A publication of the Act for Youth Center of Excellence
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by Somjen Frazer, Strength in Numbers Consulting Group
Strength in Numbers Consulting Group is an LGBT-led consulting firm whose mission is to contribute to the strategy, growth, and effectiveness of nonprofits, foundations, and government organizations by providing high quality research, capacity building, philanthropic strategy, and evaluation services. Strength in Numbers is committed to combining rigorous, credible research processes with efforts to enhance community participation and representation. Visit Strength in Numbers at: www.siNCG.com
Lesbian, gay, bisexual, and transgender (LGBT) youth face unique challenges to their health and well-being. Victimization at school and rejection from families of origin are prevalent for LGBT youth and are associated with poor health outcomes (Institute of Medicine, 2011). Further, clinicians who lack knowledge and understanding of LGBT youth may compound these health challenges by failing to recognize the connections between the stress LGBT youth experience in homophobic or transphobic environments and the health outcomes that result. However, when educators, parents, and health professionals support LGBT youth, they help to build their resilience and mitigate the challenges of "coming out."
This article describes how LGBT youth characterize their mental and physical health, as well as associations between health and the school, family, and health care climates LGBT youth experience in New York State. Data on youth are derived from focus groups and a survey of 3,792 LGBT individuals completed as part of the 2015 LGBT Health and Human Services Needs Assessment. Of those who participated in the survey, 524 were age 16-21.
"[My] biggest stressors are family and school" - Focus group participant
Like other young people, LGBT youth face stressors in their school environments. In addition to the normal stressors of adolescence, LGBT youth may experience hostile climates in school (Chesir-Teran & Hughes, 2009). However, affirming and protective climates and teachers and the presence of Gay-Straight Alliances can mitigate these factors (Hatzenbuehler, Birkett, Van Wagenen, & Meyer, 2013; McGuire, Anderson, Toomey, & Russell, 2010; Toomey, Ryan, Diaz, & Russell, 2011).
In this survey, just 29% of LGB youth and 18% of transgender youth who were enrolled in school indicated that there were supportive policies in place for them at their schools. While these policies may be on the books through New York State's Dignity for All Students Act, many LGB (38%) and transgender (41%) youth said they were not sure whether their schools had established such policies.
In contrast, most of the LGBT youth in our sample are experiencing support from their teachers. The majority said that teachers are supportive (74% of LGB and 67% of transgender students). Most LGB students (61%) also find support from their peers in school. However, students who are transgender are less likely to have the support of other students -- only 39% described their peers as "supportive" or "very supportive."
"[It can be] confusing because you have one side of your family saying like, 'Be yourself' and then the other is like, 'Don't tell people though, don't put it on Facebook.'" - Focus group participant
Research suggests that LGBT youth commonly experience rejecting behaviors from their parents and that these behaviors have negative health consequences (Ryan, Huebner, Diaz, & Sanchez, 2009; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010). In our sample, 25% of LGB youth and 39% of transgender youth (age 16-21) reported that their parents said they were ashamed of them, while nearly one in three (31%) LGB youth and over half (54%) of transgender youth said that their parents punished them for being too masculine or too feminine. Family rejection took other forms, too: nearly one-third of participants (32%) were told not to tell neighbors or friends that they were LGB.
Further, 22% of LGB youth had been told that being gay is against their religion or is considered sinful, while 11% of LGB youth and 14% of transgender youth had been taken to a therapist or religious leader who tried to change their sexual orientation or gender identity. Widely considered harmful to youth, so-called "conversion" or "reparative" therapy has recently been all but banned in the state by the governor's executive order (New York State, 2016).
When a clinician asked "Oh, do you have sex with men?" the young person responded "No, actually. . . I have sex with women." The young person reported that ". . . all the questions stopped. It was like even he was uncomfortable talking to me, like he didn't know what to say so I guess he just didn't have the information to give me." - Focus group report
"I was telling [a psychiatrist] my therapist is not legally allowed to [prescribe medication] -- 'That's why I'm here.' He said, 'Well, what are you going to therapy for?' I said to him, 'For gender dysphoria.' He's like, 'What's that?' When I told him what it was, he immediately closed the folder with the intake orders and said, 'I'm sorry, I don't treat your kind. You have to leave.'" - Focus group participant
In addition to experiences of ignorance or bias in health care settings like those described above, youth in focus groups raised concerns about confidentiality. One in five sexual minority youth (21%) and two in five transgender youth (41%) expressed this concern on the survey.
Only one in ten (11%) LGB youth said that it was a "problem" or "major problem" that their parents took them to see an unsupportive health care provider; however, 18% of transgender youth agreed with this statement. Among transgender youth, 27% said that their parents had refused to take them to see a provider to address gender confirming medical treatment.
LGBT young people have higher rates of depression, anxiety, and other mental health problems than the general population (Baams, Grossman, & Russell, 2015; Meyer, 2003; Shrier, Harris, Sternberg, & Beardslee, 2001; Whitbeck, Chen, Hoyt, Tyler, & Johnson, 2004), as well as some increased risk of physical health problems (Lick, Durso, & Johnson, 2013). In our sample, half of the youth (age 16-21) indicated that they experience frequent mental distress, while almost 39% screened positive for probable depression. Smaller numbers of LGBT youth reported fair or poor overall health (14%) or frequent poor physical health (11%).
Those youth (age 16-24) who had experienced family rejection were much more likely to report poor mental health, depression, and poor overall health, as were those who had been punished for their gender expression and those who had been told by their parents that being gay is a sin. LGBT youth whose families were ashamed of them were twice as likely to have frequent mental distress (46% vs. 63%), 1.6 times as likely to have depression (37% vs. 48%), and twice as likely to have fair or poor health (12% vs. 22%) in contrast to their LGBT counterparts who did not have this experience. LGBT youth who had been punished for their gender expression were almost twice as likely to be depressed (49% vs. 35%) and almost three times as likely to have fair or poor health (24% vs. 10%). Sexual minority youth were more than twice as likely to have fair or poor health if their parents had told them that being gay was a sin or against their religion (23% vs. 11%).
Clearly, there is still much to be done to combat stigma and support health among LGBT youth. In each of the social contexts we examined, there are steps providers can take to positively influence the health and well-being of LGBT youth.
Create, enforce, and raise awareness about school policies that protect LGBT students. While the presence of clear policies that protect all students from bullying and harassment related to their sexual orientation and gender identity is very important to ensure youth safety, the large number of students who were not sure whether such policies exist indicates the need for greater education about those policies.
Encourage parents and other family members to support youth who are coming out and to avoid rejecting behaviors that have long-term negative consequences to young people's health. Despite having their children's best interests at heart, many parents exhibit harmful, rejecting behaviors during the coming out process. Working with parents to understand the consequences of these behaviors and learning how to respond positively can have important favorable influences on health.
Educate clinicians and staff about inclusiveness as well as the issues LGBT youth face. Clinicians and clinic staff may not have had an opportunity to learn about what is needed to support LGBT health -- and youth are paying the price. However, resources are increasingly available to help motivated health care providers improve their practice.
Signal to youth that your office or classroom is a safe space for them to discuss gender and sexuality openly and without judgment. Youth work professionals can support LGBT youth by creating a positive climate to discuss issues affecting their lives. Encourage youth to discuss experiences they may have had in school, with family, or in a health care setting, especially if you can intervene or offer resources that may ameliorate the situation. All youth benefit from positive relationships with adults whom they trust.