accepting reactions did not directly reduce substance use, such reactions buffered the link between rejecting reactions and alcohol use. Needham and Austin assessed the relationship between LGB young adults' perceived family support e. They found that parental support either partially or fully mediated associations related to suicidal thoughts, recent drug use, and depressive symptomatology. Ryan and colleagues measured specific parental rejecting behaviors in a sample of LGB young adults, recruited from community organizations, who were open about their LGB identity to at least one parent or caregiver during adolescence.
They found associations between parental rejection and use of illegal drugs, depression, attempted suicide, and sexual health risk. A subsequent study of specific parental and caregiver supportive behaviors during adolescence found that family acceptance during adolescence predicted increased self-esteem, social support, and general health status, and also protected against depression, substance abuse, and suicidal ideation and behaviors among LGB young adults Ryan et al.
Results of the above studies provide evidence to inform family interventions aimed at reducing risk and promoting well-being among LGBT children and adolescents, thereby reducing health disparities and affecting outcomes across the life course. 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.
DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY
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, In addition, experts have developed model standards for care of LGBT youth in foster care and juvenile justice settings that are informed by research Wilbur et al. Although the data on LGBT youth are scarce, the available research offers a number of important findings about the health status of these populations.
Key findings are presented below. Research on all adolescents, regardless of their sexual orientation or gender identity, is limited. However, research on the health status of LGBT youth is particularly challenging. Other than small studies based on convenience samples, the committee found no studies addressing health and health care for subgroups of LGBT youth, such as racial and ethnic minorities, or health and health care for transgender youth. While a few studies on LGBT health have included bisexual youth, research examining health and health care for this group specifically is quite limited.
Both cross-sectional and longitudinal research is especially needed to explore the demographic realities of LGBT youth in an intersectional and social ecology framework, and to illuminate the mechanisms of both risk and resilience so that appropriate interventions for LGBT youth can be developed. These parameters could be brought to bear in research in the following areas:.
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Mood and Anxiety Disorders Most of the research that has been conducted on mental health disorders among LGBT youth has relied on symptom or distress scales rather than formal clinical diagnoses Mustanski et al. 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.
Obesity Childhood obesity rates have risen dramatically in the United States in the past few decades Ogden et al. Transgender-Specific Physical Health Status Although some literature addresses the process of gender identity development among transgender youth, little of this literature is supported by empirical evidence or longitudinal data.
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. Harassment, Victimization, and Violence Compared with heterosexual youth, LGBT youth report experiencing higher levels of harassment, victimization, and violence, including verbal, physical, and sexual abuse.
Substance Use Disparities in rates of substance use exist between LGB and heterosexual youth, with sexual minority youth reporting increased substance use and initiation of use at younger ages Corliss et al. Homelessness Lesbian , gay, and bisexual youth are disproportionately represented among the homeless youth population.
Protective Factors While some may view the absence of risk factors as protective, there is, as noted earlier, a paucity of data on specific protective factors that affect the health of LGBT youth.
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Access and Utilization With the recent implementation of health care reform, access to health services has increased for many youth since they can now be covered under their parents' insurance until age Quality of Care Studies utilizing convenience samples of LGBT youth show that they value the same health provider characteristics as other youth. Sociodemographic Factors Few recent population-based studies have published substantive sociodemographic findings on LGBT youth.
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. Development of Sexual Orientation and Gender Identity As a result of the ongoing process of sexual development and awareness among adolescents, self-identification of sexual orientation and the sex of sexual partners may change over time and may not necessarily be congruent.
Some research examining sexual identity development among ethnically diverse sexual-minority adolescents suggests that the process may differ as adolescents negotiate both ethnic and sexual orientation identity. A relatively small percentage of gender-variant children may develop an adult transgender identity.
Gender-variant children may have more difficulties with peer relationships and behavioral problems than non-gender-variant children. Mental Health Status LGB youth are at increased risk for suicidal ideation, attempted suicide, and depression. This increased risk appears to be consistent across age group, gender, race, and self-identified orientation.
A few studies with small nonprobability samples suggest the same is true for transgender youth. 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. Physical Health Status Pregnancy rates may be the same or possibly even higher for lesbian and bisexual girls than for heterosexual girls. Self-identified sexual-minority females may have elevated BMIs relative to their heterosexual peers.
While GnRH analogs may be used to alleviate gender dysphoria among adolescents, a paucity of empirical data exists concerning how these medical interventions affect overall physical health and well-being. The burden of HIV infection falls disproportionately on young men who have sex with men, particularly young black men who have sex with men. These racial disparities are likely due to the intersection of race, sexual orientation, and other social determinants. Additionally, interventions are lacking for this group of LGBT youth. Limited studies suggest that male-to-female transgender youth may face a risk for HIV similar to or even higher than that faced by young men who have sex with men.
Risk and Protective Factors LGBT youth report experiencing elevated levels of harassment, victimization, and violence. School-based victimization due to known or perceived identity has been documented, although very little literature exists on violence experienced by young lesbians, bisexual women, or transgender people. Compared with other students, sexual-minority youth may be more likely to report feeling unsafe at school, being offered weaker support by school staff, and receiving lower grades.
Rates of substance use, including smoking and alcohol consumption, may be higher among LGB than heterosexual youth. Few interventions have been developed to address these disparities. The homeless youth population comprises a disproportionate number of LGB youth. Some research suggests that young transgender women are also at significant risk for homelessness.
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There are almost no data on homelessness among young transgender men. Interventions designed to decrease homelessness are lacking, and limited research on the specific health needs of homeless LGBT youth has been conducted. 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. Limited studies evaluating the impact of school polices on the experiences of LGB students indicate that students attending schools with antiharassment policies report that they feel safer and are less likely to be harassed.
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Family acceptance among LGBT youth may be a protective factor against depression, substance use, and suicidal ideation and attempts. Small studies suggest that many LGB youth have not disclosed their sexual orientation to their physician. Similarly, there appears to be some unease among physicians about addressing sexual orientation with their adolescent patients. Studies with small samples suggest that sociodemographic factors, including race, ethnicity, geography, religion, and socioeconomic status, play a role in the lives of LGBT youth.
While research on families suggests that family support may be protective, most research has focused on negative interactions with families. Results of this research suggest that family rejection may be associated with negative mental health outcomes. Research Opportunities Research on all adolescents, regardless of their sexual orientation or gender identity, is limited. These parameters could be brought to bear in research in the following areas: Demographic and descriptive information , including the percentage of adolescents who are LGBT and how that percentage varies by demographic characteristics such as race, ethnicity, socioeconomic status, geography, and religion; also, the general experiences and health status of LGBT adolescents and how these vary by demographic characteristics.
Family and interpersonal relations , including the family life of LGBT youth from diverse backgrounds e. Health services , including barriers to access particularly related to identity disclosure and interactions with providers , utilization rates, and quality of care received. Mental health , including the diagnosis of disorders among LGBT youth, their rates of suicidal behavior and suicidality, identity-related issues and experiences of stigma and discrimination, and eating disorders.
Physical health , including obesity and substance use including smoking and alcohol use. Sexual and reproductive health , including sexual development, sexual health, reproductive health, risk behaviors, pregnancy, STIs, and HIV rates and interventions with a focus on natural history studies of high-risk groups. Transgender -specific health care , including the effects, benefits, and risks of puberty-delaying hormone therapy.
Sexual behaviors and risks among bisexually- and gay-identified young Latino men.