A Longitudinal Examination of Risk and Protective Factors for Cigarette Smoking Among Lesbian,Gay, Bisexual,and Transgender Youth

PurposeTo investigate change across development in two smoking outcomes (smoking status and rate), describe demographic differences in smoking, and longitudinally examine the effects of psychosocial variables on smoking (psychological distress, victimization, and social support) in lesbian, gay, bisexual, and transgender (LGBT) youth.MethodsParticipants were 248 ethnically diverse LGBT youth (ages 16–20 years at baseline) from a longitudinal cohort study with six waves over 3.5 years. Baseline questionnaires included demographic variables and a measure of impulsivity, and longitudinal questionnaires included measures of cigarette smoking (status and average number of cigarettes smoked daily), LGBT-based victimization, psychological distress, and perceived social support. Analyses were conducted with hierarchical linear modeling.ResultsMales had higher odds of smoking and smoking rate than females, but females' smoking rate increased more rapidly over time. Psychological distress was associated with higher odds of smoking and smoking rate at the same wave, and it predicted smoking rate at the subsequent wave. LGBT victimization was associated with higher odds of smoking at the same wave and predicted smoking rate at the subsequent wave. Finally, significant other support predicted higher odds of smoking and smoking rate at the subsequent wave, but family support was negatively correlated with smoking rate at the same wave.ConclusionsThere are several viable avenues for the development of smoking prevention interventions for LGBT youth. To optimize the efficacy of prevention strategies, we must consider experiences with victimization, the impact of psychological distress, and optimizing support from families and romantic partners.     

Embracing Gay, Lesbian, Bisexual, and Transgendered Youth in School-Based Settings

Youth with invisible challenges constitute a special area of concern for child and youth care workers. Youth struggling with gender and sexual orientation are reported to comprise ten percent of our youth population yet they may often be unknown to teachers and other school personnel. These adolescents face unique challenges in developing their identity and gaining social acceptance. This paper explores the challenges faced by these youth, the consequences of underserving this population and proposes some strategies for improving their educational experience.     

Factors Associated With Emergency Department Utilization By Urban Lesbian, Gay, And Bisexual Individuals

There are no published studies to date on emergency department (ED) utilization by the lesbian, gay, and bisexual (LGB) community despite documented lack of access to health care for this community. This study explored the frequency of ED visits and socio-demographic and health-related factors associated with ED utilization among a convenience sample of LGB individuals. A sample of 360 LGB individuals was interviewed to assess socio-demographics, sexual practices, mental health, drug use, chronic disease history, and frequency of emergency department use. Emergency department utilization was categorized as 0, 1, or ≥2 visits. Bivariate statistics were applied to assess the association of various factors with emergency department utilization. Patient characteristics were as follows: age, 29.0; male, 53.1 percent; Hispanic, 57.8 percent; Black, 37.2 percent; and reported less than a college degree, 79.4 percent. Most (77.7 percent) had a primary care doctor and (86.3 percent) were comfortable discussing LGB-related health issues with their provider. Over 12 months, 25.3 percent had 1 ED visit and 16.4 percent had ≥2 ED visits. One or more emergency department visits was significantly associated with lower age, lower education, lower income, recent psychological distress, recent mental health counseling or medications, desired mental health treatment, abuse by partner, cigarette use, marijuana use, and asthma (p < 0.05). Despite reported access to primary care, our LGB sample exhibited a higher proportion of single and ≥2 ED visits than comparable populations. Mental health and cigarette use were associated with emergency department utilization and deserve further exploration for reducing emergency department visitation by and improving emergency department care for LGB individuals.     

Associations of Lesbian,Gay, Bisexual,Transgender, and Questioning–Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students

Purpose

Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth.

Pediatric Residency Training and the Needs of Gay, Lesbian, and Bisexual Youth

Objective: This study surveys the education of pediatric residents about the needs of gay, lesbian, and bisexual (GLB) youth. The report measures the extent to which such training is considered valuable by those responsible for its administration and it evaluates the awareness of community referrals for GLB youth. Methodology: U.S. pediatric residency directors and chief residents were surveyed using a questionnaire designed by the authors. Percentage tabulation of the questions was performed. Chi-square analysis of two questions was done to determine if there was an association between the responses given and whether or not a respondent was from a program that offered training to their residents. Results: Over half of the respondents indicated that their programs offered training in the care of GLB youth. This increased to over three fourths when those respondents who indicated that their program was planning such training efforts were included. There was a broad distribution in the form and prevalence of training techniques. Over 90% of the respondents indicated that they valued the inclusion of GLB youth issues into residency curricula. A lesser majority indicated an awareness of community referrals for GLB youth. Conclusions: A large majority of pediatric residencies are either training their residents about the needs of GLB youth or are developing such training opportunities. The form and extent of the training varies widely. As such, the continued development of educational approaches and evaluation measures are encouraged.     

A Longitudinal Study of Predictors of Suicide Attempts Among Lesbian, Gay, Bisexual, and Transgender Youth

This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects.     

Estimating Population Size and Demographic Characteristics of Lesbian,Gay, Bisexual,and Transgender Youth in Middle School

PurposeTo estimate the size and demographic characteristics of the lesbian, gay, bisexual, and transgender youth populations using data from the 2011 Youth Risk Behavior Survey (YRBS) administered in San Francisco Unified School District middle schools.MethodsThe YRBS was administered to a stratified random sample of 2,730 youth (grades 6–8) across all 22 public middle schools in San Francisco. Cross-tabulations using complex samples analyses were used to derive population estimates and confidence intervals.Results and conclusionsResults show that 3.8% of middle school students identify as lesbian, gay, or bisexual, and 1.3% of middle school students identify as transgender. To improve our understanding of the size of these populations across the nation, researchers conclude it is imperative that all YRBS administration sites include items on sexual orientation and gender identity as they would any other demographic item, such as race/ethnicity, sex, or age. The current lack of reliable data on the size and characteristics of the lesbian, gay, bisexual, and transgender youth population limits the capacity of policy makers, administrators, and practitioners to address their needs.     

Substance Use and Abuse in Lesbian, Gay, Bisexual and Transgender Populations

Despite many gaps in the research on substance abuse and sexual orientation, recent data suggest that, overall, substance use among lesbians and gay men—particularly alcohol use—has declined over the past two decades. However, both heavy drinking and use of drugs other than alcohol appear to be prevalent among young lesbians and gay men. Much less is known about bisexual and transgender women and men, but these groups appear to be at heightened risk for substance abuse. This paper describes current research on prevalence and patterns of substance use and abuse in LGBT populations, examines potential risk and protective factors associated with substance abuse in these populations, and discusses implications for prevention, including prevention research.     

Gay, Lesbian and Bisexual (GLB) Children: Implications for Early Childhood Development Professionals

This paper focuses on the issues of gay, lesbian, and bisexual children from the perspective of early child development professionals. Early child development professionals' response to children's sexual curiosity conveys to them important messages — either positive or negative — about themselves as sexual beings. Positive responses lay the foundation for sexual health by helping children feel good about being male or female, gay, lesbian, or bisexual, and good about adults in their lives who help them understand their confusion. Background information about homosexuality and bisexu-ality in American society, needs of gay, lesbian and bisexual children, and strategies and challenges in personnel, curriculum, policies, and parental involvement will be included.     

Relationships Between Sexual Orientation and Coping Styles of Gay, Lesbian, and Bisexual Adolescents from a Community High School

Gay, lesbian, and bisexual (GLB) adolescents have been reported to be at increased risk for a variety of physical and emotional illnesses compared to heterosexual youths. Coping styles have been associated with health risks in a variety of physical and emotional illnesses. We report on the coping style of 106 self-identified GLB high school students from a total 1769 high school students who completed an anonymous health risk questionnaire that included specific questions related to coping style. We found that there was an overall significant effect of sexual orientation on coping style. In addition, both approach and avoidant styles of coping were significantly greater in those who self-identified as GLB. We conclude that when compared to a community sample of self-identified heterosexual youth, GLB youth overall demonstrate high levels of coping behaviors in order to assist them with the stresses and difficulties associated with GLB status.     

What's Unique About Lesbian,Gay, Bisexual,and Transgender (LGBT) Youth and Young Adult Suicides? Findings From the National Violent Death Reporting System

Purpose

The purpose of the study was to explore variability in circumstances around suicide deaths among youth and young adults by sexual/gender identity category (gay male, lesbian/gay female, bisexual male, bisexual female, transgender male, transgender female, non–LGBT [lesbian, gay, bisexual, and transgender] male, and non-LGBT female).

Correlates of Mental Health Service Use Among Lesbian,Gay, and Bisexual Mothers and Prospective Mothers

ABSTRACT

Lesbian, gay, and bisexual women undertake parenting in a social context that may be associated with unique risk factors for perinatal depression. This cross-sectional study aimed to describe the mental health services used by women in the perinatal period and to identify potential correlates of mental health service use. Sixty-four women who were currently trying to conceive, pregnant, or the parent of a child less than one year of age were included. One-third of women reported some mental health service use within the past year; 30.6% of women reported a perceived unmet need for mental health services in the past year, with 40% of these women citing financial barriers as the reason for their unmet need. Women who were trying to get pregnant or who were less “out” were most likely to have had recent mental health service use. Women who had conceived by having sex with a man or who reported more than three episodes of discrimination were most likely to report unmet needs for mental health services. Providers may benefit from additional knowledge about the LBG social context that is relevant to perinatal health, and from identifying a strong referral network of skilled and affordable counsellors.     

Commentary: Lesbian, Gay, Bisexual, and Transgender Medical Students and Their Ethical Conflicts

There are some studies of the ethical conflicts medical students face generally, but there are no studies that describe the ethical conflicts lesbian, gay, bisexual, and transgender (LGBT) students face by reason of their sexual and/or gender identities. Given the demonstrated presence of hostility toward homosexuality and transgenderism in medical schools, it cannot be assumed that conflicts about sexual and/or gender identities leave no impact on the personal moral development of future physicians or their views of the integrity of the profession as a whole. There is considerable need for study of the effects of homophobia and unsupportive educational environments on the values and ethical commitments of LGBT medical students. This study is important in its own right and not merely in terms of the improvement of patient care, which has usually been the justification for attention to sexual identity in medical school curricula.