By Lawrence D’Angelo, M.D., M.P.H.
When discussing health issues with and about young people, it is important to include the “Q” (for questioning) because there are so many youths whose view of themselves as a “sexual person” is evolving. Like everything else in adolescence, establishment of a sexual identity is a developmental process. To not acknowledge this may exclude up to two-thirds of youths who otherwise self-identify as someone who as yet is unclear about who they are sexually.
For example: in the Washington D.C.-area, almost 16 percent of youths self-identified as “LGBTQ” in the most recent Youth Risk Behavior survey conducted by the U.S. Centers for Disease Control and Prevention. Although a comparatively small minority identified themselves as lesbian (2.5 percent) or gay (1 percent), a surprisingly large number of individuals (12 percent), identify as “bisexual or questioning.”
Health risks for LGBTQ youths
There are a variety of risk behaviors and inherent health risks that LGBTQ young people experience. LGBTQ youths often are marginalized by family or friends, and we know that marginalized populations in general are at a higher risk for mental health and substance abuse issues. This group also is less likely to get care, especially care in which they may need to acknowledge their status to a provider. LGBTQ youths are:
- Three times more likely to use and abuse tobacco products.
- Four times more likely to use and abuse other substances such as marijuana, other psychoactive drugs or alcohol.
- Three to four times more likely to have mental health problems and four times more likely to contemplate suicide.
- Are a greater risk to contract sexually transmitted infections (STIs).
This later point is particularly true for young men who have sex with men. There has been extraordinary growth in STIs in this segment, particularly for HIV and syphilis. It is estimated that anywhere from 40 percent to 60 percent of new cases of HIV overall are young men of color who have sex with men. Young men of color who have sex with men are disproportionately represented in terms of the number of new cases of HIV infection.
Tips for talking with LGBTQ youths
Keep in mind that many young people are just beginning to grapple with the whole idea of being out about their sexuality. Given the current attention to gender fluidity this includes many LGBTQ youths, who consider themselves as something other than “cisgender,” the term for people who do identify as the gender they were assigned at birth (typically the gender on their birth certificate).
A few tips:
- When talking to LGBTQ young people, use neutral language that does not presuppose a certain gender identity or sexual orientation.
- Understand the importance of putting them at ease, and not being judgmental.
- Always ask how they would prefer you to address them. Examples: Ask “How would you like me to refer to you?” or “Do you prefer male or female pronouns?”
- Don’t give signals that can be construed as prejudging them as individuals just based on their emerging sexuality. Example: Don’t ask “Do you have a boyfriend?” or “Do you have a girlfriend?” Instead, ask “Are you involved romantically or sexually with anyone? Are they male or female?”
LGBTQ youth and their parents
Health insurance is a potential area of concern for any youth, but it can be more sensitive for LGBTQ young people concerned about being “outed” to their parents. Although health care providers can provide confidential care to a 14- or 16-year-old and must legally provide confidential care to an 18-year-old, confidentiality may still be compromised if the parent receives an explanation of benefits for teens who remain on their policy.
If parents are supportive and are able to come to terms with their children’s sexuality and sexual orientation, we know that the outcomes for those youth are much better. Research from the Family Acceptance Project has clearly shown a significant risk reduction in mental health and substance abuse issues for LGBTQ youths whose parents are supportive compared with those who are not. This may even extend to their risk for contracting a sexually transmitted disease.
Resources
- Youth Risk Behavior Survey from the CDC
- PFLAG Information for Families from Parents, Families and Friend of Lesbians and Gays (PFLAG Inc.)
- Family Acceptance Project at San Francisco State University
Journal articles
- Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health 2010;31:457–477.
- Centers for Disease Control and Prevention. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12—Youth Risk Behavior Surveillance, selected sites, United States, 2001-2009. MMWR. 2011.
- Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health 2001;91:1276–1281.
- Grossman AH, D’Augelli AR. Transgender youth and life-threatening behaviors. Suicide & life-threatening behavior 2007;37:527-537.
Lawrence D’Angelo M.D., M.P.H., is the division chief of adolescent and young adult medicine at Children’s National Health System in Washington, D.C. He is also the director of the Youth Pride Clinic at Children’s which provides primary and specialty care to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youths between the ages of 12 and 22.
